Minimal Invasive Solution with Direct Composites for Misaligned Anterior Teeth

Cases - Tips and tricks - Bleaching - Direct anteriors

The advancement of adhesive dentistry and composite resins, enables the current practioners in dentistry, to perform clinical direct interventions impossible, until a few years ago. In fact, the adhesion today allows us to work so that achieving amazing results, quickly and conservatively, since we know the materials available and their proper applicability to reproduce the beauty of dental anatomy. In this case, we present the solution of a case in which the patient, a young woman, 33 years old, that was searching to improve her smile without time-consuming treatments and also little invasiveness in relation to tooth reduction or surgery.

Fig. 1

Img. 1 – Frontal aspect of the smile, showing the disharmony on the design of the gum, multiple diastemas and giroversion of lateral incisors.

Fig. 2

Img. 2 – In the right frontal view of the smile, we can see the rotation of the lateral incisors and the misalignment of the central incisors in relation with lips.

Fig. 3

Img. 3 – In the left view of the smile, we can see a little "aggressive" form of canine and the excessive gap of the embrasure.

Fig. 4

Img. 4 – Incisal view of the six anterior teeth, showing the misalignment of the edges.

Fig. 5

Img. 5 – Approximated view of the six anteriors. Note the diastemas and the incisal embrasures gaps.

Fig. 6

Img. 6 – View in occlusion with retractors.

Fig. 7

Img. 7 – View of the smile after the recontouring of the gum and bleaching.

Fig. 8

Img. 8 – Wax-up. In this stage was perceived the necessity of reduction on some buccal and mesial areas on the lateral incisors.

Fig. 9

Img. 9 – In blue, we can see the areas that will be prepared during the procedure.

Fig. 10

Img. 10 – Modified absolute isolation and retraction cords in place.

Fig. 11

Img. 11 – The index was placed in position to help on visual perception of the areas to be prepared.

Fig. 12

Img. 12 – The index was placed in position to help on visual perception of the areas to be prepared.

Fig. 13

Img. 13 – The areas to be prepared were painted.

Fig. 14

Img. 14 – View after the planned preparation. The central incisors had only the superficial brilliance of the enamel removed to optimize the adhesion.

Fig. 15

Img. 15 – View after the planned preparation.The central incisors had only the superficial brilliance of the enamel removed to optimize the adhesion.

Fig. 16

Img. 16 – View of the index in position after the preparations.

Fig. 17

Img. 17 – Aspect after the etching – Ultra-etch (Ultradent).

Fig. 18

Img. 18 – Aspect after the adhesive application – Optibond-FL (Kerr).

Fig. 19

Img. 19 – After the application of the selected adhesive system, the palatal and proximal walls were built (Renamell OW – Cosmedent), they will define the geometry of the incisors.

Fig. 20

Img. 20 – Dentin and enamel masses were placed – Empress Direct B1 Dentin and Trans-Opal  (Ivoclar-Vivadent) and Durafill VS  B1 (Heraeus-Kulzer) for the enamel.The canines were done in the same way immediately after the incisors

Fig. 21

Img. 21 – Immediate aspect after removal of cords and isolation. The primary geometry of the anterior teeth were done at this appointment.

Fig. 22

Img. 22 – Aspect after 2 weeks. Form, secondary anatomy and polishing were refined after 1 week.

Fig. 23

Img. 23 – Frontal view before procedures with retractors.

Fig. 24

Img. 24 – Frontal view with retractors, after 2 weeks of procedures.

Fig. 25

Img. 25 – Final aspect of the smile.

Fig. 26

Img. 26 – Right view of the alignment. Note the new relation with lips.

Fig. 27

Img. 27 – Left view of the alignment. Note the new relation with lips.


With this case, we can see the results that can be achieved with direct composites and minimum intervention. Entirely reproducible by every professional.