Some cases are extremely difficult to manage directly, when the matrix and the wedge positioning could become a difficult task due to teeth crowding. A simple technique to build high-end restorations is explained step-by-step.
Additive restorations are the state-of-the-art solution for most cases. No prep, no bevel approach should be used whenever is possible, making the restoration a reversible solution if wished.
Fig.1
A young adult patient presents to the clinic with a healthy dentition and a teeth crowding in only the area of the 22 tooth, which caused aesthetic discomfort.
Fig.2
With an occlusal view of the case we can better perceive the problem. As the patient refused an orthodontic treatment a conservative approach seems to be the best alternative. Stratifying directly in these kind of cases is extremely difficult, to overcome that we will do a quick stratification that will act as a “color trial” which will not only work as a color matching procedure, but if we choose the right colors we will use it as a definite restoration.
TIP: do not exceed 3 mm, it is not very predictable.
Fig.3
Without etching or bonding, we will stratify the dentinal body, copying the mamelons from the underlying tooth in order to reproduce as much as possible its features
Fig.4
An opalescent mass was inserted in the incisal edge and proximal areas imitating the incisal outline of the tooth.
Fig.5
With the same dentin as the dentinal body the incisal halo was modeled very carefully in order to reproduce a thin opaque white line in the edge of the incisal edege.
Fig.6
The final layer of enamel was placed and modeled with spatulas and a slightly humid natural bristle brush.
Fig.7
With a curette (LM Arte, eccesso) the partial veneer is debonded carefully, making leverage to the opposite area of the thinest composite present.
Fig.8
At this point the veneer, outside of the mouth is finished taking out with a fine abrasive disc all the excess. This task would be very difficult to do it directly.
Fig.9
The case isolated must show a neat appearance.
Fig.10
With a 212 clamp the rubber dam and the gum are to be carefully displaced apically, in order to have a complete view of the cementation area.
Even though the veneer should theoretically adapt perfectly, it is tried again just to check.
Fig.11
Enamel etching for 30 seconds.
Fig.12
The veneer is loaded with a white enamel mass, the composite selected must have a very soft handling in order to be ideal for cementation. Soft pressure must be applied constantly to let all excess flow.
Fig.13
Excess is easily removed with a sharp instrument, a brush can be used in case that the excess area remains uneven.
Fig.14
Polymerization must be done at least one minute per surface.
The polishing stage is performed with brushes, polishing pastes, and felt for high gloss polishing.
Fig.15
In this image, the case just after removing the rubber dam.
Fig.16
One week control shows perfect gingival healing and color features integrate with the neighbor teeth.
Fig.17
The occlusal pictures shows the exact amount of composite added to create an “aligned” tooth effect.
Fig.18
One month control shows the situation is very stable.
Fig.19
7 years check-up.
Fig.20
Cross-polarized image obtained with a special filter (polar_eyes, emulation, Athens) was taken to see the internal color features eliminating the light reflection.
