Incisal embrasures are one of the most important factors that determine the aesthetics of a smile. They’re formed by the edges and the separations between the teeth and the dark background of the mouth. Their dimension and their volume increase as the dentition progresses distally from the midline. These embrasures tend to be reduced with age due to abrasion.
This patient presented to our clinic to enhance her smile. She complained of large incisal embrasures giving her the illusion of having diastemas and small teeth.
Fig.1
The clinical examination revealed:
– large incisal embrasures
– rounded teeth
– small and short laterals
– reduced incisal edges on the central and the lateral incisors
– surface irregularities
Fig.2
It is mandatory to always check the lateral movements in order to locate the safe zones eligible to receive the composite restoration without inducing occlusal interference that may lead to chipping of the restorations.
Fig.3
No preparation of the teeth was needed because the aim was to add, rather than reduce in volume. The fullenamel surface was ideal to optimize the restorations’ longevity. A rubber dam was placed.
Fig.4
Etching of the teeth was carried out with 37% phosphoric acid (Scotchbond, 3M/ESPE, St. Paul, MN, USA), following the total-etch protocol.
Fig.5
Afterwards, the adhesive single bond 2 (3M/ESPE, St. Paul, MN, USA) was applied in two consecutive layers, using a microbrush. A 5-second air blowing was performed after each layer to evaporate the solvent followed by light curing for 20 seconds using the Curing Pen by Eighteeth.
Fig.6
Two composite shades from CompoSite System by White Dental Beauty were used:
– Si 2, equivalent to A2, is the dentin shade used.
– Si E (Si Enamel), is used to give translucency and good opalescence properties to the restorations.
Fig.7
Since no major modifications were needed to correct the incisal edge, the freehand technique was used to build the palatal wall. Si E (Si enamel) was used.
Fig.8
After completing the incised contour of all the teeth, we were ready to complete the shape.
Fig.9
Two matrices were placed to ensure a good contact point and an adequate proximal contour of the teeth. Proximal walls were built using Si E with a total thickness of 1mm.
Fig.10
The same procedure was repeated for all the proximal walls. Notice the new shape and length of the teeth.
Fig.11
Proximal mesial wall on the left canine.
Fig.12
After all teeth were completely contoured, we were ready for final layering.
Fig.13
Si 2 was used to create the mamelons in the incisal edge of the laterals in order to avoid having highly translucent areas, and to give the restorations a natural appearance. To facilitate the modeling of the composite, the LM Solo Anterior Instrument (LM, powered by Styleitaliano) was used.
Fig.14
Si E (Si Enamel) was placed at the end in order to give the restorations the needed translucency and the opalescence properties.
Fig.15
After drawing the transitional lines and the secondary anatomy with a pencil, excess composite was removed using a tapered round-tipped bur with an extra fine grit.
Fig.16
By rubbing an articulating paper on the buccal side, we are able to mimic the surface texture on all the teeth.
Fig.17
The coarse red grit from Sof-Lex (3M/ESPE, St. Paul, MN, USA) was used to define proximal contour of the teeth. These discs should be used with caution in order to avoid removing the contact point or the transitional lines.
Fig.18
Light orange Sof-Lex disc from 3M ESPE was used to polish the proximal areas.
Fig.19
Final polishing using the Lucida Composite Gloss System by DiaShine and Style Italiano.
Fig.20
Final result.
Conclusions
Direct composite restorations can be an ideal conservative treatment to enhance shape and incisal embrasures of the teeth. The key criteria to succeed these cases are to memorize dental morphology and to master the different layers of composite (enamel, dentine, transparent…) in order to have an excellent and natural blend between the restorations and the teeth.