this case we have a 22 year old female that presents with PEG laterals and also a congenitally
missing maxillary left canine tooth number 11 the patient would like to enhance the aesthetics of
her smile by closing the dastan doors on either side of the laterals and we certainly have many
different options today in dentistry I will attempt to do this using the most minimally
invasive method by applying composite bonding to the medial and distal surfaces of the laterals so
to plan out what we're going to do for this case I went ahead and poured up a separate model and
wax the aesthetic areas up the first thing that I actually did was reduce the length of number
10 the original length is just about even with the central so we do want to shorten that a little bit
for a better aesthetic result and I did apply wax to the medial and distal surfaces of both seven
and ten but to avoid the laterals from appearing too wide I did apply wax to the medial portions
of the canines number six and I take a nines but actually again number eleven is missing so since
number twelve is occupying the space of number eleven the maxillary left canine we're going to
attempt to mimic a left canine by extending it we lengthen it a little bit and I do bring that
medial surface over so from the wax up so I can transfer what I hope to achieve intraoral II I
fabricate a putty matrix and the putty matrix I position it along the incisal edge and what
this will allow me to see and trollee is the planned position of the incisal edges and also
the scalloping also helps me determine exactly where to position the interproximal areas on each
tooth so for this case we are going to use the most minimally invasive approach which the only
area where we're moving to structure will be on the incisal edge of number 10 and the rest of the
areas we will apply composite resin the material I'm planning to use will be the camouflage
Universal it's a nano hybrid composite and it has many desirable properties that will benefit both
myself and the patient so let's go ahead and take a look at the case and see what type of results we
can achieve with the camouflage composite veneers all right at the start of the case I do recommend
using a prophy cup and pumice to ensure the tooth surfaces are nice and clean if there is calculus
president would be prudent to scale those areas to achieve the best possible bonding surface I
place a rubber dam because isolation is very important to avoid contamination since I will
perform bonding procedures on multiple teeth I use the second smallest hole punch so it will be
more constricting at the base of each tooth for additional stability I place individual floss
ligatures and they also help expose more tooth structure by displacing the soft tissue more
ethically prior to isolation I try in the putty matrix to verify that it seats completely and the
rubber dam is not interfering with its seating if it is you may need to cut some of the distal
portion off we start the bonding procedure by applying phosphoric acid in a 37% concentration to
all of the surfaces we will bond to since we are entirely in enamel we will allow the acid to etch
the surfaces for at least 20 seconds to ensure that the desired area is etched it's a good idea
to apply the acid at least 2 millimeters beyond the anticipated restorative area for these types
of aesthetic bonding cases it can be challenging to delineate where the resin application should
stop since there isn't a margin present I like this acid etch from curve because the right
viscosity allows me to apply it easily in exact areas without it being too runny or too thick and
it does rinse off very quickly and when applying the etchant to the mesial surfaces of the laterals
I protect essentials with a clear matrix you can also use teflon tape to wrap the Central's but I
like to leave them exposed so I can visualize the distal contours as I'm applying the resin
once I confirm the enamel surfaces have a frosted appearance I apply scotch bond university agent to
all of the bonding surfaces like the etchant I extend the bonds slightly beyond where I expect
to apply the resin once it is applied we Aerith in the bond to ensure the solvents evaporate the
solvents are typically very volatile liquids like ethanol methanol and water so they do evaporate
very quickly after drying we polymerize the material for 10 seconds I begin the resin
application with a spatula shaped instrument by applying the material as far cervical II that's
possible to establish a new natural emergent profile the putty matrix aids in determining
the new incisal edge position and also the interproximal scalloping along the incisal
embrasures indicate exactly where i should try to extend the resin application on the proximal
surfaces I use a spatula resin applicator for most of the resin placement and shaping for some of the
finer shaping and explore or probe can be used to fully polymerize the material we like cure for 20
seconds Here I am extending the mesial surface of the lateral out to reach the central I like
camouflage because it is actually very quite easy to manipulate into orally to the desired position
in shape also a nice benefit as it doesn't actually stick to my instruments which can
certainly be very frustrating if composite materials stick to your instruments during
application a light coat of bonding agent usually alleviates that issue in the aesthetic zone I try
to shape the resin close to the final contours as much as possible but slightly over bulked
rather than spend too much time smoothing the restoration during the resin application I find
it a bit faster to dial in the final contours during the polishing phase camouflage Universal
has desirable properties that benefit both myself as the clinician and the patient it's actually
very easy to manipulate and orally it has a really great wear characteristic very stain-resistant and
it has one of the lowest water zorkin rates on the market what that means is water does
not easily diffuse into the polymerized composite avoiding degradation and it allows it to maintain
its mechanical properties for a longer period of time here I'm using a soft flex disc the coarse
variety you can see by the black color and I use it to shorten the length of number 10 by
about half a millimeter the next time I have a similar case I will definitely do that step at
the beginning rather than wait until the end because leaving it longer can interfere with
the seeding of the putti matrix a 12 blade is very useful to remove any roughness along the
transition between the natural tooth and the resin application any overhangs or roughness
can lead to gingival inflammation in order for this to be a healthy addition to this patients
dentition we need to try to ensure that the margins are indiscernible the darker colors
of the soft flex disks are used primarily for growth reduction and the lighter ones are used
for refining the contours and margins and also removing any large areas of surface roughness
the lightest colors allow you to polish the restorations to a high shine here I go ahead
and check the occlusion and in this case I do like to try to use a slow speed round bur to
adjust any high spots it typically will remove the composite material with a minimal effect on the
enamel I finished the restoration with a coarse composite polisher and then a fine composite
polisher just to remove any surface scratches and then I'll finalize the polishing using an
aqua brush biker they have special impregnated fibers that polishes the composite material to
a high shine without the need for an additional paste once everything is completed I checked the
restorations with floss and ensure that they run smoothly and there aren't any rough areas
along the transition to the natural tooth the patient was very excited about the final aesthetic
improvement we were able to provide for her in a single appointment and I was also very pleased
to complete the case with a minimally invasive approach utilizing some of the finest materials
and tools available for us in modern dentistry and one of the nice benefits too is in the future if
for any reason we need to repair the restorations that can also be easily accomplished I hope you
enjoyed this week's case the week and we'll look forward to having you back for a future episode
you