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 本临床报告描述了1例因牙齿窄小、色泽黄染且11号与21号牙间存在牙间隙（diastema）而对微笑美学效果不满意的患者的治疗过程。临床检查显示患者无咬合引导（disocclusion guides）。治疗方案首先制取研究模型，将其装配于半可调牙合架（semi-adjustable articulator）并制作诊断蜡型（diagnostic waxing），以评估修复治疗的可行性。在该操作的可行性获得确认后，先采用38%过氧化氢行诊室牙齿漂白（in-office bleaching），联合15%过氧化脲行居家牙齿漂白（at-home bleaching），以改善牙齿黄染问题。随后，通过预先制备的试戴模型（mock-up）对修复治疗方案进行功能评估。在试戴模型通过功能评估后，实施唇系带切除术（lip frenectomy），因系带为11号与21号牙间牙间隙的致病因素。4周后，采用直接复合树脂（composite resin）对13号至23号牙实施修复治疗，改善微笑美学效果并重建咬合引导。