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    How to perform minimally invasive cosmetic bonding

    Dr. Ross Nash outlines how delivering esthetic results without causing discomfort is possible — with the right technique.

    A young man presented with a central diastema, which he desired to close.

    The lateral incisors were slightly malformed. Though orthodontic treatment was considered, cosmetic bonding was selected by the patient for its immediate effect. In addition, with cosmetic bonding, tooth contours and shade could be controlled.

    My experience tells me that 10 years is a reasonable life expectancy for a direct composite veneer. The patient was happy with the plan to place direct composite resin veneers for the maxillary central and lateral incisors.

    Figure 1 four maxillary anterior teethFigure 2 tissue contouring

    Fig. 1                                                                                                              Fig. 2

    Figure 1 shows the patient’s four maxillary anterior teeth before treatment. To improve tissue heights, tissue contouring was achieved using a diode laser (Picasso dental laser, AMD Lasers) as shown in Figure 2.

    Figure 3 Facial contouringFigure 4 Incisal contouring
    Fig. 3                                                                                                                Fig. 4

    Facial contouring to correct for slight rotation of the right central incisor was accomplished with a fine diamond bur (878KF012, Alpen) (Fig. 3). Incisal contouring was also accomplished with the same bur (Fig. 4). The minimally-prepared teeth are shown in Figure 5.

    I chose BRILLIANT EverGlow®, a universal composite of the latest generation of nano-hybrid composites by COLTENE. It was developed with a special focus on high, long-lasting gloss, shade esthetics and handling convenience. The shade assortment comprises three opacities: three opaque masking shades, seven universal Duo Shades suitable for single shade restorations and two translucent shades for optimal enamel imitation.

    Figure 5 prepared teethFigure 6 Etching gel applied

    Fig. 5                                                                                                        Fig. 6

    Figure 8 etched surfaceFigure 7 Gel rinsed
    Fig. 7                                                                                                              Fig. 8

    The right central incisor was isolated using a celluloid strip. Enamel etching gel (Etchant Gel S, COLTENE) was applied for 10 seconds and thoroughly rinsed (Figs. 6-7). The tooth was lightly dried using a water and oil free air/water syringe. The etched surface can be seen in Figure 8. 

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