A “Simple” (but not easy!) Cosmetic Bonding Case

Taking a brief break from the Coronavirus hysteria (I’m not done!) to post some dentistry.  A friend just boldly posted on Facebook:  “Stay home. Close your business. Don’t go out. Live in fear….  No thanks!”

Me, neither!  I did this case today.  It had been planned for months.  Patient is a young woman who has some congenital dental issues.  She has had cosmetic bonding done twice before.  Her chief complaint was the appearance of teeth #s 6, 7, and 10.

#6 is mesially tilted and rotated.  #7 is a peg lateral (as you’ll see).  #10 is actually #11.  The tooth in position #11 is a retained deciduous canine. 

We talked about all options including ortho and veneers.  She wanted minimally invasive and “minimally expensive” treatment.  She asked if I could JUST re-do the bonding.  I sure can!

Here are some side views:

Here’s a close-up of #s 6 and 7.  Pretty, eh?

Here’s the occlusal view, which reveals the size discrepancy between #s 7 and 10.

I took an impression, so I could play with it in the lab and do a wax-up and then make a SilTec putty matrix.

Nothing fancy… just trying to get an idea of what I can do.

The patient wanted to whiten first, which took her from an A-1 to about an 040 bleach shade.

Today she came in for the restorative part.  Honestly, I did not anticipate the amount of time it would take to remove the old bonding carefully while being minimally invasive.

Here’s the “before” and after carefully removing the old composite material from #s 6 and 7.  How do you like that lateral??  😮  Yowza!

Here we go!  I felt the KEY to this case was getting #7 looking decent FIRST.  I used the putty matrix to get an initial incisal edge shape.

Voila!

Fill in the blanks, build it up, and #7 takes shape!  Not bad! 

Then on to #6!  I used the matrix the same way.  OK… not bad. 

I forgot to get a photo of #10 stripped of the old composite.  But, once I did, it was a perfect canine (actually a mesialized #11).  I flattened the prominence on the central part of the facial and made the incisal shape to mimic a lateral incisor.  I curved the distal incisal corner to try to create an optical illusion of being more narrow. 

Here’s the final result of all three restored teeth:

She’ll be back for some minor tweaking next week.  Overall, a decent result, considering the limited approach.  We may come back and try to do something with the deciduous canine in position #11.

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