Dental Sales Flyer - October 2022 - Journal - 114

SOLUTIONS FOR
CLINICAL EXCELLENCE
Using Injection Molding Composite
Veneers as a Transitional Guide During
Orthodontic Treatment
I
Megan Shelton
DMD
Dr. Megan Shelton is a
restorative and cosmetic
dentist in Southern
California. Dr. Shelton
attended the University
of Louisville School of
Dentistry. She continued
her education at the Kois
Center and graduated in
2021, which allows her to
predictably treat patients
with complex problems.
She is known as a leader
in the industry for her
implementation of digital
dentistry, restorative
materials, and continuing
education into her private
practice and is now
helping other dentists to
do the same.
t is not uncommon for adolescents to exhibit spacing
in the anterior dentition and this can often be the
motivating factor in seeking orthodontic treatment.
Microdontia, the term used to describe teeth that
are smaller than normal, is frequently responsible for
this spacing and can lead to a Bolton discrepancy when
present in one arch relative to the opposing arch.
When it comes to the management and treatment of
microdontia, we must consider the risk associated with
each treatment option and the patient's expectations
for the esthetic result. Clinical examination of the
patient includes a medical history, examination of the
hard and soft tissues, the patient's chief concern, TMJ
analysis, occlusal assessment, and a full set of diagnostic
photographs. Photos should include a full-face smile, a
repose smile, non-retracted smiles from multiple views,
retracted views, and occlusal views using high resolution
photography. For a more comprehensive analysis, I
recommend mounted diagnostic models using a digital
or facebow transfer.
Evaluation of the photographs to evaluate how the
microdontia impacts the patient's clinical presentation
and correlating the models is critical. Consideration
should be given to how much of the patients teeth show,
the angulation of the teeth, tooth position, shade, as
well as patient expectations. If the microdontia teeth
are treated without orthodontia, the outcome may be
acceptable, but not ideal. If an interdisciplinary approach
with an orthodontist is to be considered, it is imperative
for the general dentist to carefully communicate where
to properly position the disproportionate teeth.
The evolution in composite resins has included ongoing
changes in particle size and shape, handling properties,
and pigments and fillers to try to maximize the
esthetic properties; while complimenting the physical
properties to allow for functional success. Evanesce
Flow (Clinician's Choice), has filler characteristics
that allow it to " disappear " into the tooth structure for
optimal esthetics. Its unique thixotropic properties allow
for improved control, ease of dispersion, and minimizes
slumping on vertical surfaces. The shade and opacity
match to the VITA Classic shade guide has made
Evanesce Flow a viable option for use anywhere in the
mouth, as well as distinguishable on a radiograph for
ease of diagnosis. Esthetic and strong, easy to express
and manipulate, available in the most popular shades
and opacities, Evanesce Flow is the ideal solution to
minimally invasive restorations and a vital component
to your large composite cases.
10 FALL 2022 | CLINICAL LIFE | clinicianschoice.com
CLINICAL CASE
In this case, the patient presented with the complaint
of " my teeth are small and I need braces. " The medical
history was non-contributory. Comprehensive exam
and diagnostic records were taken. It was noted that
the patient had maxillary spacing, narrow maxillary
anterior teeth, a deep bite, with no caries or periodontal
disease present. (FIG. 1)
FIG. 1
Patient presented with maxillary anterior microdontia
and spacing with a deep bite.
Treatment options discussed with the patient and
guardian included orthodontics, Invisalign, followed
by restorative options using indirect bonded porcelain
restorations or direct resin bonded restorations. The
risks and benefits were discussed at length and the
patient elected to improve tooth size and position.
The first step was creating a diagnostic wax up with a
BlueSky Bio Plan to allow for visualization of the result.
(FIG. 2)
FIG. 2
Diagnostic wax-up using a BlueSky Bio Plan.
http://www.clinicianschoice.com
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