Initial Assessment and Treatment Planning

The patient had previously undergone tooth whitening and had old composite restorations on the upper lateral incisors, now discolored and stained around the margins. Additionally, one lower anterior tooth displayed a slightly different shade, possibly due to past trauma. Endodontic testing confirmed vitality, with no signs of periapical pathology.

After discussing several treatment options—including orthodontic aligners, porcelain veneers, and tooth whitening—the patient chose a staged approach:

1. Tooth whitening with 10% carbamide peroxide.

2. Replacement of the existing composite fillings using a layered composite technique.

Whitening Phase

• Upper Arch: Whitened over 2 weeks using custom-made trays. The patient reached a B1 shade with no sensitivity.

• Lower Arch: Treated with the same method, although a segmental tray was deemed unnecessary.

• A two-week interval post-whitening ensured proper enamel remineralization and bond strength restoration before composite placement.

Diagnostic Wax-Up and Mock-Up

A diagnostic wax-up of the lateral and canine teeth was created to visualize the new smile design. A clear silicone index was fabricated from the wax-up for mock-up purposes using Luxatemp temporary acrylic. This preview allowed the patient to understand the expected outcome before the definitive treatment.

Shade Selection and Composite System

The composite system used was Ecosite Elements from DMG. This modern material supports aesthetic layering due to its:

• High filler content (~81 wt%, 65 vol%)

• Varied translucency for blending with bleached enamel

• Smooth handling and polishability

Shade selection process:

• Done immediately after isolation using Optragate (Ivoclar Vivadent)

• Prevented dehydration-induced misjudgment

• Selected shades: EB (enhance bleached tone), EL (light translucency), and B1 (base tone for central harmony)

Clinical Procedure

Step 1: Isolation and Etching

• The teeth were cleaned and etched with 37% phosphoric acid (DMG Etch).

• PTFE tape protected adjacent teeth from etching agents.

Step 2: Composite Placement and Layering

• Composite was placed directly into the transparent silicone index.

• The B1 shade was used on the mesial aspect of the upper lateral incisor.

• EB and EL shades were layered to replicate natural lobes and enamel translucency.

Step 3: Silicone Index Compression

• The index ensured accurate shape replication.

• Prevented overhang and minimized polishing time.

Step 4: Finishing and Polishing

• A flame-shaped bur removed excess material.

• Finishing included:

  • Epitex strips for interproximal flash

  • Floss checks for contact point smoothness

  • ASAP polishing spirals (purple and orange) for a high-gloss finish

Final Outcome

The result was a natural-looking, harmonious smile that maintained the integrity of the patient’s enamel. The patient was highly satisfied with the minimally invasive approach, which avoided irreversible preparations like those required for porcelain veneers.

Figure Overview:

• Figure 1–3: Whitening and mock-up results

• Figure 4–10: Composite layering and placement

• Figure 11–12: Final polishing and finished smile

Materials and Scientific Background

Ecosite Elements Composition:

• Barium dental glass fillers

• Bis-GMA resin matrix

• Silane-treated glass for optimal bonding

• Filler sizes: 0.02–0.7 µm for aesthetic texture

This formulation allows customized opacity and translucency, crucial for replicating post-whitening enamel.

Clinical Significance

This case illustrates how modern composite systems like Ecosite Elements enable conservative, aesthetic smile makeovers. By combining whitening with a multi-layered composite technique, clinicians can achieve natural results without sacrificing tooth structure.

*About the Author

Dr. Linda Greenwall BEM is an internationally respected expert in cosmetic dentistry and minimally invasive techniques. Her work emphasizes patient-centered outcomes and the application of modern composite systems in smile design.

Greenwall L. (2021). Composite smile makeover. Clinical Dentistry, 1(6), 27–30.
DMG Dental Materials – Ecosite Elements

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