CDEN0109

30 I I industry report _ veneers & composites _Ceramicveneersanddirectcompositebuild-ups present the two most popular treatment options in modern dentistry for modifying anterior teeth; both attain a harmonious aesthetic appearance and re- establish an anatomically correct form and proportion of incisor teeth. Ceramic veneers necessitate tooth preparation,whichinmostcasesinvolvesthereduction of tooth structure. Hence, ceramic veneers are cate- gorised as irreversible dental treatments. The progress achieved in the field of dental adhesives and the con- tinued improvement of the mechanical and optical properties of dental composites have opened up new possibilitiesinrestorativedentistry.Itisnowpossibleto fully restore the aesthetic appearance and function of anteriorteeththathavelosttheiroriginallengthdueto parafunctional habits or physiological abrasion, using resin-bonded composite restorations. Careful treat- ment planning is, however, essential for keeping the reductionofhealthytoothstructuretoaminimum. Direct composite build-ups provide a treatment methodforrebuildingwornanteriorteeth,ifthetreat- ment is accurately planned and performed. This is par- ticularly important if anterior guidance has to be establishedorifaguardsplinthastobeproducedupon completion of the restorative treatment. This article describes the reconstruction of anterior teeth with a nano-optimisedhybridcompositematerial. _Case report A male patient presented with abraded anterior teeth. The abrasion was caused by para-functional habits, resulting in a loss of canine and anterior guid- ance. In addition, the aesthetic appearance was com- promised (Fig. 1). As a large portion of healthy tooth structure was still present, we opted for a minimally- invasive treatment method using composite material. In addition, this method would allow us to restore the teeth with ceramic veneers at a later stage, should this becomerelevant. Initial treatment planning is best carried out on the basisofdigitalimagesofthepatient’ssituation,provid- ing the dentist and the dental technician in charge of producing the wax-up with all the necessary informa- tion. A silicone key was prepared from the wax-up and usedtofabricateamock-up.Inaddition,thesiliconekey providedaspatialreferenceforthecompositebuild-up. The dentition was bleached before commencing the restorative treatment. As a result, a consistent tooth shadewasestablishedbeforetheaestheticintervention wasstarted. Theappointmentforrestoringtheteethwassched- uled for two weeks later—this is the minimum interval thatshouldbeobservedbetweenthebleachingprocess andrestorativetreatment,toensureafirmbondtothe tooth structure and a stable tooth shade, which is essential to accurate shade selection. As the existing restorations exhibited hardly any defects, only those portions that were close to the surface were removed. Fig. 1_Initial situation: worn incisal edges, enlarged interdental spaces, and aesthetic shortcomings. cosmeticdentistry 1_2009 Asmile says more than a thousand words: Reconstruction & modification of anterior teeth Author_ Ronaldo Hirata, Brazil Fig. 1