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Dental Tribune U.S. Edition

COSMETIC TRIBUNE The World’s Dental Newspaper · US Edition Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com Chief Operating Officer Eric Seid e.seid@dental-tribune.com Group Editor & Designer Robin Goodman r.goodman@dental-tribune.com Editor in Chief Cosmetic Tribune Dr. Lorin Berland d.berland@dental-tribune.com Managing Editor/Designer Implant, Endo & Lab Tribunes Sierra Rendon s.rendon@dental-tribune.com Managing Editor/Designer Ortho Tribune & Show Dailies Kristine Colker k.colker@dental-tribune.com Online Editor Fred Michmershuizen f.michmershuizen@dental-tribune.com Account Manager Mark Eisen m.eisen@dental-tribune.com Marketing Manager Anna Wlodarczyk a.wlodarczyk@dental-tribune.com Sales & Marketing Assistant Lorrie Young l.young@dental-tribune.com C.E. Manager Julia E. Wehkamp j.wehkamp@dental-tribune.com C.E. International Sales Manager Christiane Ferret c.ferret@dtstudyclub.com Dental Tribune America, LLC 116 West 23rd Street, Suite 500 New York, NY 10011 Tel.: (212) 244-7181 Fax: (212) 244-7185 Published by Dental Tribune America © 2011 Dental Tribune America, LLC All rights reserved. Cosmetic Tribune strives to maintain utmost accuracy in its news and clini- cal reports. If you find a factual error or content that requires clarification, please contact Group Editor Robin Goodman at r.goodman@dental-tribune.com. Cosmetic Tribune cannot assume respon- sibility for the validity of product claims or for typographical errors. The pub- lisher also does not assume responsibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune America. Do you have general comments or criti- cism you would like to share? Is there a particular topic you would like to see articles about in Cosmetic Tribune? Let us know by e-mailing feedback@ dental-tribune.com. We look forward to hearing from you! Tell us what you think! 2C Clinical COSMETIC TRIBUNE | July 2011 f CT page 1C structure, improvements will con- tinue.”12 The same philosophy of using nature as a guide for restoration and regeneration can be extended to a functional solution creating missing structures in cosmetically focused patients. Minimally invasive treatments are procedures that restore form, function and esthetics with minimal removal of sound tooth structure.3 This is accomplished by remov- ing only dental tissues that cannot be adhesively bonded.9 This con- servative approach leaves patients with as much of their natural tooth structure as possible while restor- ing or creating tissue that will enhance utility and appearance. While indirect porcelain veneers can require a great amount of prep- aration and removal of tooth struc- ture, direct composite bonding fol- lows the conservative approach. Direct resin composite restora- tions offer an alternative treatment that provides excellent esthetics and preservation of tooth struc- ture given that the preparation is limited to only areas of affected unsupported enamel.23 Patients today want their den- tistry more esthetic but less inva- sive and composite resin accom- plishes both.11 Evidence suggests that composites can provide opti- mal esthetics with minimal or no tooth intervention, immediately improving esthetics while leaving options for future orthodontic and restorative care.13 Furthermore, as a person ages, so do their restora- tions. Eventually, teeth that have been restored will break down and need to have those restorations replaced.4 Fortunately, if an initial restoration was created using min- imally invasive procedures, there should be more tooth structure to work with at the time when a sec- ond restoration may be needed.2 In this way, the biomimetic approach takes into account both the present and future dental health of the patient. Nowadays, there are many mod- ern composite resins developed for highly esthetic procedures that, when properly used, can result in restorations that are indistinguish- able from natural dentition.24 This article extrapolates the minimally invasive biomimetic principles of restoration and applies them to procedures for introducing miss- ing tissue and creating cosmetic improvements, which ultimately benefit the patient’s overall oral health and appearance. The process of mimicking tissue that was not initially present uses biomimetic methodology similar to that used in restorative dentistry that conserves tooth structure. Two cases will be presented that dem- onstrate the diversity of options biomimetic techniques provide for the field of cosmetic dentistry. Case No. 1 A 34-year-old, healthy male pre- sented for treatment of the spac- ing between his upper and lower anterior teeth as well as whitening. He desired a more esthetic appear- ance overall. After an examination, the patient was presented with two options. Both porcelain veneers and biomimetic composite bond- ing would eliminate spacing and create a whiter smile, though the composite bonding technique dem- onstrated several advantages that made it the right choice for the patient. The biomimetic effect of com- posite bonding ensures that the patient will attain a natural and highly functional result. Today’s composites have much improved physical and esthetic properties, enabling minimally invasive treat- ment modalities to be performed with immediate results that are able to satisfy the most cosmeti- cally discerning patients.14–19 Porcelain veneers, on the other hand, require greater and irrevers- ible tooth intervention. In addi- tion, they would require at least two appointments and somewhat considerable tooth preparation.13 The composite bonding chosen for this patient involves minimal intra- enamel preparation from sand- blasting or cleaning the enamel surface with pumice and no local anesthetic.13 With this type of treatment, fewer teeth (or just parts of teeth) can be treated and, becuase there is no laboratory fee, there is less cost for the patient.22 Composite bonding can be considered as a viable minimal or non-invasive treatment alternative.20, 21 Treatment An initial in-office whitening pro- cedure was accomplished one week before the composite fill res- toration. Treatment for general upper and lower diastemas was then carried out and consisted of the following: the maxillary ante- rior teeth and mandibular anterior teeth were pumiced with Pumice Fig. 6: Postoperative. Fig. 4: Postoperative smile. Note the natural appearance. Fig. 5: Postoperative.