cosmetic dentistry_ beauty & science

I 21 special topic _ composite restorations I cosmeticdentistry 1_2013 placed horizontally along the incisal edge of the enamel shelf. Fig. 10_The final enamel resin layer contoured and smoothed with a brush. Fig. 11_Completed composite restoration immediately after finishing and polishing. Figs. 12 & 13_The same steps followed during reconstruction of the left lateral incisor. Figs. 14–16_Post-op view after 30 days demonstrating favourable integration of the form and colour of the restored teeth. Figs. 17 & 20_Gingival contour of conoid lateral incisors translocated coronal to the zenith of the canine and central incisor. Fig. 18_Recontoured gingiva with retraction cord inserted. Figs. 19 & 21_Very good gingival response to the polished restorations at four-week follow-up visits. increments of enamel-shade resin. Creating a lingual shelf in this manner left room for the sub- sequent dentine layering (Fig. 7). The appropriate dentine-shade resin was then applied in order to create distal and mesial lobes. These were light cured for ten seconds (Fig. 8). Dentine in a darker shade was placed onto the cervical third. Prior to light curing, the white strip was painted horizontally along the incisal edge of the enamel shelf using a white tint and smooth brush (Fig. 9). Finally, an enamel resin layer was placed, contoured, smoothed with a brush and light cured (Fig. 10). After completion of composite applications and polymerisation, fine flame-tipped finishing diamond burs and Sof-Lex discs (3M ESPE) were used for gross contouring and creating tex- ture. The final polish was achieved using rubber finishers, a brush, a felt wheel and a paste kit (Fig. 11). The same procedures were followed during reconstruction of the left lateral incisor (Figs. 12 & 13). Figures 14 to 16 show the situation 30 days post-operatively. The lateral incisors show favourable integration of form and colour as achieved through the direct composite resin restoration procedure. Adequate contours and proportions create a smile with harmonious sym- metry and a natural appearance. Some cases present with conoid lateral in- cisors displaying a lack of gingival harmony, as were the cases with those patients (Figs. 17 & 20). This usually manifests as the translocation of the gingival contour coronal to the zenith of the canine and the central incisor. Such a clinical situation requires gingival recontouring before direct restoration. In presented cases, the recontouring proce- dure was carried out using a Soft Tissue Trimmer bur (Edenta). Modifications were limited by the patientsbiologicwidth.Asobservedatfour-week follow-up visits, there was a very good gingival response to the polished restorations (Figs. 19 & 21). _Conclusion Conoid lateral incisors are not uncommon. Theymaybefoundunilaterallyorbilaterally.Their poorappearancecanspoilanotherwiseattractive smile. The case presented describes a minimally invasive way of addressing this problem using direct composite bonding. The step-by-step images illustrate how den- tists can solve this cosmetic issue without using aggressive techniques and with the advantage of being in full control of shade matching and characterisation._ Dr Monika Marciniak graduated from the Medical University of Białystok in Poland in 1992,and runs a private practice with her husband.She has been publishing articles on direct composite restorations since 2007.She is a member of the European Society of Cosmetic Dentistry. Dr Monika Marciniak Ul.Staffa 20A 18-400 Łom˝a Poland dentystamarciniak@dentonet.pl _about the author cosmeticdentistry Fig. 20 Fig. 21Fig. 19