Esthetic-functional rehabilitation: Orthodontics and restorative approach. A clinical case

Objectives Aim of this paper was to bring the attention to the feasibility of using unconventional and customized dental treatment helped by com­posite materials for direct resto­rations. In this particular case a multidisciplinary dental approach was taken to restore the upper dental arch of a young female with high esthetical demand, specifi­cally an orthodontic nontraditional procedure was carried out to avoid traditional orthodontic appli­ance before to restorations. Materials and methods A 25 years old patient came to our attention – at the Section of Den­tistry and Maxillofacial Surgery of University of Verona – asking for the alignment of the upper central incisors and closure of the diaste­mas present between all the ante­rior teeth of the upper arch. An al­ginate dental impression of both arches was taken and the intra­oral and extraoral photographs re­quired for planning the clinical case were captured. Esthetical parameters and occlusal relation­ship were registered. All records were evaluated and a treatment plan was developed in agreement with functional and esthetical pa­rameters, thereafter the treatment plan was submitted to patient in order to obtain her approval. With her informed written consent, the treatment began. Misalignment of upper central incisors was solved by using two palatal buttons posi­tioned on elements 1.1 and 2.1 and applying a rotational force by means of metallic ligatures acti­vated weekly for three months. Af­ter orthodontics, a diagnostic wax-up was made to better un­derstand proportion and reshap­ing of restorations. A digital previ­sualization of final result was therefore performed using Key­note software (iWork, Apple, Cu­pertino, California, USA) in order to face the esthetical requirements of our young patient. Moreover a silicon index was built, based on diagnostic wax-up, to help the di­rect restoration phase performed using Ceram.x composite resin (Ceram.x duo, Dentsply Sirona, Konstanz, Germany), as a result all the diastemas were closed and reshaping of elements from first left premolar to first right premolar was performed. Results and conclusions The patient was immediately pleased with the final result both from esthetic and functional point of view. She reported to be satis­fied that it was possible to avoid the traditional orthodontic treat­ment and the removal of natural dental tissue. With this in mind it could be advisable to remind that new composite resins, thanks to their high esthetical performanc­es, allow to respect biological tis­sues and to perform mimetic changes of smile. With this per­spective, a clinician could manage each case with a wider approach including different disciplines in order to guarantee the best re­sults to his patients, also in chal­lenging situations. In this particu­lar case it was possible to restore the upper arch in a young girl avoiding all invasive and nonre­versible procedures. Clinical significance This clinical case aimed to bring to the attention the possibility to achieve high-standards oral reha­bilitations in patients with high es­thetical and functional require­ments. This could be possible avoiding invasive procedures, dental tissue removal and pros­thetic definitive rehabilitations. Moreover, this case could be of in­terest because highlights the fea­sibility to use orthodontics in a nonconventional and individual­ized way, especially when the pa­tient does not cooperate and does not accept the traditional treat­ment. Furthermore, the economic cost of a short-term orthodontic procedure and of direct composite resin restorations make more ap­pealing the treatment proposed.