【转载国外病例】微创间接复合贴面

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Img. 1 – The patient after orthodontic treatment and before impression for DSD

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Img. 2 – Lateral view of the smile (initial situation)

Img. 3 – Lateral view of the smile (initial situation)

Img. 4 – Frontal view of initial situation, retracted lips. It's visible the decay of tooth 22, an existing old composite filling on teeth 12 (M), 11 (MV), 22 (MV).

Img. 5 – Before: Frontal view

Img. 6 – Before: Upper arch

Img. 7 – First step of the analysis (DSD) : Facial analysis, picture of a frontal view (with retracted lips). The main purpose is to make the parallel between bipupillar line and the line of the smile. We transfer this information of DSD, to the next step, design of the form and the position of the upper teeth.

Img. 8 – DSD (Digital Smile Design) – It's visible that the frontal teeth: 12, 11, 21, 22 – need an incisal lengthening. We use ratio between length and width = 85% of central incisors. Teeth type between triangle and square shape, which we choose from the facial analysis, the patient desire and his personal character. The domination of the form is related to his personality. The shape of the lateral incisors, followed the shape of the central incisors.

Img. 9 – Second step: Diagnostic wax-up of his new smile. The information is transferred from the DSD project.

Img. 10 – It's visible that not all surface of the tooth are covered by wax, which means that there will be areas without preparation. But it will be clearly visible after the mock-up guidance information during the preparation stage.

Img. 11 – Third step: Transferring the information from the wax-up to mock up. Mock-up is performed to visualize the aesthetic and functional project for the future situation. This is the aspect of the mock-up immediately after the removal of the silicone key and polishing.

Img. 12 – Immediate Dentin Sealing(IDS) before impression

Img. 13 – Guided minimal invasive preparation of the teeth. The lack of dental tissue of the central incisors is due to removing of old composite restorations. It's not necessary to make a big build-up because the veneers will be from composite. Immediate dentin sealing (IDS) is performed to the areas of exposed dentin tissue, medial of teeth 11, 21, 22.

Img. 14 – The preparation after IDS, teeth 11, 21 have gingival chamfer and the tooth 12, 22 are non-prep in the area of the soft tissue.

Img. 15 – Composite veneers. In this picture is visible the fluorescence of the composite, imitated the natural dental tissue.

Img. 16 – 12 , 22 – partial veneers.

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Img. 17 – Inserted veneer of tooth 21 and insertion of partial veneer – tooth 22.

Img. 18 – The border and the adaptation between the composite veneer and the tooth surface. Try-in stage.

Img. 19 – Adhesive step 1: Isolation for cementation, first teeth 11,21.

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Img. 21 – Adhesive step 3: Etching gel 36% orthophosphoric acid

Img. 22 – Adhesive step 4: Application of the adhesive system (4th generation-primer and bond in separate bottles). At this stage, no primer needs, only adhesive is applied. No light-curing of the bonding system. The cementation is with photopolymer composite.

Img. 23 – Finshing and polishing.

Img. 24 – Finishing strips.

Img. 25 – 1 week after the cementation of the veneers. We can appreciate better proportion of teeth and a more harmonious smile. The best advantage of the composite is the good adaptation of the colour, even if the border of restoration of the tooth 12, 22 is in the visible part of the crown and there is no chamfer, at all.

Img. 26 – 1 week after cementation – lateral view.

Img. 27 – 1 week after cementation – lateral view.

Img. 28 – After 1 week

Img. 29 – After 6 months recall


Conclusions

One of the best advantage of the composite is the good adaptation of the colour, even if the border of restoration is in a visible area and very good transition between composite and enamel in non-prep cases. Good polishing, functional and aesthetic qualities close to natural dentin and enamel.

Bibliography

1.Effect of Three Surface Treatments on the Adhesive Properties of Indirect Composite Restorations; Camillo D’Arcangeloa/Lorenzo Vanini – Journal of Adhesive Dentistry/JAD 2007.03
2.Adhesion of a Two-step Etch-and-Rinse Adhesive on Collagen-depleted Dentin
Vicente P. A. Saboiaa/Fernando Natob/Annalisa Mazzonic/Giovanna Orsinid/Angelo Putignanoe/ Marcelo Gianninif/Lorenzo Breschig  / JAD/ 2008.06
3.Micromorphological Effects and the Thickness of the Hybrid Layer – A Comparison of Current Adhesive Systems -Jovito Adiel Skupiena/Alexandre Henrique Susinb/Patricia D.M. Angsta/Renan Anesic / Patricia Machadoc/Tissiana Bortolotto/Ivo Krejci
4.Microtensile Bond Strength Between Indirect Composite Resin Inlays and Dentin: Effect of Cementation Strategy and Mechanical Aging – Emília Pithan Prochnowa / Marina Amaralb / César Dalmolin Bergolic / Tatiana Bernardon Silvad / Guilherme Saavedrae / Luiz Felipe Valandrof doi: 10.3290/j.jad.a31801
5.Minimally Invasive Restoration of a Maxillary Central Incisor with a Partial Veneer. Sebastian Horvath, Dr med dent?Assistant Professor, Department of Prosthodontics, School of Dentistry, Albert-Ludwigs University, Freiburg, Germany – Claus-Peter Schulz, MDT?Private Laboratory, Baden-Baden, Germany Eur J Esthet Dent 2012;1
6.SEM Analysis of Internal Adaptation of Adhesive Restorations After Contamination with Saliva – Sillas Duarte, Jr.a/Antonio Luiz Lolatob/Cláudia Regina Buainain de Freitasc/Welingtom Dinellid, J Adhes Dent 2005; 7: 51–56.
7.Effect of Re-etching Oxalate-occluded Dentin and Enamel on Bonding Effectiveness of Etch-and-rinse Adhesives Mai Mahmoud Yousrya JAD 2012.01
8.Page 223-227, Influence of Operator Experience on In Vitro Bond Strength of Dentin Adhesives Unlu, Nimet / Gunal, Solen / Ulker, Mustafa / Ozer, Fusun / Blatz, Markus B.
9.Layering concepts in anterior composite restorations. J Adhesive Dent 2001;3:71-80. – Dietschi D.
10.Prefabricated composite veneers : historical perspectives, indications and clinical application. Eur J Esthet Dent 2011 ; 6 : 178-187 -Dietschi D./Devigus A.
11.Influence of Operator Experience on In Vitro Bond Strength of Dentin Adhesives
Nimet Unlua / Solen Gunalb / Mustafa Ulkerc / Fusun Ozerd / Markus B. Blatze J Adhes Dent 2012; 14: 223–227
12.Indirect composite restorations in the anterior region : a predictable technique for complex cases. Pract Periodont Aesthet Dent 1997 ; 9 (7) : 795-802 – Vanini L., DeSimone F, Tammaro S.
13.Approche clinique dans le secteur antérieur avec des facettes composite. Eur J Esthet Dent 2010 été; vol 2 n°2 : 120-139 – Mangani F. et al.
14.The direct/indirect composite resin veneers : a case report. Pract Periodontics Aesthet Dent 1996 ; 8 : 627-638 – Fahl Junior N.
15.Restauration du sourire par composite en technique indirecte. Information Dentaire n°36/37, 21 Octobre 2015 – C. Bernard.

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