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Name Shuaib Hadadi Professor Mr M Jerreat University Peninsula Dental School, UK

IPS Empress Direct ®

Direct Esthetic Composite

National Direct Restoratives ʻCOMPʼetition Introduction to the case This 32 year-old male patient was referred to our primary care clinic concerned with spacing in his dentition as well as the appearance of the upper anterior teeth and his smile. The patient was diagnosed with severe hypodontia and peg shaped upper lateral incisors and lower second premolars.

He was under the joint care of Orthodontic and Restorative Consultants with the long term aim of creating space in the lower arch for a resin-retained bridge as well as placing implants to replace missing upper molars. Teeth 12 to 22 and 24 were restored with IPS Empress Direct. Build up stages are shown below.

Before

After A before picture is mandantory. Please insert here your picture.

Pre-operative frontal view Peg-shaped upper lateral incisors, enamel caries affecting left lateral incisor and upper left first premolar palatally inclined apparent.

Post-operative frontal view All teeth were restored with IPS Empress Direct, the patient‘s smile was transformed giving an extremely aethetic result.

Initial Presentation

Shade selection, Isolation & preparation

Tooth conditioning & bonding

Enamel layer placement • Gold composite instruments were used to build-up teeth in increments no more than 2mm • 24 was built-up free hand buccally using enamel shade A3 applied in thin layers to constrcut the buccal profile

• Oral hygiene instruction and supragingival scaling were conducted to improve gingival and oral health • Study models and diagnositic wax-ups were produced

• IPS Empress Direct shade A3 was chosen for both enamel and dentine • Teeth were isolated using OptraDam Plus • Teeth were then polished with prophylaxis paste

• Translucent matrix bands were placed along with PTFE tape • Teeth etched, washed and dried without causing desciation • Adhesive applied for bonding

Composite curing

Finishing

Polishing

Post-operative view

• Mamelon structure of natural dentine was considered when building up 12 and 22. • Transparent silicone matrix was used to build up palatal contour and incisal height for 12 to 22

• Diamond polishing burs, Sof-lex discs and interproximal strips were used to define contour and natural anatomy of teeth

• Teeth were polished with discs and points as well as polishing paste

• A natural lusture and shine were achieved

Treatment plan and method • This patient with hypodontia was being treated by both orthodontic and restorative specialists. The pateint presented with a fixed orthodontic appliance in the lower arch. He was referred for treatment on his peg-shaped lateral incisors and a more aesthetic smile. After discussing treatment options, the benefits of direct composite bonding were highlighted. This minimally invasive approach which preserved the existing tooth strcuture was chosen as the means of treatment. It was important to improve gingival and oral heath therefore oral hygiene instruction and supra-gingival scaling were conducted. • Study models and a diagnostic wax-up were produced. A temporary mock-up was also constructed and shown to the patient to aid the patients understanding of the clinical outcome.Following caries excavation, all tooth surfaces were prepared and built-up using IPS Empress Direct composite. All restorations were finsihed and polished to give a natural lusture and shine which the patient was extremely pleased with. • Future treatment involving a resin-retained bridge and implants are due to be completed once orthodontic treatment on the lower arch is complete.

Discussion and conclusion • IPS Empress Direct composite restorations have provided a natural aesthetic result and with minial preparation. With good oral hygiene and regular maintenance these restorations will provide a natural appearance for many years to come.

First Place - Shuaib Hadadi  
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