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ePaper created 2015-03-10, 11:16:47 | version 1.33.01
44 — issue 1/2015 Aesthetic and Restorative Dentistry Article which results from an underlying orthog- nathic deviation (dental arches and smile are not aligned with the face) which the patient refused to treat. A computer as- sisted smile analysis was performed with extra-andintra-oralphotographs,manip- ulated and altered with PowerPoint Soft- ware(Microsoft).10Theremainingesthetic deficiencies following orthodontic treat- ment could be better identified and the resulting treatment planning was ex- plained to the patient (Figs. 3c and d). Thefollowingestheticabnormalitieswereto be corrected: Tooth axis (upper laterals and canines). Tooth forms (upper centrals, canines and lower incisors). Tooth color (upper canines). Gingival profile (upper premolars). It was agreed with the patient to conduct the gingival profile correction for upper first premolars at a later stage. With the first case, all adhesive and restorative procedures were performed under rubber dam to optimize the quality and longevity of the restorations. The same composite system was used (in- spiro), based on a bi-laminar approach (bodyandskinshades = dentinandenamel shades) to emulate the natural tooth anatomy and the optical characteristics. The body shade (inspiro i2) was used only for the canines (transformed into laterals incisors), to block the light and translu- cency within the large preexisting incisal embrasures. For central incisors (axis and mesio-distal width corrections), only an enamel shade was used (inspiro skin white &ivory)asthetotallayerthicknessdidnot exceed 1 to 1.25mm, which is the natural enamelthickness.Pre-contouredmatrixes helpedtoobtainnaturalproximalcontours and emergence profile (Lucifix 775 & 776, Kerr). Finishing and polishing procedures were identical to those used for the case.1 Postoperative views (Figs. 4e and 5) demonstrate improved intra-oral and extra-oral smile integration, although the dento-facial asymmetrycould not be cor- rected through restorative procedures. Thistreatmentapproachisconsideredop- timal for young patients showing notice- ableestheticdeficiencies,ofanotherwise perfectly healthy dentition. Discussion–conclusion The natural layering concept has enabled patient’s aesthetic expectationsto beful- filledinapredictableway,byincorporating new knowledge about natural tissue opti- cal properties into a new restorative ap- proach for direct, freehand restorations. It allowed a significant simplification of clinicalprocedures,makingthistechnique accessibletogeneralpractitionersaswell. This advance can be regarded as a mile- stone in operative dentistry, giving a new input to freehand bonding and helping morepatientstoreceiveconservativeand highly aesthetic restorations. Fig.1b Fig.1d Fig.1f Fig.1c Fig.1e Fig.1g Figs. 1b–g Intra-operative view of the case appearing on the cover page; direct composite veneers were made of 2 only layers (dentin & enamel), with apposition of some blue & white effect shades (inspiro, Edelweiss DR) following the Natural Layering Concept (NLC). Figs. 1b–c Post-finishing using a fine diamond bur (flame shape) and silicone pre-polishers. Figs. 1c–g Polished restorations before rubber dam removal and after functional adjustments.