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ePaper created 2017-05-10, 09:20:47 | version 1.38.0
case report _ aesthetic and restorative dentistry Figs. 2o-q_Smile and occlusal views of this full-mouth rehabilitation, using only direct restorations. Such an approach is highly conservative, comfortable for the patient owing to the short treatment time, and cost- effective. Fig. 2o diate tissue loss or destruction.13-16 Among the benefits of a direct composite restoration are its highly conservative approach, the ability to replace or reshape small portions of the tooth, reparability, simplified replacement and relatively limited cost (Fig. 2). Conversely, it is more tech- nique sensitive and might result in thin layers of material over some surfaces, placing them me- chanically at risk. When using a sculpting tech- nique, proper anatomy can be created also with a direct technique, favouring the selection of a highly filled material with a firm consistency.27-29 In the case illustrating this treatment modality, a highly filled homogenous nanohybrid material (inspiro, Edelweiss DR) was used owing to its firm consistency, favourable for free-hand sculpting and modelling (Figs. 2f-l). _Indirect composite option The indirect option is logically preferred when larger restorations or tissue destruction of a greater severity is present. It also provides greater control of the anatomy and occlusion in complex or advanced cases. Nevertheless, one should not neglect the direct option only in fa- vour of this last parameter, as occlusion seems not to play a major role in the origin of parafunc- tion.4,5,30-32 Since direct and indirect techniques can be used together to treat the same patient, when indirect restorations are chosen, they have to be fabricated first, at the new VDO, and then direct composites placed. _Material selection Today, the debate about whether ceramics or composite is best indicated for such restorations is some- times based on personal experience and belief, rather than on scientific or clinical evidence. The rather abundant clinical literature dealing with the clinical behaviour of composite _Direct composite option The direct composite option is logically in- dicated for all forms of moderate to interme- Fig. 2p Fig. 2q 18 cosmetic dentistry 2_2017