Dental Tribune Middle East & Africa Edition | 5/2021 ORTHO TRIBUNE D3 ◊Page D2 Fig. 4a: A 16-year-old patient completed orthodontic space closure after the traumatic loss of the maxillary right lateral and maxillary central incisors. Apart from the numerous aesthetic and anatomical discrepan- cies, gingival hyperplasia required some correction before initiating the restorative corrections. Fig. 4b: Postsurgical view after gingivectomy and a slight reduction of the cervical diameter of both canines. Fig. 4c: Try-in of the mock-up enabled selection of the right anterior tooth length and display. Fig. 4d: Intra-op view showing the application of the body shade (den- tine) and the incisal build-up of the incisors with enamel, using an index replicating the mock-up configuration (inspiro Body i2 and Skin White, Edelweiss DR). Figs. 4e & f: Post-op views showing the significant improvement of the tooth anatomy and anterior inter-arch relationship, although such a treatment approach implies intrinsically some compromises related to tooth diameter, proportions and gingival profile. AD canines have to be moved into the positions of the lateral incisors, there is usually a space discrepancy. In this situation, the careful reduction of canine diameter and palatal volume will improve the inter-arch relation- ship as well as reconstructive proce- dures (Figs. 4a & b). The ratio of the root diameter to the crown diameter will dictate the amount of tissue that can be removed interproximally, provided that corrections can be made entirely in enamel to avoid dentine exposition or root proxim- ity. Whitening A problem of tooth colour often aris- es when the canines are in a more mesial position. These teeth present with a more saturated colour (nor- mally, a similar hue but a higher chroma) compared with that of inci- sors (Figs. 3a & c). After the required odontoplasty has been performed, colour correction should be tried, using one of the available whitening techniques for vital teeth, namely chairside whitening or home whit- ening.6–8 Direct composite bonding Modern composite resin kits pro- vide very performant restorative materials. Besides the dramatic im- provements made in their physico- chemical properties, modern com- posites have satisfactory colour stability and aesthetic potential.11–13 Among the various layering op- tions, the which became the refer- ence in reliability and simplicity is the natural layering concept, which corresponds to a bilaminar, ana- tomical application of dentine- and enamel- like shades which closely emulate natural hard tissue. When forms or dimensions have to be only slightly modified, a mono- laminar approach can be followed, using an enamel shade (achromatic) exclusively (Figs. 3a & d). For larger corrections, the bilaminar approach with dentine and enamel masses is to be applied (Figs. 3d & 4d–f; e.g. inspiro, Edelweiss DR). Gingival and periodontal recon- touring In many circumstances, gingival recontouring is indicated to correct minor defects of soft-tissue con- tours or to modify the clinical crown length. This can be achieved using electrosurgery, laser or traditional surgery (Fig. 4b), provided the pro- cedures respect the biological width and do not result in an excessive loss of keratinised gingiva. Conclusion The two basic therapeutic approach- es for the replacement of anterior teeth in young patients are space clo- sure or maintenance, which require orthodontic or prosthodontic pro- cedures, respectively, to be applied. To satisfy new demands regarding tissue conservation, function and aesthetics, treatment decision pa- rameters have to be redefined. An extended list of general, local and secondary parameters have now to be taken into consideration to pro- pose the best available solution to the patient. The most common problems after teeth have been orthodontically transposed are unusual function, shape, dimension and colour or de- ficient periodontal integration while with prosthetically replaced miss- ing teeth, long-term maintenance will be critical, including implant- supported restorations. This article has also presented clinical outcomes demonstrating the benefits and pos- itive impact of direct composite ap- plication to improve aesthetics and function after orthodontic space closure. Editorial note: This article was first published in the September 2016 issue of the Italian Journal of Dental Medi- cine, and an edited version is provided here with permission from “il dentista moderno”. 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About the author Dr Didier Dietschi Dr Dietschhi is a senior lecturer in the Division of Cariology and Endodontology of the section of dental medicine at the University of Geneva in Switzerland and an adjunct professor in the Department of Comprehensive Care at Case Western Reserve University School of Dental Medi- cine in Cleveland in the US. He also runs a private education centre in Switzerland and is in private practice at the Geneva Smile Center.