The indications for direct composite materials have recently been
expanded to include predictable and convenient application in the aesthetic zone.
The availability of composite materials with improved physical and optical
characteristics facilitates the development of enhanced aesthetics while
maintaining vital function. This article presents a simplified technique that
combines function with aesthetics by utilizing an intraoral composite mock-up
for initial communication and the implementation of a lingual/incisal silicone
stent of the mock-up to transfer the information to the definitive restorative
The direct application of composite resin has grown in importance
to contemporary dentistry, and its use will continue to expand as material
composition is improved by future research. Due to the variety of
dentin and enamel bonding agents that are currently available, the direct
application of composite resin can now be performed with success and
predictability. These expanded indications for direct techniques are primarily
the result of recent advances in composite resin formulation, which include
enhanced strength, wear, stability, aesthetics, and ease of manipulation.
The direct application of a restorative material satisfies various
considerations (eg, single appointment, direct clinician control, and reduced
expense) for the patient and practitioner. While the indications for composite
resins are constantly increasing, the proficiency of clinicians
using direct procedures must be improved. The use of veneers to restore
aesthetics in the anterior has evolved into treatment that strengthens and
replaces lost or worn tooth structure (ie, biomimetics) while
regaining proper function and anterior guidance. Significant
improvements in the stratification of composites permit natural depth and
visual effects similar to those of porcelain buildup techniques to be achieved. The use of light polymerization, incremental layering techniques, and the
profusion of opaquers and tints have enabled clinicians to exercise the
artistic skills that are traditionally reserved for dental technicians.
Nevertheless, simplified methods are required to fabricate aesthetic
restorations that reduce patient expense and chairtime.
The direct restoration of the entire arch allows an aesthetic,
natural appearance to be achieved with simplified layering and color
stratification, as it is not necessary to match the adjacent teeth. Once the
aesthetic expectations of the patient and a comprehensive treatment plan have
been determined, the sequential application of the direct resin can proceed.
This article demonstrates a clinical protocol for the direct restoration of the
anterior dentition utilizing composite resin, an intraoral mock-up, and buildup
guide. As an alternative to the use of preliminary impressions, occlusal records, and a laboratory waxup, an intraoral composite mock-up technique was utilized to determine the correct length of the restorations.
A 40-year-old male patient presented with unaesthetic teeth, which had been restored 14 years previously with direct microfilled
composite resin for diastema closure. Although the material and underlying
dentition had become discolored, the patient declined treatment with porcelain
restorations due to the success and durability of the previous treatment and
the increased expense and chairtime associated with a prosthetic solution.
Clinical examination revealed Class I occlusion with evidence of bruxism and
loss of cuspid guidance that resulted in group function on the left and right
sides. Centric relation was within 1 mm of centric occlusion and was corrected
with occlusal equilibration. Due to a lack of cuspid protection and various
lateral forces, approximately 1 mm to 2 mm of gingival clefts and
recession were evident on teeth #4(15), #5(14), #12(24), and #13(25). As a
result of the patient's aesthetic expectations and the availability of
contemporary composite materials, a treatment plan that increased the length of
the 10 maxillary teeth (#4 through #13) was developed. This would establish
optimal aesthetics and anterior guidance, prevent additional recession of the
gingiva on the premolars, and reduce bruxism without using an appliance. Wear on the opposing dentition would be prevented, since the wear of
light-cured microhybrid composites is similar to that of natural teeth.
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