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ePaper created 2016-01-08, 09:25:11 | version 1.38.0
I case report Fig. 17_Etching of enamel with laser at the lateral surfaces of the teeth to be restored with composite resin and around a Class V cavity on tooth #13. Fig. 18_Additional acid etching was performed on enamel. Fig. 19_Final frontal view of restored teeth. Fig. 20_Final palatinal view of restored diastemas. Fig. 21_Final right side view. restorations; appropriate tooth proportions were cal- culatedandcheckedwiththegoldenproportionstool, which can simultaneously define the width of central incisors in comparison to the lateral incisors, or the width of the laterals in comparison to the canines (Fig.15).Thisgivesanideaoftheidealplacementofthe composite resin regarding its placement at the proxi- malareaoftwoneighboringteethandhowmanymil- limetersofcompositeresinarerequiredformesialand distal closure of a specific diastema. During this plan- ning, the difference in facial and dental mid-line was also considered (Fig. 1) in order to achieve an even re- sult. Priortoaestheticrehabilitation,carieson#13was removed using an Er,Cr:YSGG laser (2.780nm, Water- lase MD, Biolase, USA, Fig. 16). Average output power was set to 6W, with a pulse duration of 140µsec (H-Mode)andapulserepetitionrateof15Hzusingan MZ6tipunderwaterspray(Air:50%–Water:80%).All margins and enamel were etched with the same laser device (Fig. 17). Power settings for bond preparation were(MZ6tip,averageoutputpower4,5W,pulserep- etitionrate50Hz,H-mode). Restorativeproceduretookplacefree-handedlyaf- ter placement of a rubber dam. Enamel was addition- allyetchedwith37%phosphoricacidwhilethemesial surfaceofthePFMcrownwasetchedwith9%hydro- fluoric acid (Fig. 18). Thus, resin composite bond to enamel will benefit both from laser etching and from acid etching. Starting from the central incisors, di- astemas were closed using a single composite resin shade(A3Shade,Beautifil,SHOFUInc),firstpalatinally and then bucally. It was decided to use a single com- posite shade, as teeth presented high color saturation andnoprominenttranslucencyorspecialcharacteris- tics.Specialattentionwasgiventotheproximaltransi- tion lines in order to create the illusion of narrower teeth.Microstructurewascreatedafterpolishingwith fine and ultra-fine diamond burs, with decreasing roughnessofpolishingdiscs,siliconpointsandbrushes coated with diamond paste for the final gloss. The in- cisal plane could not be evened, despite the patient’s wish, due to occlusional restraints. Final adjustments were made during polishing at the proximal curvature andattheincisalplane,toenhancethenatural-looking effect.ThefinaloutcomeisshownatFig.19bucallyand Fig. 20 palatinally. Side photographs were also taken (Figs.21and22).Notethat,inordertogaininaesthet- ics, the diastema between #11–12 was decided not to be fully restored (Fig. 21). Otherwise, we would end up with very wide central or lateral incisors, which would compromisethefinalaestheticresult.Atthesameap- pointment, lower jaw bleaching was performed, with the same procedure described above. Fluoride gel was then applied at the end of the treatment at the dem- ineralisedareasaroundthebrackets,inthebuccalsur- faces of 11, 12 and 21. Patient recall was at seven days post-op(Fig.23). _Results The aesthetic rehabilitation of this complex case was completely performed with the use of an Er,Cr:YSGG laser. Laser treatment was performed 18 I laser4_2015 Fig. 19 Fig. 21Fig. 20 Fig. 17 Fig. 18