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24 cosmetic section DENTAL TECHNOLOGY, JULY-SEPTEMBER 2023

FIG 5a: Installation of ‘wish smile’ facets as a surgical guide FIG 5b: Immediately after surgery

FIG 6: Smile after composite resin on anterior teeth FIG 7: Postoperative upper arch, restoration of all lost enamel and dentin on the
occlusal and palatal face

masticatory system.

• Day five: final finish, fine or extra fine-grained drills and polish-
ing with sanding discs, rubber bowl and felt discs. Thus, the rehabil-
itation protocol was finalized (Figure 9), observing the initial and
final case with restoration of aesthetics, function and dental struc-
ture.
The dental substrate treatment was done with 35% phosphoric
acid (Ultra Etch, Ultradent) for 15 seconds and subsequent flushing
with a water jet. The adhesive system was then applied (Single
Bond Universal, 3M).
Relative isolation with a retraction wire started the replacement
of increments of composite resin of UR1, UR2, UR3, UR4, UR5, UL1,
UL2, UL3, UL4 and UL5 with the resin colour BL (Empress), then the
photo activation for 20 seconds of each resin increment.
The final result of this case revealed not only an improvement in
FIG 8: Added composite resin in the lower posterior teeth. Note the severe dental loss of
the smile, but also more harmony in the middle and lower third of
the lower arch, in addition to the vertical overlap that also guides the limit of the added
the face, observed in Figure 8; in addition to the patient’s report of
resin in the occlusal
improved chewing quality and muscle comfort.
overbite by increasing the vertical dimension of occlusion (VDO)
and create space to rehabilitate the palate of the upper anterior DISCUSSION
teeth. Only what was lost by dental erosion was restored. The first appointment, besides providing important diagnostic data,
will also help to define the future of aesthetic and functional treat-
• Day two: the resin reconstruction of UR3, UR2, UR1, UL1, UL2 ment. Organized case planning includes intraoral and extraoral pho-
and UL3 was done in this session. The measures used were the ones tographs, radiographic tests, diagnostic model studies, and face and
defined by the ‘rule of 20’ and approved by ‘wish smile’ at the initial smile measurements (Baratieri and Guimarães, 2008; Fradeani and
appointment (Figures 6 and 7) Corrado, 2006).
This session showed how important it is to increase the occlusal Constantly searching for aesthetic results has led patients to look
surface of the teeth to balance the vertical overlap to make the at dentistry as an important ally in this process. The planning goes
occlusal addition of 3mm, plus the canine guides are a valuable ref- far beyond making the teeth with precise anatomical details, it
erence for defining the required increase (Figure 8) needs to be integrated into facial harmony (Baratieri and
Guimarães, 2008; Frese et al, 2012; Medeiros, 2013; 2018;
• Day four: creation of teeth resins LL3, LL2, LL1, LR1, LR2 and Mondelli, 2003) and the correctness of dental measurements is a big
LR3. The following step was the occlusal adjustment of the restora- challenge at this point.
tions and protrusive guides, so the occlusal relations were re-estab- The 4D protocol presents a step by- step guide that allows impor-
lished harmonically with the other teeth and the physiology of the tant aspects to be evaluated in the first appointment. The didactic