A clinical case by our Community member Dr. Maxstein Abuzaid
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One of the most crucial criteria in modern dentistry is the reestablishment of a patient’s dental aesthetics. Recent advancements in the field of adhesive dentistry have broadened and changed restorative dental practice. In fact, dental composite veneers have developed into a solution for anterior teeth in the modern dental industry with a tendency towards minimal intervention. Direct placement of composite veneers provide greater material control, require only a small amount of tooth structure to be removed, and is easily repairable and modifiable at any point. Further, the use of a Digital Smile Design (DSD) and a mock-up technique for Aesthetic Crown Lengthening (ACL) was a predictable treatment to correct smile disharmony in the patient’s mouth. The following clinical case depicts the use of this aesthetic restorative material by means of a DSD approach.
Pre-operative photographs were taken to analyze the smile of the patient.
A female patient came to the dental office demanding a better smile. She refused orthodontic treatment and preferred a more rapid line of treatment. After evaluation of her smile clinically and radiographically, and based on the DSD, ACL was performed.
Diastema closure and direct composite veneer were the golden option here. Not only are direct composite veneers a minimally invasive approach, but also accept future correction and reintervention. With today’s resin composite materials and accurate polishing techniques, the durability of direct restorations increased in addition to the fact that they were one of the most conservative options.
Pre-operative photographs showing gingival tissues covering parts of the teeth, also known as “Gummy Smile”. Diastema appears between upper anterior teeth, and a tilted left central incisor is observed as well.
A DSD was done to better frame the field of work.
The work was initiated with a DSD to design the new smile of the patient and to serve as a guide for the ACL perio-surgery.
ACL surgery is indicated in this case to provide adequate clinical crown length, ensuring gingival symmetry and harmony. This picture was taken prior to the surgery.
After inserting the mock-up into the patient‘s mouth, bleeding points were detected.
Step by step guide of the surgery: Removal of some bony exostosis was done, then stitches were placed. A follow-up was mandatory to check the healing progress and to remove the suture.
Isolation was done to prepare the teeth for the restorative work.
In this case, choosing Medium Dentin (MD) and Light Enamel (LE) shades from GC Essentia offered her a color matching natural white teeth.
A rubber index for building the palatal enamel shell was used. Matrix bands from Palodent V3 sectional matrix system were placed for proximal walls and emergence profile creation.
Finishing and polishing using Enhance finishing system and Enhance POGO cups with Prisma Gloss polishing paste, gave the composite veneers a highly polished shiny appearance.
Complete intraoral view of the initial and the final situation.
Final outcome. The patient was satisfied.
The patient was happy and satisfied with the result.
Nature is the ideal model to imitate, and the comprehension of what nature looks or feels like is essential in aesthetic dentistry.
Nowadays, clinicians are able to offer beautiful smiles conservatively without any loss of the tooth structure. It was a challenge to combine the functional, aesthetic, and biological considerations to satisfy the patient.
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