Confidence restored with minimally invasive treatment

Tariq Bashir describes how he uses a minimally invasive layered composite technique to aesthetically repair a patient’s damaged central incisors.

A 20-year-old student attended Visage Clinic because she was unhappy with the appearance of her upper central incisors (Figure 1).

The teeth had fractured in a childhood swimming pool accident. The patient had undergone multiple composite restorations to repair the uneven edges, but they had continually chipped and did not match the natural tooth colour. After a recommendation from her general dental practitioner, she had decided to consult with Visage.

The patient requested a minimally invasive approach to improve her smile. Following examination, she was advised that replacement composite restorations were possible. The patient also wanted her teeth whitened.

Tooth preparation

We took pre-treatment photographs. The patient whitened her teeth prior to the restorative appointment (Figure 2). To whiten the teeth we used Boutique By Night tooth whitening gel with 10% carbamide peroxide over three weeks. After bleaching, composite bonding was delayed for 14 days to obtain optimal bond strength and allow the shade to settle.

Before the old composite was removed, a direct mock-up was placed on top of the existing restoration using Kulzer Venus Pearl B1 shade. This was to confirm the ideal shape and test the planned outcome. The composite was light-cured and a palatal putty index matrix fabricated using Kulzer Provil Novo.

This impression system is easy to use and accurate, with a fast setting time and good rigidity. Composite buttons were placed to help determine the correct dentine and enamel shades (Figure 3). The photograph was converted to black and white to better assess the enamel shade value (Figure…