Dental Tribune U.S. Edition

Susan McMahon, DMD, has served as a clinical professor in prosthodontics and opera- tive dentistry at the University of Pittsburgh School of Dental Medicine. She is a guest lec- turer in cosmetic dentistry at West Virginia University School of Dentistry and lectures to den- tists in the United States and Europe on tooth whitening and cosmetic dentistry. McMahon is a six-time award winner in the prestigious Amer- ican Academy of Cosmetic Den- tistry Smile Gallery competition. You may contact McMahon at: SouthSide Works Office 2643 East Carson St. Pittsburgh, Pa. 15203 (412) 381-3969 www.wowinsmile.com About the author COSMETIC TRIBUNE | July 2011 Clinical 3C Preppies (Whip Mix Corp.), rinsed and dried. The teeth were then treated with Ultra Etch 35 percent phosphor- ic acid (Ultradent Products) for 15 seconds, rinsed and left moist. Bonding agent Prime & Bond NT (Dentsply Corp.) was applied to the teeth, air thinned and then light cured for 20 seconds. The diastemas were restored with Esthet-X HD Micro Matrix Restorative (Dentsply Corp.). A layer of A2 was applied to block light transmission through the diastema, simulating the dentin layer. Characterization was accom- plished by adding Pink Tint Venus applied with a No. 10 endodontic file into the surface of the A2. This layer was cured for 20 sec- onds. A second layer of Esthet-X HD enamel shade WE was applied and contoured simulating the enamel layer. This layer was light cured for 20 seconds. The com- posite resin was then contoured, finished and polished with Sof-lex discs (3M ESPE). Case No. 2 A 23 year-old healthy male pre- sented with one peg-lateral incisor that he wished to improve estheti- cally. A peg-shaped lateral incisor can be defined as a tooth with reduced meso-distal diameter and with proximal surfaces converging markedly in the incisal direction.25 This tooth’s shape and size alter- ation is inherited genetically and occurs in the range of 1–2 percent of the population.25,26 Options for treatment again included a por- celain veneer or restoration with composite bonding. The patient again opted for the biomimetic procedure of restoring with com- posite bonding. Treatment Treatment consisted of direct com- posite bonding to the upper right lateral incisor. No prepping of the tooth was required. The tooth was cleaned with pumice (Pumice Preppy, Whip Mix Corp.). A 35 per- cent phosphoric acid (Ultra Etch, Ultradent Products) was applied to the entire enamel surface for 15 seconds. The etchant was then rinsed off, leaving the enamel sur- face moist. The bonding agent, Prime & Bond NT (Dentsply Corp.), was applied, air thinned and light cured for 20 seconds. Esthet-X HD Micro Matrix Restorative (Dentsply Corp.) shade C1 was applied, contoured and cured. This was followed by a layer of Esthet-X HD Micro Matrix Restorative (Dentsply Corp.). The ideal characteristics of very high polishability, varied opacity options and contourability make the Esthetix-X HD an excellent choice for this application. The restoration was then finished and polished with Sof-lex Discs (3M ESPE). Summary Biomimetic principles can be applied to cosmetic dental cases to minimize the reduction of existing healthy tooth structure in the pur- suit of improved esthetics. The results can accomplish the esthetic enhancement, the cost to the patient can be reduced and the underlying tooth structure can be preserved for the present and future dental health of the patient. CT References 1. Magne M, Magne P. The Cen- ter for Esthetic and Biomimet- ic Restorative Dentistry. USC Oral Health Center. 2004–2006. 2. Malterud MI. Minimally Inva- sive Restorative Dentistry: A Biomimetic Approach. Pract Proced Aesthet Dent. 2006; 18(7): 409–414. 3. Christensen GJ. The Advantag- es of Minimally Invasive Den- tistry. J Am Dent Assoc. 2005; 136(11):1563–1565. 4. White JM, Eakle WS. Rationale and Treatment Approach in Minimally Invasive Dentistry. J Am Dent Assoc. 2000; 131(9): 1250, 1252. 5. Rainey JT. Understanding the Applications of Microdentistry. Compend Contin Educ Dent. 2001; 22 (11A):1018–1025. 6. Brantley CF, Bader JD, Shugars DA, Nesbit SP. Does the Cycle of Restoration Lead to Larger Restorations? 1995; 126(10):1407–1413. 7. Lutz F, Krejci I, Besek M. Operative Dentistry: The Miss- ing Clinical Standards. Pract Periodont Aesth Dent. 1997; 9(5):541–548. 8. DiMatteo AM. Duplicating Nature: Biomimetics and Den- tistry. Inside Dentistry. 2009; 5 (10). 9. Alleman D, Deliperi, S. Stress- Reducing Protocol for Direct Composite Restorations in Min- imally Invasive Cavity Prepara- tions. Pract Proced Aesth Dent. 2009; 21(2):E1–E6. 10. Firth A, Aggeli A, Burke JL, et al. Biomimetic Self-Assembling Peptides as Injectable scaffolds for Hard Tissue Engineering. Nanomed. 2006; 1(2):189–199. 11. Chistensen GJ. Veneer Mania. J Am Dent Assoc. 2008; 137:1161–1163. 12. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomi- metic Approach. 1st ed. Carol Stream, IL: Quintessence Pub- lishing; 2002. 13. Nalbandian S, Millar BJ. The Effect of Veneers on Cosmetic Improvement. British Dental Journal. 2009; 207:E3 14. Morley J. The Role of Cos- metic Dentistry in Restoring a Youthful Appearance. J Am Dent Assoc. 1999; 8:1166–1172. 15. Dietschi D. Free-hand Com- posite Resin Restorations: A Key to Anterior Aesthetics. The International Aesthetic Chron- icle. 1995; 7:15–25. 16. Goldstein RE, Lancaster JS. Survey of Patient Attitudes Toward Current Esthetic Pro- cedures. J Prosthet Dent 1984; 52:775–780. 17. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G. The Five-year Clinical Perfor- mance Direct Composite Addi- tions to Correct Tooth Form and Position. Part I: Aesthetic Qualities. Clin Oral Investig. 1997, 1:12–18. 18. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G. The Five-year Clinical Perfor- mance Direct Composite Addi- tions to Correct Tooth Form and Position. Part II: Marginal Qualities. Clin Oral Investig. 1997, 1:19–26. 19. Meijering AC, Roeters FJM, Mulder J, Creugers NHJ. Patients’ satisfaction with dif- ferent types of veneer restora- tions. J Dent. 1997; 25:493–497. 20. Douglass T. Application of Direct and Indirect Composite Parts I Et. II. Int Dent (Austral- asian ed) 2008; 3(1):50–54. 21. Tyas M. Lack of Reliable Clini- cal Evidence for or Against Direct and Indirect Veneers. Evid Bosed Dent. 2004; 5:43. 22. Jackson, RD. Today’s Compos- ite Resins Part I: Versatile, Aes- thetic and Conservative. Dent Today. 2009 Jul; 28(7):116, 118–119. 23. Higashi C, Loguercio A, Rels A. Anterior Crossbite Correc- tion with a Series of Clear Removable Appliances: A Case Report. J Esthet Restor Dent. 2009; 21(5):304–316. 24. Higashi C, Loguercio A, Reis A. Re-anatomization of Anterior Eroded Teeth by Stratification with Direct Composite Resin. J Esthet Restor Dent. 21:304– 317, 2009. 25. Alvesalo L., Portin P. The inheritance pattern of miss- ing, peg–shaped, and strongly mesio-distally reduced upper lateral incisors. Dental Aktie- selskabet. 1969; 18(6):563–575. 26. Meskin L.H., Gorlin R.J. Agen- esis and peg-shaped perma- nent maxillary lateral incisors. J Dent Res 1969; 27:563–573. Fig. 7: Pre-operative peg-lateral incisor. Fig. 8: Postoperative.