Dental Tribune U.S. Edition

COSMETIC TRIBUNE The World’s Dental Newspaper · US Edition Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com Chief Operating Officer Eric Seid e.seid@dental-tribune.com Group Editor & Designer Robin Goodman r.goodman@dental-tribune.com Editor in Chief Cosmetic Tribune Dr. Lorin Berland d.berland@dental-tribune.com Managing Editor/Designer Implant, Endo & Lab Tribunes Sierra Rendon s.rendon@dental-tribune.com Managing Editor/Designer Ortho Tribune & Show Dailies Kristine Colker k.colker@dental-tribune.com Online Editor Fred Michmershuizen f.michmershuizen@dental-tribune.com Account Manager Mark Eisen m.eisen@dental-tribune.com Marketing Manager Anna Wlodarczyk a.wlodarczyk@dental-tribune.com Sales & Marketing Assistant Lorrie Young l.young@dental-tribune.com C.E. Manager Julia E. Wehkamp j.wehkamp@dental-tribune.com C.E. International Sales Manager Christiane Ferret c.ferret@dtstudyclub.com Dental Tribune America, LLC 116 West 23rd Street, Suite 500 New York, NY 10011 Tel.: (212) 244-7181 Fax: (212) 244-7185 Published by Dental Tribune America © 2011 Dental Tribune America, LLC All rights reserved. Cosmetic Tribune strives to maintain utmost accuracy in its news and clini- cal reports. If you find a factual error or content that requires clarification, please contact Group Editor Robin Goodman at r.goodman@dental-tribune.com. Cosmetic Tribune cannot assume respon- sibility for the validity of product claims or for typographical errors. The pub- lisher also does not assume responsibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune America. Do you have general comments or criti- cism you would like to share? Is there a particular topic you would like to see articles about in Cosmetic Tribune? Let us know by e-mailing feedback@ dental-tribune.com. We look forward to hearing from you! Tell us what you think! alternatives that patients enthusi- astically accept in that they mini- mize tooth removal and reduce immediate costs. Case No. 1 Often in orthodontics, tooth shapes can present challenges in achiev- ing optimal results. Some condi- tions may require restorative as well as orthodontic treatment to complete. In this case, we were presented with a challenge that many of us encounter routinely in practice: peg-shaped lateral incisors with very pointed cuspids. Figure 1 shows the patient in mid treatment for orthodontics with the upper cuspid rotated past 90 degrees. The orthodontist corrected the rotation and created appropriate spacing on each side of the peg laterals to facilitate optimal tooth shapes during reconstruction. When dealing with peg later- als, it is my preference that 60 percent of the space be orthodonti- cally positioned on the mesial of the lateral incisor and 40 percent on the distal. This allows the shaping of the lateral incisor to have proper mesi- al canting in appearance. Figure 2 shows the final condition after braces were removed. At this point, I would ask you to consider what options you would offer for a similar case in your practice. In my opinion, it was nec- essary to address not only the peg laterals and spacing, but the shape of the cuspids. Prescribing multiple porcelain restorations was not only finan- cially unrealistic for the patient, but also required considerable removal of sound tooth structure. Our initial treatment was to use take-home bleaching to lighten the tooth color to a “realistic to main- tain” B1 range. It is my belief, based on what I see clinically at recalls of treat- ment we have previously provided, that nanohybrid direct composite restorations offer durable out- comes while removing minimal tooth structure. In my practice, Kerr Premise, Herculite Ultra and Cosmedent Nano are materials of choice that sculpt nicely, blend easily and maintain a gloss polish at recall that maximizes appearance while minimizing plaque retention I am convinced that it is cru- cial to use bonding agents that maximize etching and sealing of enamel. For that reason, I continue to use etch/rinse multi-bottle sys- tems that allow proper application and drying of primers to eliminate solvents and minimize sensitivity. I believe proper enamel sealing and adhesion is a critical compo- nent of durable adhesive restora- tions and an important barrier in protecting the underlying dentin. This case required no tooth removal. For many patients, con- serving tooth structure makes direct composite dentistry very appealing. Treatment was com- pleted with one shade of nanohy- brid. The relaxed posture of the smile, shown at completion of treatment in Figure 3, indicates the patient was comfortable with her appear- ance. For this patient, the outcome was life changing. Follow-up photos taken at one year postop shown in Figures 4 and 5 show close-up views of the completed restorations exhibiting a retained polish and esthetics that can be typical and predictable with nanohybrid composites. f CT page 1B 2B Clinical COSMETIC TRIBUNE | June 2011 Fig. 3 Fig. 5 Fig. 4 Fig. 6 Fig. 7 Fig. 8 Fig. 9