Aesthetic / Restorative Dentistry

At this point, there were some minor defects in the interproximal areas, but these were not filled until the general shape of the restoration had been observed from a distance (Fig 10). Once the shape was determined to be compatible, the adjacent central incisor was completed. After the facial surfaces of the two incisors were completed, the interproximal regions were easily refined. These surfaces were re-etched with phosphoric acid. A Mylar matrix strip was placed between the teeth, and Venus A1 flowable composite was used to fill in any minor defects. It was important to compress the gingival area against the tooth while light-curing (Figs 11 & 12).

(Fig 11) After both central incisors were restored, the interproximal surfaces were re-etched in preparation for the application of a flowable composite resin.

(Fig 13) The lateral incisors, canines, and premolar teeth were similarly restored though direct resin build-up, finishing, and polishing procedures.

(Fig 12) Flowable composite was then applied; the gingival area was compressed against the tooth during light-curing.

(Fig 14) Facial view of the completed build-up. Note that occlusion was not a factor, or even with the additional length of the anterior dentition.

Once the two centrals were completed, the lateral, canine, and pre-molar on one side were finished before proceeding to the other side. The facial surfaces were finished before proceeding to the other side. The facial surfaces were finished using a 10-mm tapered fine finishing diamond. The interproximal areas were finished using a 4-mm flame-shaped finishing diamond; and a flame-shaped carbide finishing bur was used to open the incisal, facial, and gingival embrasures. To break any inadvertent composite bonding between the teeth, a separating strip was employed. The subsequent use of the perforated diamond strips (Brassler; Savannnah, GA) and Epitex abraxive strips (GC America; Alsip, IL) provided tight contacts and a fine finish. The lingual surfaces were refined with more flowable composite and finished with a football-shaped finishing diamond and composite polishing cups. Given that the surface was composed of microfill composite, a fine finish was attained with a bristle wheel and a composite polishing paste (Enamelize, Cosmedent; Chicago, IL) while retaining natural surface textures (Fig 13). Because occlusion was not a factor (Fig 14), the only real functional aspect was phonetics, which was evaluated over the days following placement of the restorations. Evaluation of the final esthetics revealed the materials' excellent shade compatibility and lifelike appearance, due to the polychromatic resin layering of the selected composite resin (Fig 15-17)

(Fig 15) Postoperative facial view of the completed direct resin restorations. Note the improvement in tooth preparation achieved through the adhesive bond protocol.

(Fig 17) The postoperative facial view exhibited a dramatic change in the appearance of the patient's smile. The mandibular dentition would be restored in a subsequent appointment.

(Fig 16) Buccal view of the completed resin build-up demonstrates the embrasures and compatibility of the restorations.

Dr Rhys Spoor DDS Aesthetic / Restorative Dentistry - Providing services in cosmetic and sleep dentistry to the area of Seattle, Washington.

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