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Treatment steps
Introduction to the case
Material and Method
Discussion and Conclusion
A 23-year old male came to the Department of Conservative
Dentistry with complaints of smile imperfection caused by the
gap at his upper front teeth and malformed maxillary right
lateral insicor. Among the treatments that we recommended,
the patient choose direct resin composite restoration.
The clinical examination showed multiple diastemas between
13 12 11 21 22 23, and a peg-shaped 12.
Treatment plan: Diastema closure with direct veneer
composite restoration and reshape 12 using ceram.x® one.
Digital smile design approach is very beneficial in deciding the preferred ideal outcome, which is analyzed through basic
principles of smile design. Interpretation onto the diagnostic mock up wax enhanced the quality of palatal matrix, which
works to help reconstruct teeth anatomy. ceram.x® one resin composite was used for this case. Etchant agent was
DeTrey® Conditioner 36 and bonding agent was prime&bond® one Universal Etch and Rinse Adhesive. For polishing,
Enhance® Finishing and PogoTM Polishing System combined with Prisma® GlossTM were used.
Treatment approaches for diastema closure and malformed teeth reshaping include orthodontics, indirect restorations,
and direct composite restorations. Direct composite restoration was finally chosen due to its minimally invasive procedure,
time-efficiency, and cost-effectiveness. The final restoration satisfy patient‘s expectation. ceram.x® one showed a
remarkable final natural appearance for this case. ceram.x® one has an excellent handling, finishing, and polishing
properties that resulted in highly aesthetic outcome.
A before picture is mandantory.
Please insert here your picture.
After picture is mandantory.
Please insert here your picture.
Preoperative intraoral view showed multiple diastemas between 13-12-11-21-22-23 and
peg-shaped 12.
Postoperative intraoral view showed complete diastema closure and reshaped 12.
Step 1 Digital Smile Design
Picture shows interpretation of digital
smile design onto the diagnostic mock up
wax. A putty index was used to duplicate
the mock up and later used as palatal
matrix.
Step 2 Mock up and Putty Index Step 3 Teeth Preparation Step 4 Etching and Bonding
After shade selection (shade B1), anterior
area was isolated with rubber dam. Central
incisors were prepared intra-enamel to
represent the mamellon structure. Right
lateral insicor and canines were only slightly
roughened.
Isolation of adjacent teeth with Plumber‘s
tape (PTFE). Adhesive system used was
DeTrey ® Conditioner (for 15s, then rinsed
with water spray), and prime&bond® one
(applied for 20s, blowed with air syringe for
5s, then light cured for 10s).
Step 5 Palatal wall build up and layering
technique
Step 6 Contouring Step 7 Finishing and Polishing Step 8 Result
Final result of finished direct composite
restoration showed a complete diastema
closure and a natural apperance.
Rubber dam was detached. A #12 blade
was used to remove any excess material
around proximal and cervical area.
Finishing and polishing were completed by
Enhance® Finishing and PoGo ®
Polishing System combined with Prisma®
GlossTM.
Colour lines were made to guide the
contouring of transitional line, mesial –
distal inclination, and design of
developmental groove.
Palatal matrix was used to assist
construction of palatal shell and proximal
dimension of the missing interdental space.
A thin layer of enamel shade (E1) was
placed on palatal side. Then dentin shade
was apllied (D1). Lastly enamel shade (E1)
was sculpted to recreate labial surface.
Preoperative digital smile design was made
to analyze patient‘s most ideal smile using
Corel Draw, referring to basic principles of
smile design. The measurement and
calculation were adapted to design the
desired outcome.
1st Place
Name:
Raissa Indiwina
Tutor:
Taofik Hidayat, drg., Sp.KG
University / Country:
Padjadjaran University / Indonesia
Before After
1 2 3 4
5 6 7 8
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