Marcelo Balsamo is a dentist and professor at Associacao Paulista de Cirurgioes Dentistas, APCD, Sao Paulo, Brazil.
When someone smiles, there are positive and negative aspects of the presentation of the teeth. Positive aspects are natural brightness, natural translucency, symmetry and a harmonious relationship of teeth and lips.
Negative aspects are discoloured teeth, broken symmetry and spaces. The latter are quite common, and the dentist plays an important role in the removal of these disturbances which impair a natural and aesthetic smile.
The photographs shown here describe a clinical problem which can be solved quickly and easily with the help of direct composites and a good finishing technique.
The first two photographs show a young woman with a diastema (fig 1) and small spaces in the anterior occlusion (fig 2, circled).
After shade selection (figs 3 and 4) the enamel surfaces were prepared for the application of a self-etching adhesive and the composite by roughening with a fine diamond (figs 5, 6 and 7). To confirm the shade selection, a small volume of composite can be light-cured on the tooth (fig 9).
A special matrix system was used to separate the incisors when closing the diastema (figs 10, 11 and 12). The matrix supports contouring and the preservation of the gingival papilla. After the placing of the matrix the self-etching adhesive Futurabond NR (VOCO) was applied (figs 13, 14).
The nanohybrid composite Grandio (VOCO) was chosen for the restoration. This system has good translucency and ideal resistance against chewing forces. In the first step, material of a higher colour saturation (A2) was applied in the cervical area (fig 15), A1 was chosen as the main shade. Then the main build-up was carried out with A1 (fig 16). Finally, a translucent area was created with the incisal shade (figure 17), the shade transitions were carefully homogenised with a small brush (fig 18). After removal of cervical excess with a scalpel and finishing, the polishing was carried out with the Easygloss brush and polishing strips (figs 19, 20, 21). Fig 22 shows the closed diastema.
The same procedure was then used to enlarge the cervical-incisal dimension of teeth 11, 12, 13, 33, 43 and 44 (fig 23). Figures 24 and 25 show the closed diastema and the closed spaces in the anterior occlusion (black circles). The white circle shows a space which could not be fully closed since this would have changed the occlusion. Figure 25 shows how it was possible to establish the harmony of the smile with these minimal corrections. This confirms our conviction that good aesthetics can be reached with minimally-invasive corrections if the material is known and its use mastered.
For more information call 07500 769 613 or email t.mccarthy@voco.com