Dr. Asya Petrova
ALL CLINICAL CASES
Case description
A female patient, 40 years of age, was seeking dental treatment to correct
the aesthetic of her smile,specifically to close the gaps between her teeth.
A consultation with an orthodontist was made, but the patient refused an orthodontic treatment. During the second consultation, digital photographs and a full- arch impressions were taken to carefully design the initial diagnostic wax-up and then a treatment plan was done.
The clinical examinaton revealed bilateral agenesis of maxillary lateral incisors and diastema that leads to functional problems and poor smile aesthetics.
In the wax-up canines were converted into lateral incisors and the first premolars into canines to achieve a nice and harmonious result.
For presentation and visualization of the treatment, an intraoral mock-up, based on the wax up was made using BIS-acrylic resin provisional material (Luxatemp Star, DMG). After the patient, the clinician and the dental technician approved the result , the mock up was done again but this time with prior spot etching of the tooth structure, application of adhesive and photopolymerization. Tooth form was carefully adjusted to be in functional and aesthetic harmony with the patient’s lip and smile line. Anterior guidance was established.
Tooth preparation were subsequently done according to the technique suggested by Dr. Galip Gurel and Dr. Pascal Magne with orientation groves on the mock up.
The preparations were restricted to enamel and no dentin was exposed. A silicone template based on a diagnostic waxup during preparation was used to control tooth reduction. The entire preparation was finished and polished with silicone rubber wheel to obtain smooth margins.
After the finalization of the preparations impression was made using two retraction cords (000 and 00 Ultrapack) – for vertical and horizontal retraction of the gingiva.
The shade 1M1 was chosen using the photographic protocol with digital camera and Smile Lite with the live-polarization filter.
The restorations were fabricated using the inverse layering technique by Dr.
Vincenzo Musella, based on the use of a precise wax-up to carefully design the anatomical tooth via silicone index. Alveolar model was used. To compensate for the deficient volume of papilla during closure the gaps the concept of „mini wings“ of dr. Pascal Magne was used. Seven composite veneers and one composite overlay were made. Composite Micerium Enamel Plus was used – universal dentine (UD2), universal dentine (UD1), universal enamel (UE2), Opalescent Blue Natural.
The final polymerization treatment inside a light-curing unit ( Laborlux Micerium) was made.
Final polishing was performed in a simple manner without lightcuring
varnishes, using three polishing pastes (Shiny System, Micerium S.p.a., Italy).
Field isolation was made using rubber dam and floss binding. The teeth were sandblasted with low pressure and then the enamel was etched with phosphoric acid , followed by washing and drying to achieve a frosted appearance. Adhesive was applied (Optibond FL, Кеrr).
The inner surfaces of the veneers were sandblasted and then coated with
hydrophobic adhesive, air thinned, and left uncured.
The composite veneers were bonded with heated composite resin (UD2), using composite heater conditioner ENA HEAT after heating up to 55°C/131°F and positioned on the prepared teeth.
The cementation process was performed two by two, starting with the central incisors. Excess resin was removed using brushes,probes, and floss and then the proper part of insertion evaluated. After that a light curing was performed for 40 sec in four directions. Glycerin jelly was applied and light cured.
The occlusion was evaluated and the margins were finished with silicone rubber wheel.
The final result showed a natural and dynamic appearance.
The clinical examination revealed bilateral agenesis of maxillary lateral incisors and diastema that leads to functional problems and poor smile aesthetics.
In the wax-up canines were converted into lateral incisors and the first premolars into canines to achieve a nice and harmonious result.
The mock up was done again but this time with prior spot etching of the tooth structure, application of adhesive and photopolymerization.
Tooth preparation were subsequently done according to the technique suggested by Dr. Galip Gurel and Dr. Pascal Magne with orientation groves on the mock up.
The preparations were restricted to enamel and no dentin was exposed
Alveolar model 
The restorations were fabricated using the inverse layering technique by Dr. Vincenzo Musella, based on the use of a precise wax-up to carefully design the anatomical tooth via silicone index. 
Composite Micerium Enamel Plus was used – universal dentine (UD2), universal dentine (UD1), universal enamel (UE2), Opalescent Blue Natural.
To compensate for the deficient volume of papilla during closure the gaps the concept of „mini wings“ of dr. Pascal Magne was used.
Final polishing was performed in a simple manner without lightcuring varnishes, using three polishing pastes.
Field isolation was made using rubber dam and floss binding
The teeth were sandblasted with low pressure
The final result showed a natural and dynamic appearance. 
Check up after 1 year- frontal view
Check up after 1 year- occlusal view
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