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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
SMILE REHABILITATION — A direct therapeutic approach assisted by digital diagnosis and mock-up Dr. Didier Dietschi, Switzerland A successful rehabilitation in the esthetic zone depends on criteria that are well- known today, and the use of a direct tech- nique is not an exception to the rule. On the contrary, a general approach without preparation—or at least an ultraconserva- tive approach (reshaping the enamel or preparing a cavosurface bevel if neces- sary)—might even add a hint of additional complexity. As a reminder, the most impor tant parameters that must be con- sidered are the following: – the integration of the shape (teeth in relation to the smile and the face) and implicitly its impact on function; – the shade in the broad sense (in relation to the tissue and the adjacent teeth), encompassing mainly the color, the lumi nosity/translucency, the chroma, the opalescence and the fluorescence; – the surface micromorphology and the luster of the restorative material; and – the biological, functional and esthetic continuity of the restorations. When considering a rehabilitation in young patients, who often need profes- sional dental care from their teenage years, the direct technique is most fre- quently required because of the anatom- ical and functional immaturity of the dental arches. The procedure should in- clude the use of a material or technique that will make possible the necessary ad- justments and modifications resulting from the ongoing bio-functional dental development of the patient. Among the criteria to be considered when selecting the composite system, the material strength and its ease of use should be pri- oritized in order to achieve an optimal esthetic result. The layering technique must therefore be efective and simple; in other words, it is futile to perform com- plicated multilayering methods in the daily practice and there is a definite ad- vantage to using products that are based on the Natural Layering Concept (e.g., inspiro, Edelweiss DR; Miris, Coltène/ Whaledent; Essentia, GC; Enamel HRi, Micerium). This article will highlight the advantages of this technique that, as its name suggests, makes use of the anatom- ical characteristics of the natural tooth (contour, volume and thickness of the dentin and enamel). This significantly sim- plifies the clinician’s work, provided it is associated with functional and esthetic planning tools, as described next. Once the choice of therapeutic ap- proach and restorative system has been confirmed, it is very important to develop a comprehensive esthetic and functional plan in order to improve the communica- tion with the patient and to help the den- tist to elaborate his or her restorative and layering techniques if needed. Nowadays, simplified approaches are available, com- pared with the conventional wax-up and hand-fabricated acrylic mock-ups; indeed, digital imaging and even programming tools of numerous CAD/CAM systems (e.g., CEREC, Dentsply Sirona) ofer in- novative solutions, also outlined in this article.1, 2 A successful treatment, especially an esthetic treatment, relies on the imple- mentation of a standardized therapeutic approach and clinical protocol, including ideally any development aiming to make them more reliable and simpler. The es- thetic treatment plan using software tools (general software, dental software or a CAD/CAM system) has made a comeback and its use has become more prevalent, and is likely to remain so.1, 2 Besides a 16 — issue 2017 Esthetic and Restorative Dentistry Article legitimate concern of simplification and cost-efectiveness, the thrust of this ap- proach is to contextualize and allow the preview of the treatment during planning, before any procedure has been per- formed in the mouth. The advantage is twofold, both in terms of communication and prior acceptance of the result by the patient. Of course, sensitive situations with patients who had expected a result that is impossible to achieve with the ther- apeutic means at the clinician’s disposal should be avoided. With regard to the choice of restorative material, while also attempting to meet the multiple requirements related to the dental biomechanics, function and the esthetic aspects, the decision criteria should be redefined in light of the latest developments in composites and their longevity properties. A comprehensive perspective encompassing the long-term outcome of the tooth and its restoration should be explained to the patient in order to assist him or her in determining the most appropriate choice. Very often, the best way is to sacrifice the weakest tissue. Today, a basic approach involving the use of direct composite resins in addition to whitening and microabrasion would there- fore be a sensible approach for young patients in need of esthetic treatment, as highlighted in this article. In this area, a concept embracing both the shade and the layering has gradually established it- self as the most efective solution. Editorial note: A list of references is available from the publisher.