The esthetic management of the anterior sector using digital smile design

A clinical case by our Community member Dr. Lisa Fernandes Gonçalves

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

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.

style italiano styleitaliano first appointment

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.

style italiano styleitaliano Initial intra-oral situation

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.

style italiano styleitaliano Digital Smile Design

Fig.3
With a simple DSD, a correction of facial proportions could be achieved according to the height of the patient’s teeth.

style italiano styleitaliano Shade selection

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.

style italiano styleitaliano composites used for the restoration

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.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano isolation

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.

style italiano styleitaliano Cavities preparation

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.

style italiano styleitaliano Bonding used in this case

Fig.8
In order to have a reliable adhesion, iBond universal adhesive (Kulzer GmbH) was used in this clinical case.

style italiano styleitaliano Etching and bonding

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.

style italiano styleitaliano Bonding polymerization

Fig.10
The polymerization of the adhesive system was done for 20 seconds using the Curing Pen by Eighteeth.

style italiano styleitaliano Digital wax-up and palatal key

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.

style italiano styleitaliano Palatal walls

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.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano Close-up view of the palatal walls

Fig.13
Close-up view of the palatal walls on 12, 21, and 22.

style italiano styleitaliano Translucency of the incisal edge

Fig.14
Copying the translucency of tooth 11 to tooth 21.

style italiano styleitaliano Enamel layer

Fig.15
The last layer of enamel was added.

style italiano styleitaliano Final polished situation

Fig.16
Polishing was done by means Lucida™ Star Felt and Paste. This system allows for a single-step polishing of the composite restorations.

style italiano styleitaliano Final situation

Fig.17
Final outcome. The patient was happy.

style italiano styleitaliano Before and after

Fig.18
Close-up intra-oral view of the initial and the final situation.

style italiano styleitaliano Before and after

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

  1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
  2. Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, Haikel Y, Cuevas-Suárez CE. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021 Mar 7;13(5):814.
  3. 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 Mar 1;5(1):102-24.
  4. Devoto W, Pansecchi D. Composite restorations in the anterior region: clinical and aesthetic performances. Practical Procedures & Aesthetic Dentistry: PPAD. 2007 Sep 1;19(8):465-70.
  5. Ortensi L, Sigari G, La Rosa GR, Ferri A, Grande F, Pedullà E. Digital planning of composite customized veneers using Digital Smile Design: Evaluation of its accuracy and manufacturing. Clinical and Experimental Dental Research. 2022 Apr;8(2):537-43.

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