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8762 Views - Jun 2017

The increasing demand for esthetic restoration in the anterior region of the mouth have raised the number
of dentist performing the treatment and patients receiving the treatment, especially in the anterior region
of the mouth. With the evolution of materials and techniques for simplification of esthetic dental
restoration, the need for some more simplified guidelines became mandatory.

One of main restorations that was considered in this huge demand for esthetic restoration is direct
restoration or direct veneers. This type of restoration usually needs skills and talent from the operator,
however, if we used a specific protocol and steps we would always be able to achieve an acceptable result
we the minimum requirements, time and talent.

A case of direct veneer is presented here to show how we can achieve nice results in an easy way and with
a predictable outcome.

Img. 1 - Initial situation

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Img. 2 - Initial situation, Retracted Photo

Img. 3 - Initial situation, Retracted Photo

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Img. 4 - Scaling, polishing and finishing of old restorations and composites after Orthodontic treatment.
The photo shows how the teeth are affected by previous treatments.

Img. 5 - Digital smile Design was done to see the areas needed for addition of the composite.

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Img. 6 - Isolation is always the first step in a procedure. Moisture control is an important step for extending
the life expectancy of our direct restorations.

Img. 7 - Extra Retraction and inverting of the rubber dam.

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Img. 8 - Conditioning of the enamel surface with phosphoric acid.

Img. 9 - Dryness and removal of excess water.

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Img. 10 - Bonding was done before placing the matrices. The easiest way to start in such cases, in which
there is no need to change the position of the midline, is to place two appropriate sectional matrices
vertically with a wedge to establish the place of the contact area in the midpoint. Composite body shade
was used to close the diastema on one of the centrals in the begining. Care and focusing on good
adaptation where the composite has to extend palatally to prevent over-hanging and have initial good
contours to minimize our finishing time later on.

Img. 11 - After finishing the proximal area of the first central incisor we remove the first sectional band to
have an appropriate contact. Then we proceed with the adaptation of the composites in the same manner.

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Img. 12 - The initial situation after removing of both matrices. Now we can start adaptation of composite on
the buccal surface of the two central incisors.

Img. 13 - A photo showing how the composite is anatomically adapted, right from the beginning. It becomes
easier to finish the restoration as we spend more time adapting the composite.

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Img. 14 - Sectional matrix is again used, but this time without a wedge. The wedging action of the rubber
dam was used to secure the band in place to give a maximum contour for the tooth proximally.

Img. 15 - Lateral incisor, proximal area done correctly.

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Img. 16 - Buccal surface done anatomically again.

Img. 17 - The opposing lateral incisor and both of the canines were done with the same protocol, always
starting with doing a correct proximal contour followed by mimetic buccal contours.

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Img. 18 - Immediate result after finishing and polishing. Finishing of the proximal area was done using soflex
discs for a minimal adjusment. The buccal surface was finished using a alow speed medium grit dimond
bur. The polishing was done following the recipe of J. Manauta and A. Salat in their "Layers" book.

Img. 19 - Immediate result.

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Img. 20 - The smile of the patient.

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Img. 21 - Notice the fine and natural anatomy.

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Img. 22 - Good facial integration with the smile is what we want to reach.

The use of a single shade composite was the first step to simplify our restoration. After that, the way we
start our work, and some specific guidelines can always provide the key to success. However, the need for
extra steps of pre-planning is always essential and this is where the simplified digital smile design concept
by Christian Coachman takes place.


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