CASE PRESENTATION
Turning a Blurry Start into a Stellar Finish in the COVID-19 World
It’s no secret that practices across the country have been forced to adapt their business models to meet the current COVID-19 situation. In our offices, for example, we now take extra care pre-screening our patients and carefully executing infection control protocols. Similarly, patients are adapting their approach to dental treatment, too, by trying to accomplish more virtually than I have seen in over 30 years of practice.
Case in Point
This case began when a patient sent me an email with a blurry selfie picture asking what I could do to improve his smile (Figure 1). We all know how difficult it can be to take a good selfie, and a blurry resolution definitely makes diagnosis more challenging. So, I emailed the patient some options, including orthodontics, veneers, implants, and bridges, but told him honestly that it was hard to tell which treatment would be best without a comprehensive examination. This would allow me to discuss the options in detail so he could make an informed decision. He agreed, and I had an opportunity to see him in person and learn more about what he envisioned.
During the consultation, I discovered his main concerns were the alignment of his front teeth, their color, and the gap between them (Figure 2). The patient also lived a few hours away, so he wanted to do the treatment in as few visits as possible. The treatment we elected to do that met his criteria—esthetic, conservative, and fast—was to do at-home tooth whitening and then direct composite restorations. I told him the results would not only be very esthetic, but minimally invasive, and I felt confident we could meet his desires.
His teeth were a VITA A3 shade, so we had him whiten his teeth at home first, which took him to B1. We then waited a couple weeks before doing the cosmetic bonding (Figure 3).
A rubber dam was placed to protect the tissue and hold down the interdental papillae. Using an abrasive blaster (MicroEtcher CD, Zest Dental Solutions) and a 27-micron aluminum oxide abrasive, the teeth were cleaned, roughened, and the hypocalcified tooth structure was removed (Figure 4).
The teeth were etched and a universal adhesive was placed (PreludeOne, Zest Dental Solutions), thinned, and cured. Using matrices, we placed, sculpted, and light-cured a B1/A1 flowable and sculptable composite (ZNano, Zest Dental Solutions) (Figure 6). I like to use a large H284K-021 carbide bur (Figure 7) when possible to efficiently remove the flash and polish the composite, while leaving some of the surface texture needed to properly reflect the light (Figure 8).
Conclusion
While this case may have began with a blurry start, the results made for a stellar finish that met all the patient’s desires. Because we used air abrasion to clean and prepare the teeth, as well as to enhance the bond strength and chameleon properties of the ZNano composite, treatment did not require anesthetic. Using a composite material like ZNano that has great handling and polishability was essential to achieving an esthetic result. In the end, we were able to place very simple direct composite restorations in one visit (Figure 9). The patient’s comment to us when we gave him a mirror was, “I love my smile.” Mission accomplished.
Go-To Product Used in this Case
A shade-adaptive universal nanocomposite, ZNano offers easy, nonsticky handling and good polishability in a wide range of indications, including all classes of direct restorations, composite inlays and onlays, reconstruction of damaged teeth, diastema closure, and shade correction. The light-cured, resin-based composite material simplifies the shade selection process by balancing the chroma and value of one hue with another—for example, A1 with B1. It is dispensed in a 0.2-gram unit dose tip or 4-gram syringe.
MICHAEL A. MIYASAKI, DDS
Dr. Michael A. Miyasaki is a 1987 graduate of the University of the Southern California School of Dentistry. With 3 decades of teaching experience, he enjoys leading livepatient treatment courses, which he does with the Pacific Aesthetic Continuum and Myotronics. His goal is to increase the success of his colleagues and improve outcomes for a lifetime of dental health for their patients.
