Case of the week – direct composite bonding

Dr Sanj Sethi, discusses a multi-disciplinary approach to restore the tired appearance of the patient’s teeth and narrow the gaps between their upper incisors.

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This patient was a multi-disciplinary case. The teeth were aligned to allow for the correct occlusion and incisal relationship given the skeletal arch form.

The main issue was the size of the upper incisors were narrower than the arch form that was required to create a positive overjet.

Hence the teeth were positioned with good communication with orthodontist Dr Kaval Patel.

Creating a natural smile

The patient’s main concerns were the gaps between the upper incisors and the tired appearance of the teeth.

She was keen to have a natural smile. But did not want any teeth whitening prior to the planned restorative treatment.

Given the spaces and symmetry required, freehand composite even with stents and guides would be a more complicated procedure to get absolute control of form, proportions and gingival architecture.

Laboratory-made veneers

Our aim was to keep treatment as conservative as possible, at the patient’s request. But also create harmony and an aesthetic outcome.

The original plan was a combination of minimal to no preparation ceramic veneers as per the digital preview.

However, nearer the time of the initial appointment, the patient was very concerned at any tooth surface reduction and opted for no preparation and direct composite bonding and understood the technical issues and limitations when compared to laboratory-made prostheses.

After discussions with the patient, it was agreed that her decision was respected and she was clear that the absolute symmetry and proportions compared to laboratory-made veneers would be extremely challenging. She understood that this may not result in the most ideal aesthetic outcome as planned on the digital preview.