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03 Apr 2017

By Stars Of Dentistry

[Restorative]

Durable aesthetic composite restoration on a young patient

A 25-year-old male patient came to Seven Fields Dental Practice on the recommendation of his mother as he was unhappy with the appearance of his front teeth. He had a significant diastema between the upper central incisors and his upper laterals were diminutive (Figures 1 and 2). The patient’s oral health was otherwise good.

 
Fig 1.jpg
 
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Figures 1 and 2: The patient had a significant diastema between the upper central incisors and his upper laterals were diminutive

 

Treatment options

Several treatment options were discussed including orthodontics, veneers, composite restoration or a combination thereof. Orthodontics alone was dismissed as an option, as this would not correct the issue of the size of the lateral incisors. The patient chose to have composite restorations, due to his age. More invasive treatment would have been detrimental to the future of his otherwise healthy natural teeth. He was reassured by the confidence I had in the strong, durable and aesthetic outcome I knew I could create with Heraeus Kulzer materials.

Mock-ups were created on the upper central and lateral incisors to show the patient what could be achieved (Figures 3 and 4). These were quickly applied using Heraeus Kulzer Venus Pearl dentine composite with a short cure. The patient was very happy with the mock-ups and consented to treatment.

 

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Figures 3 and 4: Mock-ups were created on the upper central and lateral incisors to show the patient what could be achieved

 

Layered restoration technique

Impressions were taken using Kulzer Xantasil to fabricate the palatal guide (Figure 5). Xantasil is an A-silicone precision impression material, which provides a high-quality alternative to alginate materials.  I use it because it sets quickly, is reliable and gives consistently clear results.

The patient was given local anaesthetic via The Wand computer-assisted injection system (Figure 6). The incisive canal block anaesthetises the soft tissue without the patient having the facial numbness associated with traditional injection techniques. Rubber dam was then applied and a combination of PTFE tape and floss was used to gain adequate soft tissue retraction (Figure 7).

The upper incisors were built up in layers with Kulzer Venus Pearl. After an initial increment of the Clear (CL) shade was applied to the upper right central incisor (UR1), a piece of floss was held down the midline of the patient’s face (Figure 8). This technique quickly confirms where the centre line of the planned restorations should be, so any necessary adjustments can easily be made at this stage.

The interproximal edges of the UR1 (Figure 9), followed by the upper left central incisor (UL1) (Figure 10), were built up using CL shade composite.

The frames of the restorations were then filled with increments of the Opaque Medium Chromatic (OMC) and A3 shades before a final incisal layer of CL shade was applied. Each increment was light cured in accordance with the manufacturer’s instructions. This technique was then repeated for the upper lateral incisors (UR2 and UL2) (Figure 11).

The restorations were coated with Benzer Texturmarker Silver to confirm the correct surface texture had been achieved (Figure 12). Then rubber polishing points and glycerine were used to polish the restorations to a high gloss, whilst preserving micro-anatomy. This technique makes the teeth look artificially shiny in the short term (Figure 13). The patient was astounded that composites alone could deliver the aesthetic outcome he desired (Figure 14).

 

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Figure 5: Impressions were taken using Kulzer Xantasil to fabricate the palatal guide
 
Fig 6.jpg
Figure 6: The patient was given local anaesthetic via The Wand computer-assisted injection system
 

Fig 7.jpg

Figure 7: Rubber dam was then applied and a combination of PTFE tape and floss was used to gain adequate soft tissue retraction

Fig 8.jpg

Figure 8: A piece of floss was held down the midline of the patient’s face to confirm where the centre line of the planned restorations should be. Any necessary adjustments can easily be made at this stage
 

Fig 9.jpg

 

Fig 10.jpg

Figures 9 and 10: The interproximal edges of the UR1, followed by the UL1, were built up using CL shade composite

 

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Figure 11: This technique was then repeated for the UR2 and UL2

 

Fig 12.jpg
Figure 12: The restorations were coated with Benzer Texturmarker Silver to confirm the correct surface texture had been achieved

 

Fig 13.jpg

Figure 13: Rubber polishing points and glycerine were used to polish the restorations to a high gloss, whilst preserving micro-anatomy. This technique makes the teeth look artificially shiny in the short term
 

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Figure 14: The patient was astounded that composites alone could deliver the aesthetic outcome he desired

 

 

Long-term outcome

At the first review appointment after 14 months, the teeth were air-dried to make it easier to assess the micro-anatomy and stability of the restorations (Figure 15). The smallest detail had been maintained with imperceptible deterioration of the aesthetics (Figures 16-18). The patient has since returned for a further review after two and a half years and is still delighted with the results. The patient has elected to have the same treatment again, should the restorations need to be replaced in the future. The composites would be taken back to almost exactly where they began, with no damage to the natural tooth beneath. 

 

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Figure 15: At the first review appointment after 14 months, the teeth were air-dried to make it easier to assess the micro-anatomy and stability of the restorations

 

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Figures 16-18: The smallest detail had been maintained with imperceptible deterioration of the aesthetics

 

 

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