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• Day four: Creation of teeth resins LL3, LL2, LL1, LR1, LR2 and LR3.
The following step was the occlusal adjustment of the restorations
and protrusive guides, so the occlusal relations were re-established
harmonically with the other teeth and the physiology of the masticatory
system.

• Day five: Final finish, fine or extra fine-grained drills and polishing
with sanding discs, rubber bowl and felt discs. Thus, the rehabilitation
protocol was finalized (Figure 9), observing the initial and final case
with restoration of aesthetics, function and dental structure.

The dental substrate treatment was done with 35% phosphoric acid
(Ultra Etch, Ultradent) for 15 seconds and was subsequently flushed
Fig 8: Added composite resin in the lower posterior teeth. Note the with a water jet. The adhesive system was then applied (Single Bond
severe dental loss of the lower arch, in addition to the vertical overlap Universal, 3M).
that also guides the limit of the added resin in the occlusal Relative isolation with a retraction wire initiated the replacement
of increments of composite resin of UR1, UR2, UR3, UR4, UR5, UL1,
UR7, UR6, UR5, UR4, UL4, UL5, UL6 and UL7 - to reduce overbite by UL2, UL3, UL4 and UL5 with the resin colour BL (Empress) Photo
increasing the vertical dimension of occlusion (VDO) and create space activation was performed for 20 seconds for each resin increment.
to rehabilitate the palate of the upper anterior teeth. Only what was lost The final result of this case revealed not only an improvement in the
due to dental erosion was restored. smile, but also more harmony in the middle and lower third of the face,
observed in Figure 8; in addition to the patient’s report of improved
• Day two: The resin reconstruction of UR3, UR2, UR1, UL1, UL2 chewing quality and muscle comfort.
and UL3 was done in this session. The measures used were the ones
defined by the ‘rule of 20’ and approved by ‘wish smile’ at the initial Discussion
appointment (Figures 6 and 7) The first appointment, besides providing important diagnostic data,
will also help to define the future of aesthetic and functional treatment.
• Day three: The posterior inferior resins were done: LL7, LL6, LL5, Organized case planning includes intraoral and extraoral photographs,
LL4, LR4, LR5, LR6 and LR7. This session showed how important it radiographic tests, diagnostic model studies, and face and smile
is to increase the occlusal surface of the teeth to balance the vertical measurements (Baratieri and Guimarães, 2008; Fradeani and Corrado,
overlap to make the occlusal addition of 3mm. Additionally, the canine 2006).
guides served as a valuable reference for defining the required increase Constantly searching for aesthetic results has led patients to look
(Figure 8) at dentistry as an important ally in this process. The planning goes far
beyond making the teeth with precise anatomical details, it needs to be

MY TAKE Another misconception is the use of non breakable and very hard
Dr. Nikhil Bahuguna materials to restore teeth which naturally can undergo physiologic
aging and attrition or breakage under loads.

Teeth go beyond smiles. Dental rehabil- The author in the current article has beautifully explained the role
itation is many a times associated only of creating the right structural balance by rehabilitating the vertical
with smile correction and is sought by dimension and also the function.
the patients for mainly esthetic needs. The use of conservative resin materials can also be justified
considering the load distribution and effective translation thereby
The role of teeth expands far beyond stabilizing the Joint-Muscle-Teeth apparatus.
just chewing and smiling.
They are the foremost structures that
create and stabilize a proper balance
of the stomatognathic system. The loss Dr. Nikhil Bahuguna. MDS. Conservative dentistry and Endodontics.
or wear of tooth structure not only Fellow - American Society for Dental Aesthetics.
affects function, it also has a serious Diplomate - American Board of Aesthetic Dentistry.
bearing towards the entire body fascia Maintains a private practice in Noida - Demystifying Smiles.
from skull to digital extremities. Practicing since 2004

Dental Practice i November-December 2023 i Vol 19 No 6 17