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News Bulletin : ADA News Bulletin September 2011
45 SePtember 2011 aesthetic update Fig 5. Following contouring and bonding the canines have assumed the appearance of lateral incisors. Following preliminary shaping of the canines the patient was asked to wear the tray with a slurry of Tooth Mousse and either Sensodyne or Colgate Sensitive toothpaste for three nights, before commencing bleaching. If symptoms arose the protocol was to be repeated. Bleaching does not routinely interfere with adhesion but there is equivocal evidence that bonding immediately following whitening can lead to lower bond strengths. It is assumed this is due to oxygen temporarily trapped in the tooth inhibiting the adhesive’s curing through competition with monomers in the polymerisation process. The patient was further instructed to cease bleaching one week prior to the next appointment. contouring Four weeks later the contouring of the canines recommenced. The buccal and distal walls were effectively sculptured using a long, fine grit diamond bur, with the greatest reduction in the bulbous cervical regions. At the gingival margins the preparations ended in chamfers. The mesial drifting of the 13 had reduced the space available for a realistic, rounded profile. To accommodate a composite buildup, the distal curvature of the 11 was reduced slightly. Small mesio-labial bondings were then placed on both 3s to complete the illusion of lateral incisors (Fig 5). It has been suggested that a smile is most harmonious when, viewed frontally, laterals display approximately three-fifths the width of the centrals. Although the trimming of these teeth was extensive, the new incisors were still somewhat broader than most 2s. As the patient’s central incisors lacked symmetry and required some restoration, it was decided to place thin direct facings, widen them appropriately and at the same time correct the centreline shift. Following treatment the importance of good oral hygiene and a mineralising program was emphasised. ‘GAPS In THE SMILE’ Dentistry is a demanding, and at times, frustrating profession. Much of our treatment planning is formulaic and provides little intellectual challenge. In addition, patients can rarely give meaningful feedback as most have difficulty relating to the work we do. The caries that is detected radiographically can not be seen and usually does not hurt. Deep restorations, placed conscientiously, can precipitate symptoms that were not there previously. It is hard for people to know if we have done a good job or a bad one. On the other hand, everyone can tell when a smile looks a great deal better than it did before treatment. Cosmetic problems normally have a variety of solutions but procedures such as shaping and bonding are simple and financially accessible to most individuals. Being able to devise and offer such treatments is highly satisfying and can benefit the patient in ways that are readily appreciated. dISCLAIMER The statements made in the above article are published on the authority of the author and have not been peer-reviewed. They do not necessarily reflect the views of the ADA and publishing them is not to be regarded as an endorsement of them by the ADA. “Cosmetic problems normally have a variety of solutions but procedures such as shaping and bonding are simple and financially accessible to most individuals. being able to devise and offer such treatments is highly satisfying and can benefit the patient in ways that are readily appreciated.”
ADA News Bulletin August 2011
ADA News Bulletin October 2011