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Dental Tribune Middle East & Africa No. 4, 2016

Dental Tribune Middle East & Africa Edition | 4/2016 25 general dentistry Before treatment anteriors Smileat endof treatment Before treatment left side Left sidesmileat endof treatment Afterposteriorocclusalbuildupchin-upview After retraction and alignment of anterior teethchin-upview case where there is no labial enamel erosion or thinning, ceramics are very much a second choice material since veneering or crowning necessi- tatesenamelpreparationtogetgood margins for the technician to work to in order to avoid over-contouring the restorations. In addition, crown- ing would have made reliable acid etch bonding of a retention wire im- possible on the palatal side and mac- ro-retention grooves in the palatal ceramic surface would necessitate more aggressive palato-incisal prep- arationtomakesufficientspacesoas not to weaken the ceramic. Ceramic veneers would fare no better as their palatal margins would be right on the line of the bonded retainer and the bonding footprint for the wire to enamel would be much reduced, bothincreasingchancesoffailure. AndrewWakefieldBDSLDSRCSisageneraldentalpractitioner workingat ApollineHouseDentalPracticeinNortheast London. ◊Page24 AndrewWakefield took “TheNewConcept ofAlignment BleachingandBondingcourse” withIASAcademyinLondon2014andsince thenhascompleted over40InmanAlignercases. The flexural strength of an incisor comes primarily from the labial and the palatal enamel 3 which was left intactinthiscase.Highstrengthcom- posite bonded over both the unpre- pared labial and palatal enamel sur- facesgaveanoptimalbiomechanical result as the flexural strength of the incisors will have been substantially increased. This should reduce the chances of marginal breakdown of the composite in the long term. To further reduce flexural stresses on the upper incisors, the small ledge created by the bonded wire acts as a vertical stop for the lower incisors to occlude against, favourably trans- mitting forces down the vertical axis ofeachtooth2. The psychological impact of the treatment has been substantial. There was a total transformation of his appearance and smile, with a noticeable effect upon the patient’s self-confidence. The patient’s identi- cal twin has followed his brother’s treatment closely and it is looking like I might need to repeat the pro- cess all over again! If not, we have a good ‘control’ subject for the future in order to observe what might have happened had my patient not had thistreatment. References 1. Mizrahi, B. 2004. A technique for Simple and Aesthetic Treatment of Anterior Toothwear. Dental Update (31)109-114 The full list of references available fromthepublisher Dental Tribune Middle East & Africa Edition | 4/201625

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