Esthetic Smile Enhancement With Direct Composite Overmolding
Achieving proper tooth proportions and diastemata closure in a case involving congenitally missing lateral incisors
Jihyon Kim, DDS
Maxillary lateral incisors are the third most common teeth to be congenitally missing among patients. Today, numerous options for replacement are available. In this case, a 36-year-old male patient with bilateral congenitally missing maxillary lateral incisors presented with maxillary cuspids that had been orthodontically repositioned into the lateral incisor spaces and bonded with composite to simulate the contours of lateral incisors. The patient's priorities for smile enhancement included conservation of tooth structure, closure of all diastemata, and attainment of a brighter color.
An indirect restorative approach would necessitate the removal of sound tooth structure due to the path of draw and insertion. Alternatively, a direct restorative method would be the most conservative, but it would be challenging to camouflage the large cuspids to simulate smaller lateral incisors without removing tooth structure. This case was treated using a monolithic direct composite overmolding approach to add volume to the teeth and change the proportions of the patient's smile. The method used an extension of the "snow plough" technique, in which warmed flowable composite was used to wet the tooth and constricted areas then further adapted with warmed regular composite. The effect of injecting two viscosities of composite around a tooth is similar to the effect of crown and bridge impression techniques involving two viscosities of vinyl polysiloxane impression materials. The result is a highly polished monolithic restoration with the potential for improved longevity regarding wear and esthetics.
About the Author
JIHYON KIM, DDS
Injection Overmolding Institute