Anterior rehabilitation involving dental bleaching, frenectomy and composite resin: a case report

ABSTRACT This clinical report describes the treatment of a patient dissatisfied with the esthetics of the smile due to the presence of narrow teeth, yellow and the presence of diastema between teeth 11 and 21. Clinical examination revealed absence of the disocclusion guides. The treatment plan consisted in obtaining study casts, assembly in a semi-adjustable articulator and diagnostic waxing, to evaluate the possibilities of a restorative treatment. After the approved the viability of the procedure, dental bleaching was started in-office with 38% hydrogen peroxide associated with at-home bleaching with 15% carbamide peroxide, in order to reduce the yellowing of the teeth. Afterwards, the functional evaluation of the restorative procedure was carried out through the prior preparation of the mock-up. After functional approval of the mock-up, lip frenectomy was performed, since the frenulum is the cause of the diastema between the teeth 11 and 21. After 4 weeks was carried out the restorative procedure of teeth 13 to 23, with direct composite resin, improving the aesthetics of the smile and restoring the disocclusion guides.

摘要（ABSTRACT）：本临床报告详述了1例因牙体窄小、牙齿泛黄且11号与21号牙之间存在牙间隙，而对微笑美学效果不满意的患者的诊疗流程。临床检查显示患者缺失咬合引导（disocclusion guides）。本次治疗方案首先制取研究模型（study casts），将模型安装于半可调式咬合架（semi-adjustable articulator）并制作诊断性蜡型（diagnostic waxing），以评估修复治疗的可行性。确认该诊疗方案可行后，启动牙齿漂白（dental bleaching）治疗：采用38%过氧化氢行诊室漂白，联合15%过氧化脲行家庭漂白，以改善牙齿泛黄症状。随后，通过预先制作美学模拟修复体（mock-up）开展修复治疗的功能评估。待美学模拟修复体通过功能验证后，实施唇系带切除术（lip frenectomy），因系带为11号与21号牙间隙的致病诱因。术后4周，对13号至23号牙采用直接复合树脂实施修复治疗，既改善了微笑美学效果，又重建了咬合引导。