Enhancing a Smile with Conservative Composites

By Rhys Spoor, DDS

This patient presented with a desire to eliminate the hypocalcified white spots on her two central incisors. She also thought those teeth had always seemed disproportionately large and wanted to see if there was a way to make them look smaller (Figure 01).

The key to a better smile was to create better symmetry (Figure 02). She had a significant asymmetry between #7 and #10. The two central incisors were also slightly divergent and the hypocalcified areas had a difference in texture (Figures 03 and 04). We discussed orthodontics as an option but the patient rejected that, so we decided to do it as conservatively as possible using direct composites.

Since #7 was gingivally short (Figure 05), the first step was to create better contralateral
symmetry between #7 and #10 by increasing the gingival height of #7 with osseous crown lengthening (Figures 06 and 07). A diode laser was used to perform a bloodless gingivectomy followed by a directly-placed gingival composite (Figure 08). The composite was placed to create the proper healing contour for the gingival tissue (Figure 09). Using an ophthalmic micro-knife, an intrasulcular incision was created and then bluntly dissected. The osseous crest was reduced the same amount as the gingivectomy. The area was closed and stabilized with one 6-0 Prolene horizontal sling suture (Figures 10 and 11). The suture was removed at two weeks and the area healed two months before the final composites were placed.

The distal line angles of the central incisors were recontoured to create more parallelism to narrow the centrals and reduce the divergence. Teflon plumber’s tape was used to isolate individual teeth when placing the composites (Figure 12).

The final step was to shape and highly polish the composite restorations (Ivoclar Empress Direct). Shade B-1 enamel and opal translucent were used with subsurface Kerr Kolorplus composite tints. The goal was to create a surface texture and luster similar to the natural dentition (Figures 13 and 14). The final result satisfied all of the patient’s desires and was done in a timely and conservative manner (Figure 15).

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