Rebuilding Self-Esteem: Esthetic Rehabilitation in a Young Patient Using Injectable Composite Resin Technique

A 23-year-old female patient presented dissatisfied with her smile esthetically, associating it with low self-esteem and a negative impact on social interactions. Clinical and radiographic examination revealed retained primary teeth in the maxillary premolar regions associated with agenesis of the permanent successors, indicating the need for definitive rehabilitation through orthodontics followed by placement of osseointegrated implants. The patient, however, declined the proposed plan primarily due to the extended treatment duration and the need for surgeries. Therefore, a conservative, interim approach was selected aimed at providing immediate esthetic rehabilitation while preserving the deciduous teeth until their physiological exfoliation and postponing orthodontic and implant therapies until a more appropriate time. After 2 weeks of supervised vital teeth bleaching for color stabilization, digital smile design was performed, followed by a diagnostic wax-up and intraoral mockup to validate the proposed esthetic and functional outcomes. Following patient approval, the restorative phase was initiated. Relative isolation of the operative field was achieved, and the adhesive system BeautiBond® Xtreme (Shofu, shofu.com) was applied according to the manufacturer’s instructions. The injectable composite resin technique was used for reanatomization of the dental elements, utilizing a silicone index fabricated from the diagnostic wax-up. Beautifil Flow Plus® (Shofu) restorative material—shade B1 for the maxillary arch and A2 for the mandibular arch—provided optimal shade matching and natural esthetic integration.

KEY TAKEAWAYS

• The use of retained deciduous teeth as a provisional foundation can allow for clinical time management, preservation of tooth structure, and rapid, minimally invasive esthetic improvement even in cases where the ideal treatment plan may entail orthodontics and implant-supported rehabilitation.
• The injectable flowable composite technique, using a silicone index, provides excellent adaptation, accurate reproduction of the planned anatomy, and optimization of clinical time, often enabling completion in just a few appointments. Clinical outcomes typically offer immediate improvement in smile harmony, helping to positively impact patient self-esteem.
• Materials such as Beautifil Flow Plus offer suitable mechanical properties, superb esthetics, and added biological benefits through Giomer Technology, with ion release that helps control plaque, neutralize acids, and prevent secondary caries.

Figures and Images

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Figure 10

Figure 11

Figure 12

Flavio Henriques, DDS, MS, PhD

Figure 1

Initial smile showing maxillary lateral incisor agenesis, dental misalignment, and retained primary teeth in the maxillary first premolar areas. Anterior incisal wear due to the absence of anterior guidance was evident.

Figure 2

Initial smile showing maxillary lateral incisor agenesis, dental misalignment, and retained primary teeth in the maxillary first premolar areas. Anterior incisal wear due to the absence of anterior guidance was evident.

Figure 3

Pretreatment frontal occlusion view.

Figure 4

Pretreatment lips in repose.

Figure 5

A wax-up was performed (top) to allow a smile test drive (bottom), during which esthetics, phonetics, and the functional behavior of the teeth were evaluated.

Figure 6

Teeth bleaching was performed to improve the esthetic outcome of the composite restorations, since the resins used present a certain degree of translucency.

Figure 7

Post–teeth whitening.

Figure 8

Injection of the flowable resin (Beautifil Flow Plus, shade B1) into the transparent matrix on the maxillary arch after adhesive application.

Figure 9

Shade A2 (Beautifil Flow Plus), rather than B1, was used to restore the mandibular arch due to the mandibular teeth returning to their original color after teeth whitening.

Figure 10

Final result of the maxillary and mandibular arches, highlighting proper dental alignment and restoration of balanced esthetics. The minimally invasive, highly predictable treatment was completed in two clinical sessions, providing significant improvement in tooth morphology, volume, and proportional harmony.

Figure 11

Completed case demonstrating a beautiful, youthful smile. The high-quality composite resin material mimicked the natural teeth color. The clinical outcome demonstrated immediate enhancement of smile esthetics and function, with a positive impact on the patient’s self-esteem and successful reintegration into the workforce.

Figure 12

Post-treatment full-face smile, demonstrating the patient’s satisfaction and the beauty and natural appearance of the completed esthetic rehabilitation. The patient was informed about the interim, provisional nature of the treatment, particularly regarding the retained deciduous premolars and their eventual exfoliation or replacement. She was also advised of the future need for definitive rehabilitation in accordance with the initially proposed treatment plan.

Flavio Henriques, DDS, MS, PhD

Associate Professor, Fluminense Federal University – Niterói, Rio de Janeiro, Brazil; Private Practice, Rio de Janeiro, Brazil