A college student was unhappy with the results of orthodontic treatment, showing a prominent upper left canine, muscle tenderness, and tooth wear. Previous composite restorations and generalized enamel decalcification were removed conservatively. The erbium laser was used to create a gingival frame and remove remaining affected enamel. Teeth were prepared, acid etched, and bonded with a universal bonding resin and Aura Enamel composite. Finishing and polishing resulted in a uniform color and contours balancing the smile.

1. College student very unhappy with her post-orthodontic results. Among the problems was a prominent
upper left canine. Muscle tenderness and sense of not having a consistent bite, prominent canine, slight
fremitis of Nos. 6-11, and general tooth wear were indicative of occlusal dysfuction.

2. Discolored cervical composites and generalized “white spots” were indicative of a
history of decalcification.

3. Using the Erbium laser in soft tissue mode of 2 Watts to create a better
“gingival frame” prior to bonding.

4. Surface discolorations and previous composites conservatively removed with a flame-shaped
diamond maintaining the outer enamel and creating room for forthcoming layer of Aura.

5. Suspicious decalcifications checked with cavity detection dye

6. Suspicious decalcifications checked with cavity detection dye

7. All remaining “affected” enamel removed with the Erbium laser.

8. Conservative preparation of enamel surfaces

9. Air particle abrasion with a small tip (27 micron Aluminum oxide; 40 psi) has been
shown to greatly enhance the shear bond strength of materials to enamel and dentin.

10. 37% phosphoric acid was placed over the entire labial surface with a 30 second exposure time
(since no dentin was involved) and thoroughly rinsed with water for 15 seconds each.

11. A universal bonding resin was carefully placed using a microbrush and thinned with
a warm air dryer.

12. Each tooth being treated was cured for 20 seconds using SDI’s Radii Plus light with its wide tip. Aura Enamel
(Shade E1) was thinly applied and sculpted using Cosmedent’s Titanium IPCT Instrument placing the gingival
half first blending the interproximal. After a 40 second cure, the incisal portion is adapted to the tooth using
the anatomy of the incisal edge and adjacent anatomy to guide initial contouring.

13. Gross finishing is achieved with a thin 16 bladed ET 9 bur to clean the gingival margins and
establish labial anatomy. Interproximal surfaces were smoothed with plastic finishing strips.

14. Labial surfaces were polished using a series of abrasive disks.

15. Final gloss achieved using a flexible felt disk and aluminum oxide paste.

16. Note the uniformity of color and contours that give the smile better balance and
esthetic harmony.