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white Dental Beauty Case: The No-prep Approach. When And How? By Stefan Koubi

No-Prep Veneers have changed the way we think about cosmetic dentistry.

Not only can they be an excellent option for post orthodontic treatment, but they can also assist with smile design corrections.

Prior to treatment, it is important to consider the end goal for the case, considering the patient’s desires.

Often, patients are seeking a brighter, whiter smile – as the demand for whitening rises.

In this clinical case, Stefan Koubi presents “The No-Prep Approach”, bleaching the patient’s teeth before starting the case to increase the aesthetic integration of chips.

The whitening system of choice in this case was White Dental Beauty, using a strength of 5% Carbamide Peroxide.

Profile Picture ImageStefan Koubi: The No-prep Approach. When and How?

Dr Koubi is the author of various national and international publications and reports. He has lectured internationally on the topics of aesthetic dentistry, smile design, wear and erosion. 

He graduated from the Marseille University School of Dentistry, France, where he now holds the position of associate professor. Dr Koubi opened a private dental practice in Marseille in 2002. He is also the founder of L’Institut de la Facette, a training centre focused mainly around the science of laminate veneers in the cosmetic and functional field. In addition to being a speaker for more than 250 national and international lectures, Dr Koubi also won the title of 'Best Lecturer of the year in France' in 2011.

No-Prep Protocols

Indications for no-prep protocols are quite strict and may be summarized as follows:

  • Post orthodontic treatment needing some small improvement
  • Minor smile design corrections (embrasures, diastemas, etc...)

Nowadays, the no-prep concept is popular, but in order to plan correctly the practitioner should have a precise idea of dos and don’ts.

This article hopes to highlight the use of chips in aesthetic treatment.

Tips for this case:

  • Basic way of producing the restoration in the lab: press and polish
  • Bleaching was undertaken before starting the case to increase aesthetic integration of chips – bonding sequences start with chips first and laminate afterwards.

Initial Review

Initial situation (Fig 1.)

Intra-oral view: note the low value of the colour, diastema between 11 and 21 and the narrow shape of 12 (Fig 2.)

Occlusal check: incisal edge must be reduced during preparation to allow sufficient thickness of incisal ceramic (1.5 mm) (Fig.3)

Analysis of the shape (Fig 4.)

Intra-oral view of upper arch (with flexipalette). Decision process should focus on the design of the augmentation of white tissue (Fig 5.) 

 

First Steps & Whitening

A mock-up is created with chemical cure composite (Luxatemp Star, DMG) to visualise the aesthetics. Of course the final result must fulfill biological and functional criteria. (Fig 6.)

Laminate veneering is chosen to enhance tooth 12 (Fig 7.)

After bleaching with 5% carbamide peroxide (White Dental Beauty, Optident), slight preparation is performed to follow prep-less concept in order to visualise the cervical margin. Increasing the colour value is key to improving aesthetic integration and imitation of restorations (Fig 8.)

 

About White Dental Beauty

White Dental Beauty has a range of high quality tooth whitening gels includes 6% hydrogen peroxide and 5% 10% & 16% carbamide peroxide with NOVON, providing great versatility and clinical freedom to whiten patients’ teeth with as little as 30 minutes a day active treatment. Powered by NOVON, which uses an intelligent pH acceleration for maximum whitening effect, speeding up the whitening process whilst still being highly effective. 

NOVON is a new, patented whitening compound that comprises hydrogen peroxide, urea and sodium tripolyphosphate and is the active ingredient in a new generation of tooth whitening gels. NOVON has a unique inherent feature in that, on application, it produces a ‘pH jump’ into the alkaline pH range. This ‘pH jump’ enhances the release of perhydroxyl ions which give a faster whitening effect. NOVON – containing gels can therefore produce a similar whitening effect within a shorter timeframe, in comparison to whitening using a regular gel. Alternatively, within the same time frame, a similar level of whitening can be achieved using a lower concentration of NOVON (Hyland et al., 2014). This should be an advantage to patients with sensitive teeth. 

NOVON has 4 options for home bleaching:

  • 6% Hydrogen Peroxide from as little as 30 minutes a day
  • 16% Carbamide Peroxide from as little as 60 minutes a day
  • 10% Carbamide Peroxide 2-4 hours overnight
  • 5% Mild Carbamide Peroxide 2 hours a day

As mentioned previously, in this case, White Dental Beauty 5% carbamide peroxide was used. 

Next Steps

A no-prep approach was chosen for teeth 11 and 21 (Fig 9.)

No-prep restorations are made with e.maX press and then polished. No stain is required. (Fig 10.)

Note the opalescence of the material. (Fig 11.)

Try-in of the three restorations with glycerine paste (Vitique veneer B1, DMG ) (Fig 12.)

Individual dam (Nictone 212, Hu-Friedy) (Fig 13.)

Placement of the chip prior to laminate veneer. Margins are polished with silicone wheel using a low-speed handpiece. (Fig 14.)

Use of Optrasculpt pad (Ivoclar Vivadent) with a soft pressure on the restoration (Fig 15.)

Individual dam for bonding of the laminate after the chip, because it is less fragile (Fig 16.)

Same procedure for the placement of the laminate veneer on tooth 12 (Fig 17.)

Optical integration of both restorations (Fig 18.)

 

Review

Close-up of the lateral (Fig 19.)

Final result (Ceramist, Gerald Ubassy) (Fig 20.)

Before and after (Fig 21.)

 

No Prep Restorations

No-prep restorations can be very useful in contemporary treatment planning as they are able to solve some everyday cases. However, it is important to integrate this type of restoration into a basic workflow in which it is simple for both the technician and the dentist to achieve in a feasible and repeatable way.

The role of the dentist as a smile architect is fundamental in order to visualise the ideal pink/black/white ratio for top quality aesthetics and biological preservation.

Koubi - Before & After (7)

White Dental Beauty Teeth Whitening Gels are specifically formulated, packaged and delivered with your patients in mind, ensuring you have everything you need to offer them a successful whitening treatment. 

White Dental Beauty's whitening products are available worldwide from your local distributor including Optident for the UK. To order in the UK visit the White Dental Beauty manufacturer page or call +44 (0) 1943 60 50 50. 

Become a Leader in Professional Tooth Whitening - White Dental Beauty

 

 

 

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