Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-08-28, 13:01:48 | version 1.38.0
18 I I case report _ adhesive restorations cosmeticdentistry 2_2015 _Introduction The use of ceramics in the form of veneers or crowns was, for a long time, considered the only satisfactory and durable solution to the aesthetic deficiencies of the smile, in young as well as adult patients.Thishegemonyofceramicswhich,forthat matter tends to linger, is favored by the dental in- dustrythatinvestssignificantamountsofmoneyto promote its materials and new technologies, with- out always showing a lot of consideration for the biomechanics of the healthy tooth. The sheer aesthetic criteria must, therefore, be weighed against the biological and mechanical fundamentalprinciplesofthenaturaltoothinorder to ensure the longevity of the restorations on one hand, and preserve the vitality and the integrity of the dental organ on the other hand. Thus, these considerationshavebeenencouragingusforalong timetoconsiderdirectbondingtechniquesasafirst choice alternative for the treatment of aesthetics deficiencies of the young smile especially, and in general, every time the extent of the defects allows it.1–6 The improvement of the aesthetic properties of restorativecompositematerialsbasedonthemodel ofthenaturaltooth5–9,alsopermittedtomakedirect restorations available to everyone, since they are nolongertheprerogativeofgiftedclinicianstrained tocomplexstratificationtechniques,inaccessibleto the general practitioner. Indeed, several systems have been developed duringthesepasttenyears,buildingonthe‘Natural Layering Concept’, consisting of only two basic layers (dentin and enamel) and an appropriate shade guide. The clinical protocols logically fol- lowed a simplification and an increase in reliability, which bodes well for our profession, always under economic pressure. Moreover, clinical results in the mediumandlongtermabouttheuseofdirectcom- positeasanaestheticcorrectionmaterial,provedto be reliable.10–12 The goal of this article is, therefore, topresenttwoclinicalcasesthatillustratethedirect therapeuticapproachandtheaestheticpotentialof composite systems based on the ‘Natural Layering Concept’. _Clinical cases Case1—Diastemaclosure This first case presents a simple application of direct bonding for diastema closure in a young pa- tient also showing a dark dentin shade, as well as a mild fluorosis especially visible on incisal edges and canine tips (Fig.1). Given the age of the patient (15yearsold),itwasdecidednottotreatthefluoro- sis, which would have made whitening necessary, but also critical in view of the risks of sensitivity (Figs. 1–4). The treatment was carried out under rubber dam to ensure the quality of the bonding in theproximalareas,juxta-gingivalandalsoforsafety andcomfortofwork.Theenamelsurfaceswereonly prepared by sandblasting (aluminum oxide 25 μm) before phosphoric acid etching (H3PO4 35–37 %) for 45–60 seconds, given the fluorosis. The bonding procedure was carried out with a multicomponent system (OptiBond FL, Kerr) before the direct ap- plication of the composite in two layers, plus the application of an effect shade (inspiro system, EdelweissDR). The stratification started with a layer of den- tin (Body i3, inspiro) on the distal surfaces of the upper lateral incisors and on the mesial face of therightcanine.Asemi-opaquewhiteeffectshade (Ice, inspiro) applied on the dentin layer enabled to imitate the fluorosis stains and to improve the restoration mimicry; (Figs. 5 & 6). A layer of enamel (Skin White, inspiro) allowed to com- plete the restorations and perfect their aesthetic integration. The ‘Natural Layering Concept’ was followed to carry out this treatment, based on a bi-laminar application of the composite and ‘No-Prep’adhesive restorations: another way to deal with aesthetic deficiencies Author_Dr Didier Dietschi, Switzerland