Anterior Direct Restorations PDF

Anterior Direct Restorations  The purpose of restorative dentistry is to lose tissue due to caries, trauma, etc. physiological and aesthetic properties of teeth and It is the restoration of its anatomical structure. Treatment in restorative dentistry Alternatives have increased with the dev...

Anterior Direct Restorations  The purpose of restorative dentistry is to lose tissue due to caries, trauma, etc. physiological and aesthetic properties of teeth and It is the restoration of its anatomical structure. Treatment in restorative dentistry Alternatives have increased with the development of adhesive dentistry. Lesions in the dental tissue are treated conservatively.  Restorations for aesthetic purposes Direct composite restorations Indirect composite & porcelain veneers All-ceramic crowns  Thanks to advances in adhesive technology and composite resins,  without the need for any form of preparation or some tissue Closing the gaps by applying the composite resin to the tooth surface by removing it,  It has become possible to reshape the teeth.  Caries & Trauma & Tissue loss due to collateral lesions without caries Diastema Deformities Tooth discoloration The Purpose of Minimally Invasive Treatment in Aesthetic Dentistry To be able to protect dental tissue Maintaining gum health Achieving successful results in a short time What does a good restoration depend on? 1- Physician 2- To the method of treatment 3- Material 4- Patient Aesthetic principles in the anterior region Macro Micro  Macro Mini In the resting - Midline position: - Facial triad Komissura level Inter-papillae Filtrum height plane Naso-labial angle Visibility of the upper cutters In the laughing position: Laugh line Dental midline Smile symmetry Buccal corridor Appearing in the laughing field mouth area Lip line  Micro - Proportion of upper power plants - Golden ratio - Incisal embryos - Location of contact points - Color gradient - Surface microstructure - Gum shape - Gingival contour - Gingival embryo - Zenith points - Gingival level  Direct Aesthetic Restorative Materials Composi Glass Resin Kompomer Giomer te resin ionomer modified glass ionomer Material losses in dental tissues A wide variety of restorations are carried out to eliminate it. In the construction of these restorations, different materials are selected for the region and purpose.  Factors influencing the choice of restorative material The characteristic structure of the tooth itself Factors of the material to be used (resistance of the material, wear, residence time in the mouth, technical sensitivity) Dentist factors (skill, experience) Patient's factors (expectation, oral hygiene, habits, extent of restoration applied, socioeconomic level)  Factors related to the characteristic structure of the tooth The amount of substance loss in the tooth Support of dental tissues Localization of the tooth Discoloration of the teeth Dental anomalies  Composite resins have physical and mechanical properties very close to natural tooth tissue today. Due to these materials, we can give a natural dentin and enamel-like appearance on tooth surfaces. 1- colour 2- isolation Selection 3- Preparation 7- Treatment 4- preserva Finishi protocol tion of ng and pulp polishi ng 6- material Application of restorative  5- Aci d- bondi ng  Color selection Before the preparation Under proper light Dentin from slave (Middle triplet is an important criterion) Incisalden enamel  isolation Rubber-dam Teflon tape Cotton bumper Retractor  Preparation Removal of decayed tissue Bizotage preservat ion of pulp calcium hydroxide (Dycal etc.) mineral trioxide aggregate (MTA) resin based calcium silicate (TheraCal) Tricalcium silicate (Biodentine)  For retention, 0.5 mm enamel bevelage is applied. There is no beotage in the palatinal part. Heymann, H. O., Swift Jr., E. J., & Ritter, A. V. (2012). Sturdevant's Art & Science of Operative Dentistry-E-Book. Elsevier Health Sciences.  The root surface is not beveled. Heymann, H. O., Swift Jr., E. J., & Ritter, A. V. (2012). Sturdevant's Art & Science of Operative Dentistry-E-Book. Elsevier Health Sciences.  Traditional cavity preparation with byotage: In cases where old restorations need to be renewed, or It is used if the restoration of large areas is to be made. This cavity shape is most preferred in class III, IV or V restorations.  If there is any defect or bruise, it is included in the cavity. The size of the old or faulty restoration determines the outer boundary of the cavity. The enamel prisms exposed by the biblotage process are roughened more effectively with acid. Acid on the byodated surface, enamel It acts at the maximum rate at the appropriate angle to its prisms. The only difference from the traditional preparation is that the cavity edges limited by enamel are beveled and the composite resin After moving a little to the beveled enamel surface, it is reset is to be finished. Conservatism is basically micro- It is provided by mechanical adhesion, so the tooth structures are preserved.  After some composite is carried to the surface of the composite tooth is finished.  Advantages of the byotage process  The roughened enamel area expands.  By removing the fluorine-rich outer layer of the enamel, the prism tips are exposed and a more effective roughening is made.  The retention of resin increases.  Since there is no need for retention grooves, substance loss is low and A more conservative preparation is prepared.  Edge leakage and secondary caries and discoloration are significantly reduced.  Since the resin is carried to the surface of the beveled enamel, the enamel with resin The line image formed as a result of the end-to-end combination disappears. Surfaces on which the bioraging process cannot be performed:  Due to the lack of little or no enamel and also due to transportation difficulties, it should not be applied to the gingival edges in the aproximal areas.  Thin composite edges of the cavity edges, which coincide with areas of centric contact points and intense chewing forces on palatinal surfaces It should not be done as it may break. Application of restorative materials  Layering Method Method one: After obliquely applying one or two layers of dentin-like composite layer, an enamel-like layer that completely covers the surface is applied. This method is used in class 3 and small class 4 cavities and small shape arrangements.  Second method: It is the technique used in simple cases with a hand-prepared mock-up or in advanced cases with a silicone key (index / matrix) prepared from wax-up.  The first layer, enamel composite, is applied directly on the silicone key.  Single at once Restoration Palatinate (linguali) and Incisal Edge is created.  Dentin composite and effect materials can then be placed in three dimensions.  This method provides suitable conditions for the most suitable aesthetic result, in which we can create natural traslucensi, opacity, halo effect.  Enamel colors  A1, A2, A3.., B1, B2,..  A1E,..., B1E,,,  Light enamel, dark enamel  E1,E2,E3  Incisal edge colors  Translucency  OBN  Ambergris  Clear  Blue  Gray  Dentin colors  A1, A2, A3.., B1, B2,..  A1D,..., B1D,...  Light dentin, medium dentin, dark dentin  D1, D2,.....  UD0,UD1,UD2,.... UD6  Opaque colors  Intensitive milky  Intensive white  Intensive white spot  Illusion perception Mauro Fradeani, Aesthetic Treatment in Fixed Prostheses, Aesthetic Analysis: Systematic Approach to Prosthetic Treatment - Volume 1, Quintessence Publishing Mauro Fradeani, Aesthetic Treatment in Fixed Prostheses, Aesthetic Analysis: Systematic Approach to Prosthetic Treatment - Volume 1, Publishing Quintessence Mauro Fradeani, Aesthetic Treatment in Fixed Prostheses, Aesthetic Analysis: A Systematic Approach to Prosthetic Treatment - Volume 1, Quintessence Publishing DIASTEMA, DIAGNOSIS AND TREATMENT PROF. DR. ŞÖEN GÜNAL  Diastema Diastema has different perceptions according to different cultures and societies. In France, "dents du bonheur" are called lucky teeth. In order to talk about the existence of diastema, There must be a gap of more than 0.5 mm between two teeth The most common type that disturbs the aesthetic perception midline diastema between the maxillary centers  DENTITION - DIASTEMA Diastema in Milk Teeth The important common feature of the primary dentition is that it has diastema. Prediction of crookedness risk in permanent teeth can be determined by diastema in primary teeth. It is more common in the maxilla than in the mandible. Diastema in Permanent Teeth In studies conducted, individuals in societies It is possible to talk about the presence of diastema in at least one tooth in 50% of the patients. In permanent teeth, as in milk teeth, Diastemas are often seen in the maxilla.  DIASTEMA ETIOLOGY 1. Hereditary / Physiological Tooth size - dental arch mismatch Hypertrophic upper lip frenulum Congenital missing teeth supernumerary teeth macroglossia 2. Functional finger sucking baby swallowing long period in infancy using a pacifier Tongue piercing use in adults  3. pathological Pathological growth in the tongue Tooth extractions - missing tooth Delay in tooth eruption Advanced gum diseases can be listed 4. Orthodontic Treatment / RPE (Rapid Palatal Extension) In orthodontic cases where the palatal suture needs to be opened to expand the upper jaw, the maxilla is expanded using the RPE device. Expansion of up to 1 mm per day is achieved through RPE. As the maxilla transitions from V-shape to U-shape, a diastema forms in the upper incisors due to the opening of the midline due to the opening of the palatal suture. 5. Genetic Predisposition Diastema has an ethnic and familial basis and transmission. The presence of diastema is especially common in African/American races.  DIASTEMAS Local (Anterior or Posterior) Can be generalized (Anterior + Posterior)  Diastema 1. Types Midline Diastema The most common type of diastema is seen between the maxillary centers. Midline diastema when the gap between two central teeth is 2 mm or more is called 2. Polydiastema Describes multiple diastemas commonly found on the jaw. The main reason is small teeth from parents due to cross-inheritance. and the removal of large jaw features.  Diastema Diagnosis Comprehensive Oral Diagnosis 1- Comprehensive anamnesis, medical history, family history and clinical observation should be performed. 2- The mesio-distal dimensions of the teeth should be measured by taking diagnostic models if necessary, and determinations should be made for incompatibilities between the teeth and the arch length and the necessary material selection. 3. Blanch Test : In the presence of frenulum, the upper lip should be grasped and pulled outwards. It should be observed how much the color of the soft tissues between the two central teeth and on the palatal side of these teeth has lightened. Blanch Test will reveal the rate of lightening in the tissues, how far the frenulum extends, and how connected the midline diastema is to the frenulum. 4. Parafunctions and harmful habits should be examined 5. Periapical radiography should be taken to examine the presence of a hard tissue defect in the interdental bone due to the frenulum. 6. The presence of pathology in the midline and surrounding soft and hard tissues should be checked by taking a Panoramic Radiograph or Occlusal Radiograph. Diastema Treatment 1- Treatment of Mixed Dentition Diastema Physiological Median Diastema It is seen in the maxillary incisor region at the age of 8-9; It is a temporary, self-correcting malocclusion. It is especially seen during the eruption period of permanent canines. With the eruption of the canines, the lattices become mesialized. Diastema usually closes There is no need for operative treatment 2. Treatment of Developmental/Acquired Dental Defects MICRODONTIA Microdontia is smaller than normal tooth sizes It is an anomaly characterized by teeth. In Down Syndrome and Ectodermal Dysplasia Microdontia is frequently observed MACROGNATIA Macrognathia, a jaw structure that is wider than its normal size It is a developmental anomaly characterized by. Even though the tooth sizes are normal, the jaw Diastema is seen because it is wider than normal In such cases, orthodontic treatment should be preferred initially. After the teeth are brought to ideal/appropriate occlusion and the gaps between them are Orthodontic treatment should be completed after it is distributed evenly and symmetrically, It should be completed with composite build-up and, if necessary, porcelain laminates  Cone-Shaped Dwarf Laterals * Congenital Lateral Deficiency * Extracted Missing Tooth Depending on the lack of lateral or the presence of lateral in cone form Diastema occurs due to the gap in the dental arch. In the presence of cone-shaped dwarf lateral teeth, the laterals are restored with the composite build-up method and the diastema is closed. In case of missing teeth, the implant space is prepared with orthodontics and the implant and prosthesis are used to adjust the size of other teeth if necessary. The smile line is adjusted by adding aesthetic molding and composite 3. Treatment in case of Ectopic Tooth / Mesiodens, Ectopic tooth or mesiodens should be extracted at an early age. 4. Treatment of Midline Pathologies Diastema appears on the midline as a result of pathological formations such as cysts, tumors or odontoma observed in soft and hard tissues. If the cause of diastema is due to midline pathologies Treatment should not be started before diastema-related pathologies are operated on. 5. Treatment in the Presence of Labial Frenulum The presence of fleshy lips and thick frenulum may cause midline diastema. Diastema occurs because there is a muscle layer between the upper central incisors. In cases of diastema originating from the Labial Frenulum, the muscle layer should be thinned and re-sutured to a location closer to the buccal sulcus on the labial side, and following healing, the diastema should be closed.  In Diastema Treatment; There are three main steps in the treatment of diastema: Primarily causing diastema The causative factor must be eliminated After the causative factor is removed The arch should be corrected with orthodontic treatment The possibility of recurrence should be reduced by retention.  Restorative Dentistry; Diastema treatment steps 1-2 and 2-3 comes into play between the wheels of treatment. Diastema, after the cause is eliminated can be closed without the need for orthodontic treatment. After orthodontic treatment and before retention Smile can be arranged by closing the diastema with build-up. DESIGN AND AESTHETICS IN DIASTEMA TREATMENT  AESTHETIC 3 BASIC CONCEPTS IN DENTISTRY - HEALTH (ETHICAL VALUES) - FUNCTION (LOGIC) - BEAUTY (AESTHETICS) No decision taken in treatment can be as personal as the patient's own aesthetic understanding; Whatever standards the physician must address, the patient's own preferences and opinions must also be taken into account  aesthetic Subjective Criteria Objective Criteria External Internal Criteria Criteria Proportion and Harmony Symmetry Golden Ratio; Just as in nature, art, painting and graphic design, a harmony in accordance with the golden ratio appears in the human body. The human eye is so prone to the Golden Ratio; This is due to the fact that he prefers works and structures that are aesthetically suitable for the golden ratio, that he constantly encounters the golden ratio in nature and around him, and that he has the golden ratio in almost every part of his own body.  The Patient's Smile Defects and Aesthetic Desires Should Be Determined, To implement the philosophy of Health - Function - Aesthetics ideal proportions should be known, Examinations should be done carefully Dental Midline The midline of the face is positioned perpendicular to the interpupillary line Ideally, the papillae between the incisors and the midline of the face should intersect. According to research, approximately 70% of the population dental midline coincides with the midline of the face Studies have reported that the maxillary and mandibular midlines do not coincide in approximately 75% of cases. For this reason, it has been stated that the mandibular dental midline is not an appropriate reference in determining the maxillary midline. Since the lower jaw is not in a static position, maxillary and mandibular dental The discrepancy between the midlines will not create an aesthetically disturbing appearance.  Illusion in dentistry is examined under 3 headings. 1. Shaping and Contouring 2. Arrangement of Teeth 3. Coloring 1. Contouring and shaping The most commonly used illusion in dentistry is creating a new line by shaping the tooth. For this, symmetrical teeth can be used and the form of other teeth and the face is taken as reference.  Vertical lines emphasize length Allows less width to be perceived  Horizontal lines emphasize width Allows less perception of height  Creating shadows (Halo Effect) increases depth  Sharp embrasures and lateral edges emphasize length. Soft lines, round lines and surfaces give a feminine expression The roundness of the embrasure and edges reduces the perception of length.  Reducing Width Extra width, especially in cases of diastema closure, contact areas of the teeth can be hidden in the cervical and lingual parts The mesio/distal edge angles may be broken in the 1/3 of the gingival If the angular lines created on the labial surfaces are brought closer to the midline, a narrow labial surface is formed with less light reflection.  Reducing Width When the angles at the mesio-incisal and disto-incisal corners of the teeth are prepared by arching them towards the palatinally, the teeth have a narrower appearance. The same effect is repeated by widening the embrasures. DIASTEMA, DIAGNOSIS, DIAGNOSIS AND TREATMENT II PROF. DR. ŞÖEN GÜNAL  Selection of Materials to be Used in Treatment Developing technologies, developments in resin composite contents and adhesive materials enable restorations to be made while preserving naturalness with a strong connection without damaging the healthy tooth structure. Thanks to the developments in the content of the materials and filler technology, composite restorations can be used aesthetically and functionally in both the anterior and posterior regions.  In diastema closure treatments and anterior area restorations, dentin and enamel structures must be imitated in order to achieve a natural appearance. The layering technique applied with a composite that is suitable for manipulation and consistency is the most suitable method for the construction of natural-looking restorations. Improved polishability and optical properties are also of great importance. Thanks to the developments in filler size and morphology, the resin matrix ratio in the composite material has decreased. In this way, an improvement in polymerization and manipulation and a decrease in polymerization shrinkage were achieved.  Today, many manufacturers produce composite resins containing nano-sized fillers by using nanotechnology in order to improve the mechanical and physical properties of composite materials. Thanks to the increased filler ratio and decreased resin matrix content, the optical, mechanical and physical properties of the materials have improved. The increase in mechanical properties affects hardness, compression/flexural strength, thermal expansion coefficient, water absorption and abrasion resistance.  Today, there are many composite resin materials with different properties on the market. Material selection should be specific to the case and region.  Microfil composites can be used in aesthetic restorations in the anterior region, thanks to their good polishability and color stability. Reinforced microfil composites can be used in the construction of aesthetic and functional restorations in this area, thanks to their increased fracture resistance.  Hybrid composites, especially nanohybrids; Thanks to their advanced color stability, polishability, breakage and abrasion resistance, they can be a suitable option in the front area. Despite the high polishability properties of nanohybrids, microfilter composites still exhibit higher polish and long-term gloss.  Optical properties of materials are also of great importance in imitating natural tooth structure. Different color options (opaque, amber, blue) are available in the newly developed composite resin material sets in order to imitate the structure of the tooth and create natural-looking restorations. In the construction of natural-looking tooth-like restorations, a layering technique should be used in which dentin, enamel color and incisal characterizations can be imitated. COMPOSITES ACCORDING TO THEIR LIGHT REFLECTION INDEX Diastema Treatment Diastema Closure 1. Freehand Technique Current clinical appearance of diastema between teeth 11-21 Color selection appropriate to the composite restoration material to be applied  After etching and bonding application procedures, the tooth surface is made ready for restoration. Etch&Rinse adhesive systems should be preferred. By adding pieces of composite to the mesial surfaces of both teeth, the diastema begins to be closed by adjusting the contours of the tooth.  The composite layer on the labial surface is thinned and placed on the surface using composite modeling brushes and resin-free adhesives. When the diastema between the teeth is almost closed, a transparent strip is placed in between and composite modeling is completed towards the lingual surface.  Diastema Closure 2. FFT (Flowable Frame Technique) In addition to diastema closure, FFT technique also provides successful restorations in cases of corner fractures with diastema. After the transparent strip is placed in the area to be covered with FFT, the process is started by limiting it with a very small amount of flowable composite. Closure of the diastema begins by preparing a framework for one or both teeth on the lingual surface. If the restorations of the teeth are prepared separately, the same procedures are repeated for the adjacent tooth that is the cause of the diastema. Diastema Closure 3. Diagnostic Wax-up fter the measurement stages in the Diagnostic Wax-up technique Wax Modeling / Mock-up / Silicone Key index used Measurements taken from the patient are sent to the laboratory After wax modeling is done, a hard silicone key index and a transparent plate are created with the measurement taken from the model.  Diagnostic Wax-up, Especially minor crowding and preparation required, with ceramic laminates or indirect composite laminates or using resin nano ceramic materials and CAD/CAM It is more frequently preferred in cases that need restoration. In cases to be closed directly with composite It will create insight for both the patient and the physician. Based on the measurements taken from the patient, the smile design that will emerge after the end is first created with wax modeling. With the silicone index prepared with the measurement taken from the model, the area is prepared for the amount of composite to be added to the palatal surfaces of the teeth.  Sample Cases Diastema Closure