DPR

Fig. 01 College student (about to begin nursing school) very unhappy with her post-orthodontic results.

Fig. 02 Among the problems was a prominent upper left canine.

Fig. 03 Muscle tenderness and sense of not having a consistent bite, prominent canine, slight fremitus of Nos. 6-11, and general tooth wear were indicative of occlusal dysfunction.

Fig. 04 Discolored cervical composites and generalized “white spots” were indicative of a history of decalcification.

Fig. 05 Using the Erbium laser in soft tissue mode of 2 Watts to create a better “gingival frame” prior to bonding.

Fig. 06 Surface discolorations and previous composites conservatively removed with a flame-shaped diamond maintaining the outer enamel and creating room for forthcoming layer of Aura.

Fig. 07 Suspicious decalcifications checked with cavity detection dye

Fig. 08 Suspicious decalcifications checked with cavity detection dye

Fig. 09 All remaining “affected” enamel removed with the Erbium laser.

Fig. 10 Conservative preparation of enamel surfaces.

Fig. 11 Conservative preparation of enamel surfaces.

Fig. 12 Air particle abrasion with a small tip (27 micron Aluminum oxide; 40 psi) has been shown to greatly enhance the shear bond strength of materials to enamel and dentin.

Fig. 13 37% phosphoric acid was placed over the entire labial surface with a 30 second exposure time (since no dentin was involved) and thoroughly rinsed with water for 15 seconds each.

Fig. 14 A universal bonding resin was carefully placed using a microbrush and thinned with a warm air dryer.

Fig. 15 Each tooth being treated was cured for 20 seconds using SDI’s Radii Plus light with its wide tip. Aura Enamel (Shade E1) was thinly applied and sculpted using Cosmedent’s Titanium IPCT Instrument placing the gingival half first blending the interproximal. After a 40 second cure, the incisal portion is adapted to the tooth using the anatomy of the incisal edge and adjacent anatomy to guide initial contouring.

Fig. 16 Gross finishing is achieved with a thin 16 bladed ET 9 bur to clean the gingival margins and establish labial anatomy. Interproximal surfaces were smoothed with plastic finishing strips.

Fig. 17 Labial surfaces were polished using a series of abrasive disks.

Fig. 18 Final gloss achieved using a flexible felt disc and aluminum oxide paste.

Fig. 19 The patient’s confidence was soaring after her conservative care.

Fig. 20 Note the uniformity of color and contours that give the smile better balance and esthetic harmony.

Fig. 21 Greater esthetic brightness and occlusal harmony are evident intraorally.

Fig. 22 Gingival health and soft incisal anatomy are welcomed outcomes in this case.xw