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The most common problems following orthodontically treated teeth are unusual function, shape, dimension color and caries as a problematic long term maintenance.
So sometimes restorative treatment of anterior teeth is required as the final step of the orthodontic therapy to optimize aesthetics and function. We are aware that during orthodontic treatment the patient is often unable to maintain good oral hygiene, both because of difficulty in brushing properly, but especially because of the impossibility of flossing, resulting in food accumulation which obviously lead to enamel demineralization, discolorations and interproximal caries. In this article, we’ll show how we brought a young patient’s smile to its youth by restoring the biological health and aesthetics using direct composite restorations.
A 17-year-old female came to the dental clinic complaining of gingival inflammation, discolorations and proximal decay after finishing an orthodontic treatment. She wanted to have a beautiful and natural teeth. The treatment plan included patient motivation to improve oral hygiene, and removal of caries and discolorations without any shape or color modifications in a minimally invasive approach.
Rubber dam isolation with floss ligatures is mandatory during work to have a clean environment free from contaminants and a clear vision during the procedure.
After removal of proximal and buccal caries, and beveling around large proximal cavities, enamel is sound and clean, and ready to ensure a perfect seal between the restorations and tooth structure.
Etching the entire surfaces proximal and labial with careful selective etching around proximal cavities for 30 seconds, and washing with water for 60 seconds to ensure complete removal of the etching gel residues.
A universal adhesive is applied on the entire buccal surfaces and inside the cavities. Active rubbing of the adhesive ensures proper penetration of the adhesive. Light curing was then carried out for 60 seconds to ensure complete polymerization of the adhesive layer.
When restoring class III restorations its better to build the proximal walls first to create a box to facilitate adaptation of composite layers.
We used LumiContrast sectional matrices form Polydentia, which allow for good contrast and no light reflection thanks to the matte, blue surface.
The high contrast between dark color of the matrices allows for a precise identification of the working area. The stain on the matrices cannot be scratched away and no particles can end up in the filling material or cavity. When restoring the labial surface, the convex side of the matrix is placed towards the labial and concave side towards the palatal.
After building the proximal walls using SI3 dentine shade WDB from Optident to make the box shape and just ready to be filled with composite.
And I always prefer to use dentine shade in the proximal walls so not to have an issue with the thickness of the material, as might happen when using translucent enamel shades.
After layering all dentine layers SI3 White Dental Beauty in the proximal boxes, the final enamel layer is placed onto the entire labial surface to restore the natural translucency and rejuvenate the labial surfaces. Light curing the dentin shade for at least 40 seconds, and the enamel shade for 20 seconds.
For the finishing, we used only one coarse disc, perio bur from the Styleitaliano Finishing Kit (by Komet) to create surface texture.
The transitional lines or light lines can be drawn using a pencil. A caliper can also be used to measure the width on each tooth to create symmetrical proportions between the right and left side. The transitional lines can be easily finished using a small disc, because its flexible and can easily adapted in the proximal yellow areas to produce smooth continuous lines. I personally advise against using burs in this phase, as they sometimes produce too much force during finishing, thus reating irregularities if not controlled well.
We can use the Perio bur from the StyleItaliano Finishing Kit at low speed to make secondary and tertiary anatomy.
For pre-polishing, we used the beige spiral wheel from 3M. This tip has flexible ends which can adapt to all surfaces, including proximal and labial. Moreover, it can easily smoothen and pre-polish the surface texture without removing the surface details.
One week follow-up.
6 months follow-up.
The aim of a post-orthodontic restorative treatment is to optimize the integration between biological health, function and aesthetics, be it by direct composite restorations, dental re-contouring or bleaching. Direct composite is an affordable, minimally invasive option which can often be only additive, thus being the ideal solution for our patients.
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