A clinical case by our Community member Dr. Lisa Fernandes Gonçalves
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Modern dentistry now requires practitioners to combine the smile with the “frame” of the patient’s entire face. The key factor driving patients to seek out clinical procedures in cosmetic dentistry is the unbalanced smile, which is a result of the tooth, periodontal, and/or orofacial structures being asymmetrical and/or out of proportion. Dental technology has been continuously advancing in response to the rising demand for esthetic standards, beauty, and dental harmony, with the goal of facilitating the performance of clinical treatments by utilizing digital simulations. The Digital Smile Design (DSD), which offers a better analysis of potential treatments, predictability of results, and multidisciplinary communication between the professionals, is an example of a digital simulator.
This case aimed to present the esthetic management of the anterior sector using the DSD approach.
Fig.1
A 33-year-old-man visited the dental office and requested a solution for his teeth dilemma. He wanted a smile with better teeth proportions.
Fig.2
Close-up intra-oral view to analyze the composite restoration of tooth 21 and the fracture of tooth 22. An unesthetic arrangement of the form was clearly observed.
Fig.3
With a simple DSD, a correction of facial proportions could be achieved according to the height of the patient’s teeth.
Fig.4
Color selection. In this case, the “button-try” technique was selected. Clear translucent CL (Venus Pearl, Kulzer GmbH) and Opaque medium chromatic OMC (Venus Pearl, Kulzer GmbH) were seen in this picture.
Fig.5
In this case, a nano-hybrid composite (Venus Pearl, Kulzer GmbH) was used in order to obtain a natural outcome with improved mechanical properties.
Fig.6
As first step, isolation was performed with the rubber dam. Most dentists are well aware of the rubber dam’s significance in enabling technical perfection. Few dentists, however, are aware of the rubber dam’s capacity to protect the dentist and staff from the constantly expanding population of hepatitis and human immunodeficiency virus carriers.
Fig.7
The old restoration was removed and the surface on tooth 22 was polished. Now, the preparation was ready to receive the bonding agent.
Fig.8
In order to have a reliable adhesion, iBond universal adhesive (Kulzer GmbH) was used in this clinical case.
Fig.9
The bonding agent was applied and brushed for 20 seconds after etching the enamel surface for 30 seconds. It was gently air-blown for at least 5 seconds and light-cured for 20 seconds.
Fig.10
The polymerization of the adhesive system was done for 20 seconds using the Curing Pen by Eighteeth.
Fig.11
Following the digital wax-up, a silicone palatal key was used in order to translate this design to the mouth of the patient. In this case, the patient did not want any restoration processes for tooth 11.
Fig.12
Palatal walls were created using the translucent composite CL (Venus Pearl, Kulzer GmbH). This composite was chosen in this step to enhance the translucency of the natural teeth, and to allow light to pass through the surface.
Fig.13
Close-up view of the palatal walls on 12, 21, and 22.
Fig.14
Copying the translucency of tooth 11 to tooth 21.
Fig.15
The last layer of enamel was added.
Fig.16
Polishing was done by means Lucida™ Star Felt and Paste. This system allows for a single-step polishing of the composite restorations.
Fig.17
Final outcome. The patient was happy.
Fig.18
Close-up intra-oral view of the initial and the final situation.
Fig.19
Before and after the restoration (extra-oral view and facial frontal view).
Conclusions
Direct restorative treatments, which are an efficient substitute with minimal cost to achieve dental esthetics in a reduced time, have been employed as a tool for esthetic dentistry that enhances the predictability of rehabilitation operations like the DSD.
In addition, understanding the feature of composite currently used in dentistry is a must for all dentists to suit the therapeutic requirements in every day clinical practice.
Bibliography
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