Small Laterals, DSD and Direct Resin Veneers
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The demand for esthetics and conservative dentistry has increased tremendously in the last decade due to patient desires. Small dental esthetic defects can be easily and conservatively treated with direct resin composite restorations nowadays.
Analysis and planning is primordial for esthetic success. Digital Smile Design (DSD) is an ideal tool for analysis, planning and execution of all sorts of esthetic concerns.
The patient concern was the small size of her lateral incisors. Her desires were to have a nice smile without compromising longevity or removing any tooth structure.
Records of the patient, photographs according to the DSD protocol and casts were obtained from the patient. Subsequently analysis and planning were performed with DSD and a motivational mock up was performed. Treatment plan included crown lengthening, bleaching and direct resin veneers.
Img. 1 - View of initial condition. Patient is unhappy about the small size of lateral incisors as well as “yellowish shade”.
Img. 2 - Intraoral view of existent conditions, small laterals, width to length ratio and altered passive eruption.
Img. 3 - Photographs according to the DSD protocol were obtained as well as diagnostic casts. Keynote was used to produce a 2D smile design and obtain the calibrated measurements for a 3D smile design.
Img. 4 - Measurements from the 2D smile design were transferred to the cast and a diagnostic wax-up produced.
Img. 5 - A PVS impression was made of the wax up to produce a motivational mock up.
Img. 6 - Protemp Garant A2 (3M) was used in the PVS matrix to make the mock up. This ensured patient acceptance of the proposed treatment plan. Function is also checked at this point.
Img. 7 - Photograph 6 weeks after whitening and crown lengthening to enhance gingival contours and width to length tooth ratio.
Img. 8 - Rubber dam isolation.
Img. 9 - Palatal index fabricated in diagnostic wax-up.
Img. 10 - Index of the proposed resin composites in place.
Img. 11 - Initial build-ups with Filtek Supreme Ultra A1D and of B1E using Style Italiano principles.
Img. 12 - Immediate post op image of resin composite build ups.
Img. 13 - 2 weeks intraoral post operative photograph.
Img. 14 - Final Smile image after completion of the treatment.
ConclusionsAdequate identification of the patient’s problems and concerns, along with proper planning and execution of restorative treatment allows both the dentist and the patient to obtain predictable esthetic results. In this particular case the combination of crown lengthening, whitening and direct resin veneers facilitated with the DSD protocol allowed for a highly esthetic result.
- Calamita Digital Smile Design: A Tool for Treatment Planning and Communication in Esthetic Dentistry. QDT Pages 1:9. 2012.
- Fahl N Jr. A polychromatic composite layering approach for solving a complex Class IV/direct veneer-diastema combination: part I. Pract Proced Aesthet Dent. 18:641-645, 2006.
- Vargas M. Conservative aesthetic enhancement of the anterior dentition using a predictable direct resin protocol. Pract Proced Aesthet Dent. 18:501-507, 2006.