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cosmetic dentistry_ beauty & science

20 I I case report _ adhesive restorations the dentine and enamel shades, accurately imi- tating optical characteristics of the natural tissues (Figs. 7–11). Case2—Extensivereconstructionofthesmile The second case presents a more extensive and complex application of direct bonding, but never- theless based on the same clinical protocol. This case concerned a 17-year-old patient showing a hypodontia of the four upper incisors and also a generalised mild to moderate fluorosis (Type III according to the classification of Thilstrup and Fejerskov) (Figs. 12 & 13). A preliminary orthodon- tic consultation had led to the recommendation of an essentially restorative solution to this problem. Inaddition,therelativecomplexityofthiscasesug- gested the preparation of a diagnostic wax-up and a guided intraoral mock-up in order to confirm the therapeutic choice and allow an aesthetic preview (Figs. 14 & 15). The treatment was also realised under a rubber dam, using mainly interdental matrix, a silicone key and a caliper for the control of the new dimensions anddentalproportions(Figs.16&17).Thereconsti- tutions were carried out by applying three shades like for the first case (dentin: Body i2, effect shade: Azur, enamel: Skin White, inspiro) (Figs. 18 & 19). The treatment was performed over two clinical sessions for comfort reasons. Figures 20 and 21 summarise the positive aesthetic impact of the treatment, as well as the stability of the result two years later (Fig. 22). Thedifferencebetweenthetwocasesillustrating the versatility of bonding lies essentially in the diagnosticphase,whichwasmorethoroughforthe second treatment. _Reliable and aesthetic results The use of direct composites has thus become unavoidable in aesthetic dentistry in almost every treatment of the young smile and during aesthetic transformations of no or little restored teeth. This is a very positive evolution of conservative dentistry, supportedbytheaestheticimprovementofthema- terials and the simplification of clinical protocols. This article summarises the indications and ad- vantages of the concept of the ‘Natural Layering Concept’ to reliable and highly aesthetic results. _Figs. 1–4 Preoperativeextraandintraoralviewsofayoung patient showing bilateral diastemas, complicated by a mild fluorosis. _Figs. 5 & 6 A direct approach has naturally been followed in this case, the restorations include a dentin shade (Body i3), an effect shade (Ice) and an enamel (Skin White, inspiro). _Figs. 7 & 8 Final intraoral views showing the good integra- tion of the restorations. cosmeticdentistry 2_2015 Fig. 11 Fig. 10 Fig. 9

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