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ePaper created 2015-12-03, 09:53:15 | version 1.38.0
dentistry 4_2015 cosmetic26 case report _ adhesive restorations natural tooth in order to ensure the longevity of the restorations on one hand, and preserve the vitality and the integrity of the dental or- gan on the other hand. Thus, these consider- ations have been encouraging us for a long time to consider direct bonding techniques as a first choice alternative for the treatment of aesthetics deficiencies of the young smile es- pecially, and in general, every time the extent of the defects allows it.1–6 The improvement of the aesthetic proper- ties of restorative composite materials based on the model of the natural tooth5-9 , also per- mitted to make direct restorations available to everyone, since they are no longer the pre- rogative of gifted clinicians trained to com- plex stratification techniques, inaccessible to the general practitioner. Indeed, several systems have been devel- oped during these past ten years, building on the “Natural Layering Concept”, consisting of only two basic layers (dentin and enamel) and an appropriate shade guide. The clinical protocols logically followed a simplification and an increase in reliability, which bodes well for our profession, always under eco- nomic pressure. Moreover, clinical results in the medium and long term about the use of direct composite as an aesthetic correction material, proved to be reliable.10–12 The goal of this article is, therefore, to present two clinical cases that illustrate the direct ther- apeutic approach and the aesthetic potential of composite systems based on the “Natural Layering Concept”. _Clinical cases _Case 1 – Diastema closure This first case presents a simple applica- tion of direct bonding for diastema closure in a young patient 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 (15 years old), it was decided not to treat the fluorosis, which would have made whitening necessary, but also critical in view of the risks of sensi- tivity (Figs. 1–4). The treatment was carried out under rubber dam to ensure the quality of the bonding in the proximal areas, juxta-gin- gival and also for safety and comfort of work. The enamel surfaces were only 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) 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 integration of the restorations. Fig. 5 Fig. 7 Fig. 6 Fig. 8