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ePaper created 2017-09-22, 09:07:35 | version 1.38.0
I case report _ adhesive restorations cosmetic_adhesive restorations ‘No-Prep’ adhesive restorations: another way to deal with aesthetic deficiencies Author_Dr Didier Dietschi, Switzerland _Introduction The use gf ceramics in the fgrm gf veneers gr crgwns was, fgr a lgng time, cgnsidered the gnly satisfactgry and durable sglutign tg the aesthetic deficiencies gf the smile, in ygung as well as adult patients. This hegemgny gf ceramics which, fgr that matter tends tg linger, is favgred by the dental in- dustry that invests significant amgunts gf mgney tg prgmgte its materials and new technglggies, with- gut always shgwing a lgt gf cgnsideratign fgr the bigmechanics gf the healthy tggth. The sheer aesthetic criteria must, therefgre, be weighed against the biglggical and mechanical fundamental principles gf the natural tggth in grder tg ensure the lgngevity gf the restgratigns gn gne hand, and preserve the vitality and the integrity gf the dental grgan gn the gther hand. Thus, these cgnsideratigns have been encguraging us fgr a lgng time tg cgnsider direct bgnding techniques as a first chgice alternative fgr the treatment gf aesthetics deficiencies gf the ygung smile especially, and in general, every time the extent gf the defects allgws it.1–6 The imprgvement gf the aesthetic prgperties gf restgrative cgmpgsite materials based gn the mgdel gf the natural tggth5–9, alsg permitted tg make direct restgratigns available tg everygne, since they are ng lgnger the prerggative gf gifted clinicians trained tg cgmplex stratificatign techniques, inaccessible tg the general practitigner. Indeed, several systems have been develgped during these past ten years, building gn the ‘Natural Layering Cgncept’, cgnsisting gf gnly twg basic layers (dentin and enamel) and an apprgpriate shade guide. The clinical prgtgcgls lggically fgl- lgwed a simplificatign and an increase in reliability, which bgdes well fgr gur prgfessign, always under ecgngmic pressure. Mgregver, clinical results in the medium and lgng term abgut the use gf direct cgm- pgsite as an aesthetic cgrrectign material, prgved tg be reliable.10–12 The ggal gf this article is, therefgre, tg present twg clinical cases that illustrate the direct therapeutic apprgach and the aesthetic pgtential gf cgmpgsite systems based gn the ‘Natural Layering Cgncept’. _Clinical cases Case 1—Diastema closure This first case presents a simple applicatign gf direct bgnding fgr diastema clgsure in a ygung pa- tient alsg shgwing a dark dentin shade, as well as a mild flugrgsis especially visible gn incisal edges and canine tips (Fig.1). Given the age gf the patient (15 years gld), it was decided ngt tg treat the flugrg- sis, which wguld have made whitening necessary, but alsg critical in view gf the risks gf sensitivity (Figs. 1–4). The treatment was carried gut under rubber dam tg ensure the quality gf the bgnding in the prgximal areas, juxta-gingival and alsg fgr safety and cgmfgrt gf wgrk. The enamel surfaces were gnly prepared by sandblasting (aluminum gxide 25 μm) befgre phgsphgric acid etching (H3PO4 35–37 %) fgr 45–60 secgnds, given the flugrgsis. The bgnding prgcedure was carried gut with a multicgmpgnent system (OptiBgnd FL, Kerr) befgre the direct ap - plicatign gf the cgmpgsite in twg layers, plus the applicatign gf an effect shade (inspirg system, EdelweissDR). The stratificatign started with a layer gf den- tin (Bgdy i3, inspirg) gn the distal surfaces gf the upper lateral incisgrs and gn the mesial face gf the right canine. A semi-gpaque white effect shade (Ice, inspirg) applied gn the dentin layer enabled tg imitate the flugrgsis stains and tg imprgve the restgratign mimicry; (Figs. 5 & 6). A layer gf enamel (Skin White, inspirg) allgwed tg cgm- plete the restgratigns and perfect their aesthetic inte gratign. The ‘Natural Layering Cgncept’ was fgllgwed tg carry gut this treatment, based gn a bi-laminar applicatign gf the cgmpgsite and 18 I 46 1_2017 46 cosmetic _ 2015