cosmetic dentistry_ beauty & science International

10 I I special _ MiCD Controlofcontributingfactors Aspartofthepatient’sMiCDtreatmentplanning, all factors contributing to the aesthetic dis-ease must be addressed. Contributing factors can be divided into those that increase risk (predisposing), cause the onset (precipitating) or enhance the pro- gression (perpetuating) of the problem. Sleep brux- ism, malocclusion and the loss of posterior tooth support (leading to occlusal trauma to the remain- ing teeth or restorations) were significant issues for the patient concerned. The contributing factors and their treatment implications were discussed in depth. The need for posterior support and future protection with a stabilisation splint was high- lighted and the provisional treatment plan was formulated. Curativeandleastinvasivemanagementofdisease orpathologicaleffects Treatment according to the MiCD approach was undertaken in consultation with the patient in view of time and cost constraints. Bonding was done to close the spaces between her upper central incisors andcaninesanddirectveneerswereusedtomodify theshapeofhercaninesintolateralincisors(Figs.4a & b). The restorations were achieved using giomer restoratives (Beautifil II and Beautifil Flow) and the flowable frame technique.13 Some minor aesthetic recontouring was also done to the right central incisor. Impressions were made after restoration placement in preparation of an immediate denture replacing all the patient’s missingposteriorteethandthefracturedupperfirst premolars. The patient was also informed of the possibilityofimplants(withsinusliftandboneaug- mentation), should a fixed option be desired later. The need for conventional crown therapy should the bonded restorations not be durable was also discussed. Assessmentandmonitoringofinterventionoutcome A follow-up appointment for the seating of the immediate denture was scheduled but the patient didnotattendherappointment.Shewasveryhappy with the aesthetic outcome and only returned when her bonded restorations failed a few months later (Fig. 5). The lack of posterior tooth support and high occlusalstressessecondarytosleepbruxismresulted in the failure of the bonded restorations. The latter could have been avoided if an upper stabilisation splint had been worn during sleep. Assessment and monitoring of intervention outcome is extremely important when OD is present. If teeth fracture and wear down, restorations will perform no better un- less all contributing factors are addressed. _Conclusion MiCD aims to correct aesthetic dis-ease and fulfil patients’ aesthetic desires and demands throughconservativeandminimallyinvasivetreat- ment. Generic minimum intervention principles were proposed for all oral diseases including aes- thetic dis-ease caused by genetic or developmental anomalies, infection agents and/or environmental factors. These were: _early detection and diagnosis of disease; _control of contributing factors; _curativeandleastinvasivemanagementofdisease or pathological effects; and _assessment and monitoring of intervention out- come. Thetenetswereemployedinacasestudyinwhich giomer restoratives were used. The latter are the most recent category of glass ionomer–composite hybrid restorative materials. They are particularly useful for MiCD procedures in view of their good aesthetics, handling and anti-caries properties._ _References 1. TyasMJ,AnusaviceKJ,FrenckenJE,MountGJ.Minimal intervention dentistry—a review. FDI Commission Project 1–97. Int Dent J 2000;50(1):1–12. 2. Koirala S. Minimally invasive cosmetic dentistry— Concept and treatment protocol. Cosmetic Dent 2009;4:28–33. 3. Mickenautsch S, Tyas MJ, Yengopal V, Oliveira LB, Bönecker M. Absence of carious lesions at margins of glass ionomer cement (GIC) and resin-modified GIC restorations: A systemic review. Eur J Prosthodont Rest Dent 2010;18(3);139–45. 4. Yap AU, Tham SY, Zhu LY, Lee HK. Short-term fluoride release from various aesthetic restorative materials. Oper Dent 2002;27(3):259–65. Fig. 5_Fractured direct veneers on the upper canines. cosmeticdentistry 3_2011 Fig. 5