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24/05/2021

Mega-abrasion and cosmetic contouring with composite: minimal intervention strategies

Authors: Gregori Franco Boeira; Giulia Tarquino Demarco; Lisia Lorea Valente

Patient: 21-year-old female patient (G.T.D.)

Main complaint: “Aesthetic dissatisfaction with the hypoplasia stains and changed contours which contributed to a childish smile.”

Initial clinical/radiographic evaluation

After anamnesis, detailed clinical and radiographic evaluations, complemented with the transillumination of the element 22, it was noted that the patient had hypoplasia stans and altered teeth contours.

Treatment executed

Chromatic alterations, hypoplastic areas and the absence of dental contours end up influencing the aesthetic whole. Thus, this clinical case had the objective of minimizing and improving anti-aesthetic areas that were not resolved with dental whitening and micro-abrasion. The proposed treatment consisted of the mega-abrasion of the tooth with the deepest hypoplasia and the cosmetic recontouring of the anterior upper teeth.

Considering the products used, the first thing that was done was the color selection through pre-polymerized spheres of composite (Vittra APS, FGM). With the combined-type absolute isolation of the operation field, after the color selection, tooth 22 (the one with the deep white stain) was mega-abraded with a 1014 spheric diamond tip in the most conservative way possible.

Following that, the application of a two-step conventional adhesive system was carried out starting with acid etching with 37% phosphoric acid (Condac 37, FGM), followed by the application of the primer/adhesive (Ambar APS FGM) on the teeth (13, 12, 11,21, 22 and 23) which underwent re-anatomization.

Teeth 13,12, 11, 21 and 23 were re-anatomized with a sectional matrix and enamel composite (E-bleach, Vittra APS, FGM) e) while on tooth 22 a dentin composite was used (DA1, Vittra APS, FGM), dentin grooves were made (DA0, Vittra APS, FGM), effect composite (VH, Vittra APS, FGM) in the region of the opaque halo and enamel composite for the finishing (E-bleach, Vittra APS, FGM).

Concluding, the texturization with finishing materials such as diamond tips with F/FF granulation, abrasive disks from the most granulated to the least and polishing with spiral disks, positioning the edges (shine lines) and mirror and shadow areas through the mirroring of the adjacent tooth.

Considering the case described above, we are able to conclude that a satisfactory clinical result was achieved, showing that the market has materials capable of mimicking the dental structure and when the techniques are well carried out a great aesthetic result can be achieved both for the professional as well as for the patient.

Captions

Fig. 1: Extra-oral photo of the initial smile.

Fig. 2 – Intra-oral photo in maximum natural intercuspation.

Fig. 3 – Color selection by means of pre-polymerized spheres of the composites placed on the dental structures, photopolymerized and moist.

Fig. 3 – Color selection by means of pre-polymerized spheres of the composites placed on the dental structures, photopolymerized and moist.

Fig. 4: Transillumination of tooth 22 for the verification of the depth of the hypoplasia stain.

Fig. 4: Transillumination of tooth 22 for the verification of the depth of the hypoplasia stain.

Fig. 5: Combined-type absolute isolation of the operation field.

Fig. 5: Combined-type absolute isolation of the operation field.

Fig. 6: Testing the 1014 diamond tip for the size of the hypoplasia stain.

Fig. 6: Testing the 1014 diamond tip for the size of the hypoplasia stain.

Fig. 7: Close up view of the diamond tip with the size of the hypoplasia area.

Fig. 7: Close up view of the diamond tip with the size of the hypoplasia area.

Fig. 8: Removal of the hypoplasia stain on tooth 22.

Fig. 8: Removal of the hypoplasia stain on tooth 22.

Fig. 9: 37% phosphoric acid etching (Condac 37) on the teeth to be re-anatomized.

Fig. 10: Application of the primer (Condac 37) on the teeth that have been etched.

Fig. 10: Application of the primer (Ambar APS) on the teeth that have been etched.

Fig. 10: Application of the primer (Ambar APS) on the teeth that have been etched.

Fig. 11: Insertion of the dentin increment (DA1, Vittra APS) on tooth 22.

Fig. 11: Insertion of the dentin increment (DA1, Vittra APS) on tooth 22.

Fig. 12: Insertion of the enamel increment as the last layer (E-bleach, Vittra APS) on tooth 22.

Fig. 13: Re-anatomization of the distal surface of tooth 21 with a sectional matrix.

Fig. 13: Re-anatomization of the distal surface of tooth 21 with a sectional matrix.

Fig 14

Fig. 14: Re-anatomization of the mesial surface of tooth 21 with a sectional matrix.

Fig. 15: Dental contours of the anterior teeth are already reestablished.

Fig. 15: Dental contours of the anterior teeth are already reestablished.

Fig. 16: Marking with color pencil and definition of the shine edges.

Fig. 16: Marking with color pencil and definition of the shine edges.

Fig. 17: Close up of the reestablished dental contours.

Fig. 17: Close up of the reestablished dental contours.

Fig. 18: Intra-oral photography with maximum habitual intercuspation with the contours of the anterior teeth reestablished showing the mimicking of the composites with the dental structures.

Fig. 18: Intra-oral photography with maximum habitual intercuspation with the contours of the anterior teeth reestablished showing the mimicking of the composites with the dental structures.

Fig. 19: Initial aspect (E) and final smile (D).

Fig. 19: Initial aspect (E) and final smile (D).

Fig. 20: Close up of the reestablished dental contours.

Fig. 21: Side view of the final smile.

Fig. 21: Side view of the final smile.