Dr Charles Brandon presents: COLTENE materials. Working on the laterals for an aesthetic smile solution
A 33-year-old male patient, who had previously been seen for routine restorative dentistry, attended with cosmetic concerns regarding his discoloured and stained lateral incisor resin restorations, which extended onto a large portion of the palatal surface of both teeth (see Figure 1 top).
The central incisors had been previously veneered with ceramic A2 e-max. Poor incisal translucency was present on the veneers and high incisal translucency was present on the natural teeth.
Discussion, treatment options and preparation
It was discussed with the patient that to even out the smile we could provide composite contouring of the lateral incisors. We could also shade match to the existing central teeth, include the slightly proclined existing laterals, and eliminate the incisal translucency. This would provide him with a more homogenous, aligned and aesthetic smile. The patient was happy to proceed with this plan.
The discussion of cosmetic restoration of this site included; veneering the lateral incisors, replacing the old crowns on the central incisors combined with veneers of the lateral incisors and finally, resin bonding to the lateral incisors to improve cosmetics and blend the colour of the natural tooth/ceramic veneer together. In this instance, the patient opted to proceed with the minimally invasive option of composite bonding to the lateral incisors.
The patient had good dental hygiene, optimal periodontal health and a moderately restored dentition. He was a regular attendee and had previously had several resin restorations placed in his posterior teeth.
When reviewing the lateral incisors before restoration, LCPAs (see Figures 2 and 3) were taken of the teeth alongside periodontal evaluation and ROEKO Endo-Frost sensibility testing. Radiographically, the teeth had healthy bone levels and sound periodontal ligaments. The teeth both presented with normal response to sensibility testing and periodontal health appeared sound.
The teeth were isolated with a rubber dam using floss ligatures to invert the dam around the coronal portion of the teeth. The existing old resin was removed from the teeth with a speed-increasing handpiece. Once down to sound enamel, the lateral incisors were sandblasted with 27um AlOx and etched for 20 seconds using 37% orthophosphoric acid. ONE COAT 7 UNIVERSAL bonding agent was used to prime and bond to the enamel.
Composite material, BRILLIANT EverGlow in A2/B2, was used to sculpt the teeth to the correct shape. Following curing, the teeth were coated with glycerine gel and cured again for 20 seconds each, in order to oxygen block the composite and prevent oxygen inhibition from part-curing the surface layer, allowing for better final polish. The teeth were polished using the DIATECH Composite Polishing Kit to a high gloss finish that matched the adjacent teeth.
Immediate post-op photos are shown here (see Figures 4-6), as the patient has not yet returned for a review appointment.
The patient was very happy with the overall cosmetic improvement given to the dentition following resin bonding to the lateral incisors, resulting in a much more homogeneous appearance of the anterior teeth with closed diastemas and improved incisal levels.
COLTENE BRILLIANT EverGlow significantly improves the cosmetic workflow. The resins are extremely malleable and allow for excellent manipulation with superior polishability. I favour the use of these materials with many anterior cases, as they match the value and chroma of natural tooth tissue very well and the range of shades covered by each material makes shade matching extremely effective.
Dr Charles Brandon is a dentist at S3 Dental. To find out more about the COLTENE materials used in this case study visit www.coltene.com.