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