Smile makeover using minimally invasive multidisciplinary approach

By Dr Nadeem Younis


In this case, a female patient in her late 30s came to the practice to address her following concerns: moderate upper anterior crowding, a discoloured upper left central incisor, and defective composite restorations in the upper central incisors (Fig. 1).

Unhappy with the overall aesthetics of her smile, the patient was keen to undergo a smile makeover using a minimally invasive treatment approach.

To help ensure the patient make an informed decision, several treatment options were discussed including orthodontics, tooth whitening, composite resin restorations, and ceramic veneers.

After consultation, the patient chose the more conservative option of composite restoration, following comprehensive orthodontics and tooth whitening.

By opting for the less intrusive – and also more cost effective – process of alignment, bleaching and bonding, all of the patient’s concerns were addressed safely and effectively.

Fig. 1: Patient’s pre-op occlusion
Fig. 2: Pre-op smile
Fig. 3: Pre-op intraoral view

Alignment and bleaching

The upper anterior crowding was resolved by using a removable appliance to expand the arch followed by a conventional fixed appliance to align the anterior labial segment. The orthodontic treatment took approximately 12 months (Figs. 2-3).

Once the anterior crowding had been remedied using conventional fixed appliances, tooth whitening was carried out on the upper left incisor using the inside/outside technique to correct the internal discolouration.

For this, an Essix retainer was used with 16% carbide peroxide gel with instructions given to wear the tray at all times for three to five days while changing the whitening gel twice a day (Figs. 4-5).

After five days of whitening, the access cavity of the upper left central incisor was sealed. Then, the patient was instructed to wear the tray at night-time only while using whitening gel to whiten the rest of the upper arch (Figs. 6-7).

When the satisfactory shade was obtained, there was a pause in treatment for three weeks prior to restoring the central incisors with direct composite resin restorations. This will allow the oxygen to dissipate from the teeth, which would otherwise have interfered with the bonding process.

Fig. 4: Prep for inside/outside whitening
Fig. 5: Essix retainer used for whitening
Fig. 6: Inside/outside whitening post-op
Fig. 7: Upper arch whitening post-op

Continue reading here. Published in Dental Asia January/February 2021 issue.