Planning extensive esthetic restorations for anterior teeth: use of waxed-up study casts and composite resin mock-ups Adilson Yoshio Furuse, DDS, MSc, PhD n Samantha Schaffer Pugsley Baratto, DDS, MSc n Denis Roberto Falcão Spina, DDS, MSc Gisele Maria Correr, DDS, MSc, PhD n Leonardo Fernandes da Cunha, DDS, MSc, PhD n Carla Castiglia Gonzaga, DDS, PhD The aim of this case report is to highlight the importance of appro- priate planning protocols when direct composite resin restorations are used to solve extensive esthetic problems. A 30-year-old patient complained about her small maxillary anterior teeth and short upper lip. All teeth were healthy and light colored, and the patient exhibited good oral hygiene. The anterior teeth were relatively short, resulting in a compromised esthetic relationship between height and width. The maxillary and mandibular right central incisors were in an edge-to-edge relationship. After diagnostic casts and waxed-up study casts were obtained, occlusal adjustment and recontouring of the incisal and labial surfaces of the mandibular right central incisor were performed to increase overjet. To increase the volume of the upper lip, composite resin restorations were planned for the maxillary anterior teeth. To confirm that the contours and color of the new smile were acceptable to the patient, composite resin esthetic mock-ups were made directly in the mouth before the definitive procedure. After definitive restoration of the anterior teeth, additional occlusal adjustments were performed. At the 36-month follow-up, no fracturing or severe wear of the restora- tions was observed. The restored anterior guidance provided excellent function after 3 years of clinical service. Received: July 30, 2014 Accepted: December 1, 2014 Key words: composite resins, dental wear, esthetics, waxed-up casts T he evolution of composite resin and adhesive systems has contributed significantly to the conservation of dental structure. The dentist can now rehabilitate a patient’s smile with mini- mal or no removal of enamel and dentin. The predictable bond between composite resins and enamel enables direct place- ment of extensive esthetic and functional restorations that, in a not-too-distant past, could only have been obtained through indirect procedures. 1,2 When composite resins are selected for appropriate indications and properly applied, the transformation of a smile can occur within a few clinical hours. The dentist must understand esthetic guidelines as well as the properties of the selected restorative materials. The selection of hue, the mapping of chroma, value, translucency, and opac- ity, and the manual dexterity of the clinician are important factors in the success of treatment. 3-5 Restoration of a tooth involves not only reproduction but also creation, because every patient requires a unique design according to his or her requirements and esthetic standards. To meet the patient’s needs, the clinician must develop the abil- ity to observe the optical properties of the teeth and correlate these aspects with the patient’s age and esthetic and functional needs. The wide range of composite resins available allows the use of different com- binations of color, hue, translucency, and opacity. Details and specific aspects of the restoration can be obtained by layering different composites. 6-8 Layers are used to reproduce the nuances and anatomical details of both dentin and enamel. Use of study casts during treatment planning improves the predictability of the restoration. These initial casts are used to evaluate the occlusal pat- tern, periodontal esthetics, and width and height of the anterior dentition. Waxed-up casts should also be obtained. When extensive esthetic changes are planned, waxed-up casts allow analysis of possible results as well as direct fab- rication of mock-ups of the restorations in the patient’s mouth. The aim of this case report is to demonstrate the use of waxed-up casts and provisional mock-up restorations to improve the predictability of extensive esthetic reconstruction of worn maxillary anterior teeth. A simple, rapid technique for direct stratification of composite resins is also described. Fig 1. When the mandible is in a resting position, the anterior teeth are not visible due to excessive incisal wear. Anterior Composite Restorations e6 January/February 2016 General Dentistry www.agd.org