smile with yellow worn and rotated teeth

Smile makeover, a simple and fast way

This patient, a 45 y.o. woman, came to the office complaining about her smile. She didn’t like the shape of the central incisors, as well as their asymmetry, and the inclination of the midline. Also, she complained about the yellowish halo in the interproximal areas.
The patient refused orthodontic treatment, and asked for a non-invasive and non-expansive treatment.

contrasted picture of upper teeth

Fig.1

During the clinical examination we could easily appreciate the misalignment. Tooth 13 was tipped towards the palatal, as well as the two central incisors. Tooth 12 was rotated mesially, and the dental midline is not parallel to the facial one. We immediately proposed completely additive direct restorations to build new shapes and give a nicer color to the smile of the patient. To do so, we need a composite with some opacity to cover the highly chromatic areas, then a translucent one for the incisal third.

left and right upper teeth

Fig.2

In this image we can better appreciate shape and position of each tooth.

buccal space allowing direct veneering of teeth

Fig.3

From this point of view it’s easy to see that we have enough space to ask for the technician to create an additive wax-up.

rubber dam isolation before composite restoration

Fig.4

Of course rubber dam isolation is mandatory, speaking of adhesive procedures.

total etching with orthophosphoric ge

Fig.5

A total etching procedure was performed, acting on 3 teeth at a time, to properly control the etching time with 37% phosphoric gel (DMG Etching Gel).

white micro brush to spread the adhesive on enamel

Fig.6

A universal adhesive (DMG LuxaBond Universal) was applied all over the teeth and light-cured.

silicone key to build palatal wall with composite

Fig.7

The silicone key is useful to place the first layers of enamel composite in the right position (DMG Ecosite Elements Layer EL).

outer frame of dental direct reshaping

Fig.8

It’s time to complete the frame to our picture. Using a matrix, we can build the interproximal walls with an opaque mass (DMG Ecosite Elements Pure B1).

layering of dentin tmamelons with opaque composite

Fig.9

With the same opaque mass, we can create the dentin features, leaving some space in the incisal third for translucent materials.

translucent composite to enhance dental anatomical features

Fig.10

Making our outcome natural is our main goal, so a highly translucent mass is used in between the tmamelons to enhance their appearance (DMG Ecosite Elements Highlight INC).

white stain for anatomical detail in composite restoration

Fig.11

And, for the same reason, a white stain is used (DMG Ecosite Elements Highlight W).

composite layering of direct veneers on central incisors

Fig.12

The opaque mass (DMG Ecosite Elements Pure B1) the final shape is almost reached, we just leave some space for the final enamel layer (about 0.5 mm, just a little bit more in the incisal area).

rough composite veneers before finishing procedures

Fig.13

The layering of the two central incisors is completed with a light enamel mass (DMG Ecosite Elements Layer EL).

lateral incisor and canine being covered with composite

Fig.14

On laterals and canines the layering is even simpler. For the lateral incisors the shaping is done with an opaque mass (DMG Ecosite Eelements Pure B1) leaving the space for just a small amount of enamel in the incisal edge (DMG Ecosite Eelements Layer EL). In the canine no enamel is needed, just some B1.

lucida polishing paste and star felt

Fig.15

After finishing procedures, the final polishing is done with a polishing paste (Lucida Diashine).

final aspect of direct composite veneers

Fig.16

At one month check-up we can appreciate a natural look of the composite restorations. The patient is very happy with her new teeth and she feels much more confident when smiling.

new satisfied smile after dental restorations

Fig.17

Lateral view of the new smile.

before smile makeover

Fig.18

Before.

happy patient after smile makeover

Fig.19

After.

Conclusions

Composites are nowadays highly aesthetic and easy to use, which makes these materials a great solution for a wide variety of clinical cases.
Thanks to their versatility they can be modified, repaired, re-shaped, and, most of the times, they can be used in an additive way. The layering is simple and fast, as, after all the preliminary steps, the actual time for composite layering was about 1.5 hours. Also the financial aspect is very important, as composites are much less expensive than to porcelain.
We just need to have a good project, and to follow simple, yet strict, protocols, and, in less than 2 hours, we can give our patient a brand new smile.

Bibliography

1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 5. Quintessence Books, 2012.
2. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent. 2010 Spring;5(1):102-24.4.
3. Vichi A, Fraioli A, Davidson CL, Ferrari M. Influence of thickness on color in multi- layering technique. Dent Mater 2007;23:1584-1589.
4. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37(47): 5-13.