Shon Hamam, M43

Case 1:

We can see the anterior maxillary teeth: 11, 12, 13, 21, 22, 23, 24. We see that 21 is damage with
an enamel and dentin fracture of the crown with incised border implication (classIV)
In this case, we will take X-ray, vitality test ( but may be false + ), palpation, percussion and
mobility to see if there is any affection of the pulp and if there is luxation or root fracture due to the
trauma.

In this case there is no pulp or root affectation, we will just reconstruct the toot

First, we need to study the aesthetics: there, we are on central incisor so the incisal edge needs to
be irregular or rounded and the mesial edge has to be straight or slightly convex. There we need to
perform minimal tooth preparation with a bevel

-The 1st step is to choose the colour with Vita-pan Classic Shade Guide Shade selection (it must
be accomplished after pumicing and prior to tooth isolation
-Absolute isolatio
-Selective etching (as we have plenty enamel and deep dentin) with adhesive
-We will apply composite with a silicon key as we are in class IV, we will use the technique of
Composite Strati cation (on dentin level it will be more opaque and on enamel level, depending on
the age, we will use different opacity and translucency) and then we will polis

Case 2

We can see the 2nd and 3rd quadrant with a general discolouration
In this case, we will make a indice de placa. There we can see that we have a lot of plaque and
stains so we have to perform a pro laxis and external bleachin

First, we will perform a pro laxis. Then, we will treat the discolouration:
External bleaching: We will choose the colour
then we have 3 options: At home with a custom tray (best overnight)
At the of ce (with isolation
Or both.
They will be made with carbamide or hydrogen peroxide but at different concentrations. During the
treatment the patient must avoid coffee, smoking, everything that can colour teeth

Case 3:

We can see the upper anterior teeth from 13 to 23. We can see that the lateral incisors (12, 22) are
conoidal

In this case, it is not necessary to do an Xray as it’s only an aesthetic treatment

We start with an aesthetic analysis: Shape, Size, Volume, Colour, Texture, Translucency and
Anatomy
Here, we don’t need to remove tissue as we need to enlarge, so we just polish to wear the enamel
surface

-The 1st step is to choose the colour with Vita-pan Classic Shade Guide Shade selection (it must
be accomplished after pumicing and prior to tooth isolation
-Then, we will make an absolute isolatio
-After, a total etching (as we have only enamel) with conventional adhesive
-We will apply composite with a silicon key (useful
-Finally, we will polish and nis
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 Shon Hamam, M43

Case 4:

We can see tooth 11, 12, 21, 22. A discolouration in tooth 11

In this case, we will do a periapical Xray and perform a vitality test and percussion to see if there is
a necrotic pulp or a root canal treatment already performed.
There, we can see that the tooth has been already treated with rct

We need to perform an internal bleaching of the 11:

Firstly we have to check that the root canal treatment is correct, after we have to clean the pulp
chamber, we have to remove 2-3mm of gutta-percha below cemento-enamel junction.

Then, we have to seal (with GIC or Self-etching resin cement) to avoid ltration of the bleaching
agent at the cervical level.

Finally we have 3 type of internal bleaching:

- Walking bleach or internal tooth bleaching: Introduce 35% Hydrogen Peroxide or 10%
Carbamide Peroxide gel, cover it with a cotton pellet or with Te on. The product is renewed
every 3-5 days until reaching the right colour.
- Modi ed walking bleach technique or Inside/Outside: Bleaching gel in a Tray + The access
cavity is left open. In this technique we need to instruct the patient: 6% HP or 10%-16% CP
renewed by the patient during the day every 2 hours + Leave it overnight.
- Non-vital power bleaching (for strongly discoloured teeth): 30–35% HP is placed in the pulp
chamber and potentiated by light (or not). Several applications of 15 minutes of duration are
needed. Review every 2 weeks.

Case 5:

We can see the maxillary and mandibular teeth but we can observe that the teeth affected are 11
and 21 with inter proximal caries that affect the enamel and dentin but without incised border
implication (Class III)

In this case, we take an X-ray, vitality test and percussion to see if the pulp is affect. There, we
results are negative.

We have to clean the caries with minimum cavity preparation and we have to perform a restoration
of the 2 teeth:

-The 1st step is to choose the colour with Vita-pan Classic Shade Guide Shade selectio
-Then, we will make an absolute isolatio
-After, a selective etching with adhesive
-We will apply composite, we will use the technique of Composite Strati cation (on dentin level it
will be more opaque and on enamel level, depending on the age, we will use different opacity and
translucency
-Finally, we will polish and nis

Case 6

We can see the anterior teeth of the maxilla and the mandible with a generalised discolouratio
In this case, we will only effectuate a clinical history to see if it is well a tetracycline discolouration
and clinical exploration. We don’t perform Xray.
There we can see that it’s a tetracycline discolouration
External bleaching: We will choose the colour, then we have 3 options

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-At home with a custom tray (best overnight
-At the of ce (with isolation
-Or a combination at home and at the of ce.
Both will be made with carbamide or hydrogen peroxide but at different concentrations.
During the treatment the patient must avoid coffee, smoking, everything that can colour teeth
The reduction in cervical staining is very slow and it will take an extended time to lighten the area.
The patient will have to perform bleaching for up to a year to remove more of the cervical staining.



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