cosmetic dentistry_ beauty & science

case report _ direct restorative procedures I for a direct composite restoration, provided that a tooth-whitening procedure could be success- fully completed. Along the spectrum of possible treatments, this approach is located between “conventional” composite restoration and ceramic veneering and, therefore, appeared to be clinically appropriate. The patient, whose primary concerns were a natural tooth shade and minimal loss of tooth structure, agreed to the recommended procedure. We decided to use the nano-hybrid composite IPS Empress Direct (Ivoclar Vivadent) to fabricate the restorations.Inadditiontodentineandenamelma- terials,thisproductisalsoavailableinanopalescent material version. _Preliminary treatment First, internal bleaching was performed on the tooth, on which the success of treatment would depend. Access to the endodontic chamber was created through the old restoration. The gutta- percha increment was removed up to 3 mm below the cemento-dentinal junction. At the bottom of the cavity, a plug with a thickness of 2 mm made of glass ionomer cement was inserted to prevent the bleaching agent from accessing the sensitive areas. We used a mixture of sodium perborate and distilled water for the bleaching procedure. The access to the cavity was then sealed with a temporary material. Since the desired tooth shade was not achieved upon initial bleaching, the entire procedure had to be repeated after one week. After another week, the result was finally optimal (Fig. 3). In order to neu- tralise the bleaching agent, calcium hydroxide was placedintothecavityandleftinplaceforatleastone week.(Anadhesivemayonlybeapplied15daysafter conclusion of the bleaching procedure, in order to ensure optimum adhesion and stable shade.) _Aesthetic diagnosis and shade determination After tooth-shape analysis, we concluded that the proportions were harmonious compared with tooth #21. In order to avoid a misinterpretation of the shade owing to dry adjacent teeth, the tooth shade was determined prior to any intervention and in daylight. The IPS Empress Direct shade guide was used for the determination of the enamel and dentine materials. We determined the dentine shade based on the cervical third and the enamel material based on the incisal third of the adjacent tooth. Particular attention was paid to the anatom- ical structure of the adjacent tooth and the various opalescent reflections visible on the incisal surface, since it was our aim to imitate these features. A layering diagram detailing all the materials that we planned to use was prepared. In this case, only four shades were used: A3/A2 Dentin, A2 Enamel and Trans Opal. Fig. 5_Creating the palatal wall with enamel material (A2 Enamel). Fig. 6_Designing the proximal area and the transition lines. Fig. 7_Building up the palatal and proximal areas, or transforming a complex preparation into a simple one. Fig. 8_Application of dentine material in shade A3. I 23cosmeticdentistry 2_2013 Fig. 7 Fig. 8 Fig. 5 Fig. 6