Dr Rajiv Ruwala qualified from King’s College London in 2008. He is a Principal Dentist and Facial Aesthetics Practitioner, and currently runs 2 Green Dental Practice in Dartford. He offers surgical dentistry including implants and gum grafting surgery, as well as smile makeovers, orthodontics, and general dentistry. Rajiv is dedicated to teaching. He has received a PgCert for Dental Education from the University of Bedfordshire, and has offered training and education through the London Deanery, King’s College Dental Institute, and BDA.
Here, he presents a restorative case in which the patient was provided with dental implants, bridge work, and composite bonding to improve her overall function and aesthetics.
Patient background
A patient presented to the practice seeking improvement in her smile aesthetics. She didn’t like the gaps in between her teeth, and wanted to improve the colour too. Overall, her oral health and hygiene was good, and she had existing bridgework from UL3 to UL7.
Assessment and diagnosis
To assess her suitability for restorative treatment, a Basic Periodontal Examination (BPE) was carried out. This found BPE scores of 000 in her upper dentition, and 020 in the lower. Radiographs were also taken, which came back clear. The patient had a missing lower posterior tooth (LR5), and the site was suitable for implant placement.
Treatment planning
During the treatment planning stages the patient was presented with a number of options which might have been suitable for her situation. As always, the patient had the option not to proceed with any treatment, however, she was looking to improve her smile aesthetics, so this was not the best course of action for her.
The possibility of composite veneers was discussed, as well as porcelain veneers. Composite bonding was another appealing option, particularly in the anterior region. In addition to restoring the anterior teeth, plans to replace the bridge work with a zirconia option were discussed.
Further to this, the option of a dental implant was discussed, to replace the missing lower posterior tooth. Despite it being an invasive treatment type, the patient was happy to go forward with this, as it would improve her long-term aesthetics and function.
Treatment provision
To begin with, a dental implant was placed in the lower posterior region (LR5), in a standard surgery that observed no complications, and the patient was given clear and personalised oral hygiene instructions to keep the site clean. She was monitored closely over time to ensure that the implant site healed as expected. Following this, the patient’s existing bridge work was removed and a temporary bridge was created. SmileFast was used to create a digital design of the patient’s smile, this included plans for the posterior section. The digital plan was used to fabricate a SmileFast stent, which would guide the placement of composite on the UL2 to UR4 all at once. The stent was trialled in the mouth to ensure a good fit. In this case, BRILLIANT EverGlow™ composite from COLTENE was used in shade Opaque Bleach (OBL). BRILLIANT EverGlow™ was heated to 65°C and placed inside the stent, which was then positioned onto the teeth. The material was light cured through the stent, which was then removed. The teeth were polished, to produce a nice finish.
Subsequently, the patient was provided with zirconia bridgework from Simplee Dental Ceramics, Brentwood, which was a good colour match for the composite, and the dental implants which were placed earlier were restored.
Outcome
Overall, the patient and I were happy with the treatment outcome. This was my first time using the BRILLIANT EverGlow™ composite shade OBL, and it was slightly lighter than I had anticipated. I chose it as its colour stability is very good, and it offers good colour matching to materials like porcelain.
After some time, the patient returned to the practice requesting that the spaces in between her upper anterior teeth were made slightly larger. While this was, initially, something she disliked about her smile and wanted to change, she felt that she would feel more like herself with slight gaps.
The implant site healed as expected and the patient experienced no complications concerning this aspect of her care.
Case appraisal
My main take away from this case was the importance of digital planning and trial smiles. While the patient was happy with closing the spaces between her anterior teeth initially, she did change her mind once the final treatment was complete. It’s important to offer patients all of the information they need to provide informed consent.
COLTENE offers a wide range of restorative products to help dentists and their patients achieve high-quality functional and aesthetic outcomes. The range includes the BRILLIANT EverGlow™ composite material which is available in an array of shades including dentine shades and the brightest white bleach shades. BRILLIANT EverGlow™ and BRILLIANT EverGlow Flow™, a flowable composite based on the same advanced filler technology, offers excellent colour stability thanks to low water sorption, ideal for producing long lasting aesthetic outcomes.
For more information, visit https://colteneuk.com/BRILLIANT-EverGlow
email info.uk@coltene.com or call 0800 254 5115
