- Dr. Ridyumna Garain is the winner at 3rd position, jury special mention award for DR Pronto Esthetic Challenge 1, 2021-2022
Introduction
Discrepancy of tooth shape or size and inappropriate distribution of space between the anterior teeth is a major esthetic concern for patients.1 Proximally bonded direct composite resins are a practical and conservative treatment option for space closure. 2,3 Direct composite restorations have several distinct advantages. They permit conservation of tooth structure, reversibility of procedure, relative ease of addition or removal of materials as necessary, along with being economical for the patient.
The esthetic appearance of teeth forms a part of an overall picture, interacting closely with facial esthetics. Since a pleasant smile is governed largely by symmetry, asymmetry of shape and size creates an unacceptable esthetic presentation.
This case report details the esthetic rehabilitation of maxillary anterior teeth with interdental spacing. In the present case, the patient’s esthetic expectations were met successfully through comprehensive digital treatment planning and direct composite restorations. 4
Case Report
A 23-year-old male patient reported to the clinic with a complaint of spaces between his upper front teeth. He gave a history of having undergone orthodontic treatment previously.
Clinical Findings
Clinical examination revealed spacing between teeth 11 and 12, 22 and 23, 23 and 24, 21 and 22, 22 and 23, and 23 and 24. A faulty class IV restoration was noted with respect to mesioincisal aspect of 11. Residual composite after debonding of brackets was also noted on all the teeth. A Class II molar relation with large overjet and deep bite was also noted.
Figures 1-3 show the extra-oral and figures 4-6 show the intra-oral pre-operative status of the patient respectively.
Figure 1-3: Pre-operative Extra-oral Pictures
Figure 4-6: Pre-operative Intra-oral Pictures
Treatment Plan
The patient was provided with various treatment options. However, the patient desired a quick and minimally invasive treatment option. Hence, it was decided to carry out direct composite build up from canine to canine to close the spaces, using digital planning, diagnostic mockup and a silicon index.
Treatment
In the first visit, reference photographs were taken. Space closure was planned digitally (Figure 7,8). 4 Esthetic tooth forms were created and areas for composite addition were identified. Following this, upper and lower diagnostic casts were made on which a wax build up was done. A silicon putty matrix was prepared from this.
Figure 7,8: Digital Planning
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