Clinical cases

French and American have joined the Clinical Laboratory ITENA to present and illustrate the performance of our products in complex clinical cases.

Composite fillings are now the preferred alternative to alloy-based materials. More and more patients are refusing to have any new metallic fillings; some are even asking for their old amalgam ones to be replaced with more aesthetic materials. Composite materials continue to improve steadily, and bonding techniques even more so; this means we can offer our patients dependable, good-looking restorations which last a considerable time – provided certain conditions are met: the right choice of composite, a layering technique which allows guided shrinkage on curing (polymerization), minimum curing stress, proper rebuilding of the contact point and the correct occlusal anatomy.

 

For years, those who teach aesthetic dentistry have given lip service (no pun intended) to the oral and maxillofacial areas surrounding the teeth and the importance of the extraoral soft tissue to aesthetic dentistry. I would like to challenge this thought process and say that we as dental clinicians and educators have been wrong for the last 30 years. The facial soft tissue is part and parcel of aesthetic dentistry and is as important or, dare I say, more important than the teeth in delivering a great-looking smile. Perhaps the patient has beautiful teeth with the new crowns you placed and has maxillary gingival excess (gummy smile); is that all there is to aesthetic dentistry? Maybe you have just placed and restored 6 anterior implants, and then the patient leaves your care with deficient lip volume and radial lip-lines. Is that aesthetic dentistry? What is the purpose of placing 20 veneers if patients cannot show their teeth because they can’t raise their upper lip? In the past few years, with thousands of dentists being trained in the use of nonsurgical, minimally invasive facial injectables, such as Botox and dermal fillers, dental aesthetic and dental therapeutic (temporomandibular disorders, bruxism, myofascial pain), treatment has changed dentistry forever. 

A young patient’s right central and left lateral incisors were devitalized and restored with adhesive composite materials whose appearance degraded with time (Figure 1 and 2). Furthermore, the teeth themselves were stained and their appearance meant that ceramic crowns were fitted. Reconstruction of the devitalized front teeth involved three problems: Fragility of the teeth with a root tenon, insufficiency of root tenon retention proportional to the developed surface and influence on the shade of a full ceramic crown in the same colour as the reconstituted stump. This article presents the answers to the problems by making choices among the range of possibilities that are currently available.

Dr Thomas Lormeau, an expert dental surgeon, is a graduate of René Descartes - Paris V University. He has also undertaken further educational trainings in France, in the United Kingdom and in the United States. Today, he practices from a private clinic in Lyon, France and specializes in implantology and aesthetic dentistry