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13630 Views - Dec 2015

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In aesthetic restorations we need to get a perfect shape, color and texture of teeth. In order to do this, we need not only manual skills, but knowledge of the general principles and techniques of restorative therapy. In the daily practice, we are often faced with patients who have problems in anterior teeth. It is believed that the anterior teeth are more difficult to restore because we work in the display area. With simple techniques and protocols we are going to learn how to overcome this problems.

I would like to thank Dr. Shemsi Abdulla who was the co-author of this clinical case and article.
We were contacted by a patient aged 25 years old with complaints of hypersensitivity in the frontal area of the teeth and she doesn’t feel comfortable with her smile. During inspection of the patient, we found two old composite restorations on teeth 1.1 , 2.1 and opening portion of the dentin on the cutting edge. On teeth 3.1 and 4.1 class 4 defects were detected. In recognition of the patient, she loves to chew sunflower seeds. And that could cause the defects in the lower central incisors, and hypersensitivity can be caused due to defects in cervical areas of the teeth. The patient was adviced to do an orthodontic treatment but because of the duration of the treatment she refused. It was decided to setup ceramic veneers with material of Lithium Disilicate, in the teeth of 1.1 and 2.1; composite restorations to the teeth 3.1, 3.3, 4.1, 4.3, 4.4, 4.5
First we started with the restoration of the lower incisors. To analyze the internal structure of the teeth, we should use the intraoral photos. In this case, two photographs were made using conventional and polarizing filter.
For this we can use the camera with filters or a mobile phone with the help of Smile lite.
For removing sclerotic dentin we can use 27 micron Al2O3 sand with Rondoflex
In this case we used 37% etching gel 30 second for enamel and 5 second for the dentin
After rinsing of the etching gel we apply the adhesive. We have to wait minimum 20 seconds for the exposition of the adhesive then 5-10 second air drying. Light curing will be 60 seconds
With silicon key we start to build up palatal walls. First we used enamel layer NE from Asteria
For the dentin we used one shade A3 Body from Asteria and we add white and blue tints to the lobes of dentin
Here we finished with NE enamel. The thickness of the enamel was 0,5. We can measure it with LM missura from Style Italiano Kit
Air blocking with glycerine and light curing for 1 minute
After finishing and polishing
The final photo after restoration
In order to take such type of photos we used another type of flashes - Softboxes
This photo was taken with Polarizer filter before and after rehydration
After restoration of the lower incisors we started to restore cervical deffects. In the next visit we did 3 cervical restorations
After isolation with heavy Nictone dam we used B4 Brinkers for margin opening
For preparation we suggest to use 27 microns sandblasting. No need for any bur in this stage, just sandbasting with Rondoflex
We finished all 3 cervical restorations with one A3 body shade. No need to use many layers for this type of restorations. It always gives a good result in the cervical zone
The final photo after rehydration. very hard to find any difference between natural tissues and composite restorations
After finishing of composite restorations we start a second (prosthodontic) part of the treatment.
The preparation was finished all in enamel with a light chamfer.
The provisional crowns made with bis-acryl composite
After Isolation with Photodam (we recomended to isolate 8 teeth ) we expose the margins of the preparations with B4 brinkers clamps. Sandblasting of enamel with 27 micron Al2O3
After placing a teflon tape on the neighbor teeth, the enamel is etched for 30 seconds with orthophosphoric acid. We recommend to wash generously for about 20 seconds in order to remove all the debris that the acid could left.
Application of the bonding agent, in this case ScotchBond universal, which can act as a self-etching material or as a total etch. The bonding agent is scrubbed for 20 seconds. Then we bond the veneers.
Polymerisation should be done properly. Manufacturers recommend generally 20-30 seconds. We suggest to over-polymerize, this will grant us a strong hybrid layer even in areas where the light can not arrive from the intimate contact of the lamp but slightly further. This stage is the final polymarization after glycerine. We need minumum 1 minute of polymerization for blocking of inhibition layer
The final view of cemented veneers
This is right after cementation, cleaning of all excess and rubberdam removing. We need a time for healing of tissues
Now we can see how after 1 week the tissues have healed properly
Artistic photos taken with Softboxes
The final photo after treatment finished
Before and after treatment

Conclusions

Its very practical to combine 2 materials, Composite and Ceramic in everyday treatments. If we manage to do it in the right way we can achieve great results.
 

Bibliography

1.- Devoto W. Direct and indirect restorations in the anterior area: a comparison between the procedures. QDT Yearbook 2003;26:127-138.
2.- Devoto. W Ceramic Veneer Cementation, www.styleitaliano.org
3.- Devoto W, Saracinelli M, Manauta J. (2010). Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent Spring;5(1):102-24
4.- Manauta, J., Paolone, G. Devoto, W. 2013. IN ‘n’ OUT – A New Concept in Composite Stratification. Labline Magazine, 3 (2), pp. 110-127
5.- Manauta J. Controlled Body thickness Part 1 www.styleitaliano.org

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