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ePaper created 2016-04-15, 11:34:57 | version 1.38.0
Dental TribuneAsia Pacific Edition | 9/201516 Case study A 28-year-old patient was re- ferred to our practice. He was dis- satisfied with the colour and posi- tion of the maxillary left lateral incisor (Fig. 1). The examination showed that tooth #22 had been endodontically treated, which ex- plained its substantial discoloura- tion.Theshadeoftheexistingcom- posite restoration considerably deviated from that of the natural tooth structure. In addition, the po- sition of tooth #22 contributed to thesuboptimaloverallappearance of the dentition. It was inclined to- wards the palatal aspect and there- fore looked very small compared withtheadjacentteeth.Thepatient desired an aesthetic result that could be achieved in one appoint- ment. This was the ideal indication for IPS Empress Direct. We suggested that the patient consider having the tooth restored withadirectcomposite.Thistypeof restoration would involve mini- mally invasive preparation and could be placed in a single appoint- ment.Thepatientacceptedthispro- posal, and we proceeded to prepare tooth#22foramodifiedveneerand to remove any discoloured dental tissue. In the process, as little as possible of the healthy tooth structure was ground. Since minimally invasive criteria were being followed, the existing composite restoration was not completely removed (Fig.2). The tooth was conditioned and a bond- ing agent was applied. Next, the dis- coloureddentinewasconcealedwith IPS Empress Direct Color in white. Thematerialwasappliedtothetooth surface in such a way that the resto- ration would not appear completely opaque (Fig. 3). The tooth surface was then entirely covered with IPS EmpressDirectinA2Dentin(Fig.4). In order to impart a lifelike ap- pearance to the incisal part of the tooth,weappliedIPSEmpressDirect inA2Enamelinlayersandimitated the enamel areas of the adjacent teeth. The natural incisors exhibited several dark incisal areas as a result of their relatively high translu- cency. These areas were imitated with IPS Empress Direct Color in blue. Owing to the thin enamel layer, the cervical areas of the nat- ural teeth had a yellowish tinge. This feature was recreated in tooth #22 using IPS Empress Direct Color inhoneyyellow(Fig.5).Theenamel layer was completed with IPS Empress Direct in A2 Enamel. This layerwasshapedwiththehelpofan ingenious contouring instrument called OptraSculpt Pad (Ivoclar Vivadent; Figs. 6 & 7). This instru- ment was used to form the final contours of the restoration. The foam pad attachments allow com- posites to be shaped quickly and without sticking. This instrument has become an indispensible tool in our daily work. Finally, a thin layerofIPSEmpressDirectinTrans Opal was applied and the restora- tion was shaped again with Optra- SculptPad.TheTransOpalmaterial allowed us to imitate the natural optical properties of the tooth sur- face. Subsequently, the restoration was polymerised according to the manufacturer’srecommendations. The excess material was re- moved with finishers and fine-grit diamond burs. The occlusion and function of the restoration were checked. The restoration was then polishedtoahigh-glossfinishwith silicone polishers and polishing discs in a few easy steps. The patient was thrilled with the new appearance of his anterior teeth (Fig. 8). The shape and shade of tooth #22 blended in smoothly with the existing teeth. The optical characteristics of the restoration were comparable to those of the naturaldentition.Twomonthsaf- ter the treatment, the patient re- turned to the practice for a recall appointment.Onthisoccasion,the restoration showed excellent inte- gration. Its shape and shade com- pletely fulfilled our expectations (Figs.9 & 10). Conclusion IPS Empress Direct is a nano-hy- bridcompositefordirectrestorative procedures. It features lifelike opac- ity, fluorescence and opalescence. Aesthetic anterior restorations can be skilfully created with the mate- rial in a very short time. Given the appropriate conditions, this mate- rial can be used to offer patients an adequatealternativetolaboratory- fabricated ceramic veneers. TRENDS&APPLICATIONS 1 2 3 1 2 3 www.coltene.com 002492 ENDO POWER COMING SOON! > Up to 700% higher fracture resistance > Specially hardened surface > Less filling required for treatment success HyFlex™ EDM CanalPro™ Syringe Fill Station GuttaFlow® bioseal with COLTENE innovations! > One-hand dosing > Thought-out design > Actively supports regeneration in the root canal > Excellent flow properties Extremely break- resistant file for quick preparation Electrical Dischar- ge Machining Bioactive obturation material Not just filling, but also healing! Stainless steel bottle holder with dosing mechanism AD Dr Ali H. Ozoglu is a dentist from Adana inTurkey. Hecanbecontac- tedataliozoglu@ yahoo.com DTAP0915_14-16_Ozoglu 08.09.15 09:36 Seite 2 123 DTAP0915_14-16_Ozoglu 08.09.1509:36 Seite 2