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Conservative Esthetic Treatment for the Adolescent Patient
Slideshow by Dennis B. Hartlieb, DDS
Dark substrate, right central incisor. Vita shade-based opaquer used to blend composite to tooth structure.
Pink opaquer applied to raise value of tooth structure.
Pink opaquer placed in gingival and body thirds of #8; value mimics the contralateral central incisor.
Tints placed to add intrinsic effects.
Chromatic dentin layer placed to be veneered with high-value enamel layer.
Less chromatic dentin shade that matches viewed shade of tooth.
Initial smile, right Initial smile, left.
Initial smile, frontal.
Esthetic crown lengthening completed. Tissue contouring with radiosurgery.
Roughening of enamel with fine diamond bur.
Roughening of defect with microbur.
Etching of enamel with 37% phosphoric acid.
Clear contoured matrix positioned.
Placement of initial increment of nanofill composite.
Mesial-lingual wall created.
Incisal-lingual extension placed. Vita shade-based opaquer used to block out shine-through of composite.
Black and white image to evaluate shine-through of composite and block out effect.
White tint to replicate intrinsic hypocalcification effect.
Grey tint placed to create translucency effect.
Translucent microfill placed for incisal third.
More chromatic microfill placed in gingival third.
Body shade microfill placed.
Final contour from incisal view prior to contouring.
Carbide ET bur for contouring.
Coarse disc used for additional contouring. Contouring and polishing of distal contact.
Distal contact polishing continued. Final polishing distal contact.
Etching of canine for direct resin placement.
Placement of nanofilled composite for mesial wall of canine.
Sculpting of nanofilled composite. Nanofilled composite layer completed.
Opaquer being placed to block out shine-through and blend composite to tooth.
White tint placed.
Translucent microfill for incisal third. Body microfill placed.
Sculpting body microfill. Trimming composite with mosquito bur.
Polishing cup with subgingival flex for polish at margin.
Final polishing with subgingival flex for polish at margin.
Final contouring with medium coarse disc. Surface texture and effects created with aluminum oxide brush.
Polishing with flexible disc. Final polishing with disc.
Final smile, left lateral view. Final bonded restorations, #6, #7, #10, and #11.
Final polish lateral view, #6 and #7.
As demand for cosmetic dentistry continues to grow, it helps to be more familiar with the materials available for direct resin placement, the layering options available, and the techniques to create composite restorations that blend with the patient’s natural dentition.
