International Journal of Esthetic Dentistry (EN), 01/2025

Aim: The objective of the present study was to close multiple diastemas. This presents a significant challenge for clinicians, given the esthetic considerations and the need for precise replication of various types of tooth tissue. While direct composite resin layering is a demanding technique, it proves to be a viable approach for reshaping tooth anatomy. This article outlines a sculpting technique designed for anterior composite veneers, emphasizing the importance of marginal ridge reconstruction preceding the enamel buccal increment. Clinical considerations: This report details the clos­ure of multiple diastemas using direct composite resin without any tooth preparation, focusing on extending the lingual shell composite resin layering and subsequently sculpting marginal ridges. A mylar strip was employed to aid in accommodating the composite resin along the length of the marginal ridge. Rubber dam isolation was used, secured with dental floss ties. The final esthetic outcome was achieved through meticulous finishing and polishing procedures. Conclusions: The technique, centered on marginal ridge reconstruction, streamlines the stratification process and significantly reduces the time required for finishing and polishing. While mastering the technique demands practice, its application contributes substantially to achieving both esthetic and functional success, enhancing contact points to avoid gingival inflammation in anterior restorations. Keywords: composite, diastema closure, direct composite resin buildup, recontouring

The Injection Molding Technique (IMT) is a powerful therapeutic option in the restorative field that aims to improve the esthetics and function of the teeth. It is a repeatable and predictable technique that requires a direct/indirect procedure to transform the digital tooth design and the wax-up (analog or digital) into a definitive composite restoration. The traditional technique involves the application of a single layer of flowable composite using a silicone index. With the introduction of the innovative Customized Hybrid Index (CHI), it is possible to use both flowable or heated (thermoviscous) composites, with separate layering of dentin, enamel, and opalescent incisal masses, thus improving the esthetic result compared with the traditional technique. The CHI is a multilayer hybrid stent consisting of a 60 Shore A highly transparent silicone in which composite (fluid or thermoviscous) is injected, a 70 to 80 Shore A silicone used as a distal support, and a thermoformed resin shell used as a rigid outer layer. The holes needed for the injection phase are calibrated according to the type of compule tip or syringe needle used. The purpose of the present article (part 1) is to illustrate the innovative operating protocol for the implementation of the IMT. In the next article (part 2), all the clinical indications relating to this technique, which involves the use of both flowable and heated composites, will be defined and described. Keywords: adhesive dentistry, composite Injection Molding Technique (IMT), Customized Hybrid Index (CHI), esthetic rehabilitations, flowable injection technique, injectable technique, restorative dentistry

Aim: The canine is the tooth that, together with the third molar, presents the highest risk of inclusion: 85% of these teeth are located in the palate and 15% in the buccal area. In most treatment plans, retained canines are driven to extrusion through orthodontic treatment. However, in some cases, for technical reasons or patient choice, it is not possible to perform this consolidated approach. The present clinical report evaluates 10 ectopic canines transplanted in both adults and younger patients with up to 60 months of follow-up. Case description: Two clinical cases are described in detail with accompanying photographs and radiographs. In both of these cases, the retained canine was extracted, the receiving site prepared, a proper socket adapted through the use of implant osteotomy burs, and the canine transplanted into its ideal position. The tooth was fixed to the adjacent teeth for a variable period and healing was uneventful. After 60 months (Case 1) and 24 months (Case 2) of follow-up, the teeth did not show any color variation, the vitality tests were positive, and no signs of periapical reactions were detected. Practical implications: The transplantation of included canines, even with a formed apex, seems to be a successful procedure, although it should be reserved for those cases where an orthodontic approach is not viable. This procedure is able to provide a natural tooth with proprioceptive function, capable of accompanying the natural growth of the patient’s jaws, with consequent eruption together with the adjacent teeth. Keywords: case report, clinical cases, long-term follow-up, retained canine, tooth autotransplantation

The present case report provides a comprehensive guide to treating malpositioned implants with peri-implant mucosal dehiscence in the esthetic zone, a common yet challenging complication in implant therapy. It emphasizes the importance of evaluating implant restorability as a first step. The treatment detailed in this report adopts an interdisciplinary approach, integrating prosthetics, periodontics, and orthodontics. It starts with altering the prosthetic components to promote mucosal margin migration. After soft tissue maturation, a surgical procedure is employed that combines a modified tunnel technique with a connective tissue graft. This is followed by slow orthodontic extrusion to adjust the position of the adjacent teeth, enhancing papillae fill. The process concludes with the stabilization of the periodontal and peri-implant tissue, allowing for the final impressions and cementation of the restorations. Keywords: implantology, orthodontic extrusion, periodontology, prosthodontics, restorative dentistry

Early treatment of uncomplicated coronal fractures is crucial for both esthetic and prognostic reasons. Des­pite the importance of these procedures, current guidelines lack specificity in addressing the reattachment of tooth fragments. The present article aims to demonstrate the process of reattaching a fractured tooth fragment through a case report with detailed images, and to discuss the methodology used, including the critical use of isolation techniques and the introduction of modern advancements in composites and bonding systems. Keywords: adhesive dentistry, restorative dentistry