{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:23:34Z","timestamp":1760235814740,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,2]],"date-time":"2021-10-02T00:00:00Z","timestamp":1633132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Symmetry"],"abstract":"<jats:p>Esthetics is an increasing concern for patients, particularly in anterior teeth. The current approaches to manage the esthetic demands include options such as prosthodontic rehabilitation, orthodontic treatment, and direct restorations. Direct restorative procedures for anterior teeth have become a reliable alternative, since current composite materials can mimic teeth\u2019s esthetics and function perfectly. This article describes two clinical cases of anterior esthetic rehabilitations where the direct reshaping of the four maxillary incisors was performed using the buccolingual layering technique with the help of a silicone index. In Case 1, a diastema closure was also performed, whereas in Case 2, the replacement of old restorations was also carried out. It was possible to achieve excellent final esthetic results in both cases, recovering the smile symmetry, and both patients were satisfied. The literature supports the use of direct restorations in the anterior region with very good long-term prognosis. It is a minimally invasive approach that is reversible, repairable, cost-effective, and when combined with layering techniques and adequate restorative materials, it is possible to achieve good esthetic and functional outcomes. However, regular maintenance appointments are mandatory, and all cases should be carefully planned to ensure predictable and long-lasting results.<\/jats:p>","DOI":"10.3390\/sym13101848","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T01:59:47Z","timestamp":1633917587000},"page":"1848","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Direct Restorations for Anterior Esthetic Rehabilitation and Smile Symmetry Recovery: Two Case Reports"],"prefix":"10.3390","volume":"13","author":[{"given":"In\u00eas","family":"Amaro","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Jos\u00e9","family":"Saraiva","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Ana Catarina","family":"Gomes","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Ana","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9269-5417","authenticated-orcid":false,"given":"Carlos Miguel","family":"Marto","sequence":"additional","affiliation":[{"name":"Coimbra Institute for Clinical and Biomedical Research, Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal"},{"name":"Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, 3004-548 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2924-7926","authenticated-orcid":false,"given":"Ana","family":"Coelho","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research, Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Manuel Marques","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Coimbra Institute for Clinical and Biomedical Research, Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"given":"Anabela","family":"Paula","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research, Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5759-5557","authenticated-orcid":false,"given":"Eunice","family":"Carrilho","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research, Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/jerd.12175","article-title":"Conservative Approach for the Esthetic Management of Multiple Interdental Spaces: A Systematic Approach","volume":"27","author":"Rosales","year":"2015","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.4103\/njcp.njcp_36_18","article-title":"Comparison of two different composite resins used for tooth reshaping and diastema closure in a 4-year follow-up","volume":"21","author":"Ergin","year":"2018","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_3","first-page":"14","article-title":"Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures","volume":"3","author":"Dietschi","year":"2008","journal-title":"Eur. J. Esthet. Dent."},{"key":"ref_4","first-page":"2538526","article-title":"Diastema Closure in Anterior Teeth Using a Posterior Matrix","volume":"2016","author":"Goyal","year":"2016","journal-title":"Case Rep. Dent."},{"key":"ref_5","first-page":"6810984","article-title":"Direct Midline Diastema Closure with Composite Layering Technique: A One-Year Follow-Up","volume":"2016","author":"Korkut","year":"2016","journal-title":"Case Rep. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.dental.2015.07.005","article-title":"Anterior composite restorations: A systematic review on long-term survival and reasons for failure","volume":"31","author":"Demarco","year":"2015","journal-title":"Dent. Mater."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1007\/s00784-015-1458-8","article-title":"A 4-year clinical evaluation of direct composite build-ups for space closure after orthodontic treatment","volume":"19","author":"Demirci","year":"2015","journal-title":"Clin. Oral Investig."},{"key":"ref_8","first-page":"71","article-title":"Layering concepts in anterior compositerestorations","volume":"3","author":"Dietschi","year":"2001","journal-title":"J. Adhes. Dent."},{"key":"ref_9","first-page":"12","article-title":"Direct composite restorations in anterior teeth. Managing symmetry in central incisors","volume":"9","author":"Paolone","year":"2014","journal-title":"Int. J. Esthet. Dent."},{"key":"ref_10","first-page":"37","article-title":"Bilateral symmetry of anterior maxillary incisors: Evaluation of a community-based population","volume":"31","author":"Ormianer","year":"2017","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_11","first-page":"210","article-title":"Esthetic rehabilitation of anterior conoid teeth: Comprehensive approach for improved and predictable results","volume":"4","author":"Pena","year":"2009","journal-title":"Eur. J. Esthet. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/jerd.12305","article-title":"Does the presence of unilateral maxillary incisor edge asymmetries influence the perception of smile esthetics?","volume":"8","author":"Ribeiro","year":"2017","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_13","first-page":"355","article-title":"Clinically based diagnostic wax-up for optimal esthetics: The diagnostic mock-up","volume":"36","author":"Simon","year":"2008","journal-title":"J. Calif. Dent. Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.dental.2015.01.015","article-title":"Clinical effectiveness of direct anterior restorations\u2014A meta-analysis","volume":"31","author":"Heintze","year":"2015","journal-title":"Dent. Mater."},{"key":"ref_15","first-page":"2402","article-title":"The Success of Dental Veneers According to Preparation Design and Material Type","volume":"6","author":"Alothman","year":"2018","journal-title":"J. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/jerd.12397","article-title":"Diastema closures: A novel technique to ensure dental proportion","volume":"30","author":"Kabbach","year":"2018","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1177\/0022034518822808","article-title":"The Evolution of Dental Materials over the Past Century: Silver and Gold to Tooth Color and Beyond","volume":"98","author":"Bayne","year":"2019","journal-title":"J. Dent. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"201","DOI":"10.5005\/jp-journals-10005-1364","article-title":"A Comparative Analysis of Different Finishing and Polishing Devices on Nanofilled, Microfilled, and Hybrid Composite: A Scanning Electron Microscopy and Profilometric Study","volume":"9","author":"Yadav","year":"2016","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_19","first-page":"382","article-title":"Influence of enamel composite thickness on value, chroma and translucency of a high and a nonhigh refractive index resin composite","volume":"9","author":"Ferraris","year":"2014","journal-title":"Int. J. Esthet. Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1038\/bdj.2008.100","article-title":"Optimising aesthetics and facilitating clinicalapplication of free-hand bonding using the \u201cnaturallayering concept\u201d","volume":"204","author":"Dietschi","year":"2008","journal-title":"Br. Dent. J."},{"key":"ref_21","first-page":"610","article-title":"Transcultural perception of maxillary midline diastema","volume":"10","author":"Akinboboye","year":"2015","journal-title":"Int. J. Esthet. Dent."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"234","DOI":"10.26659\/pm3.2018.19.4.234","article-title":"Resin composite layering technique for direct anterior teeth Restorations","volume":"19","author":"Culic","year":"2018","journal-title":"Palestrica Third Millenn. Civiliz. Sport"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.dental.2010.08.004","article-title":"Shade compatibility of esthetic restorative materials\u2013A review","volume":"26","author":"Lee","year":"2010","journal-title":"Dent. Mater."},{"key":"ref_24","first-page":"139","article-title":"White defects on enamel: Diagnosis and anatomopathology: Two essential factors for proper treatment (part 1)","volume":"11","author":"Denis","year":"2013","journal-title":"Int. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Silva, J.P., Coelho, A., Paula, A., Amaro, I., Saraiva, J., Ferreira, M.M., Marto, C.M., and Carrilho, E. (2021). The Influence of Irrigation during the Finishing and Polishing of Composite Resin Restorations\u2014A Systematic Review of In Vitro Studies. Materials, 14.","DOI":"10.3390\/ma14071675"}],"container-title":["Symmetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-8994\/13\/10\/1848\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:08:52Z","timestamp":1760166532000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-8994\/13\/10\/1848"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,2]]},"references-count":25,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["sym13101848"],"URL":"https:\/\/doi.org\/10.3390\/sym13101848","relation":{},"ISSN":["2073-8994"],"issn-type":[{"type":"electronic","value":"2073-8994"}],"subject":[],"published":{"date-parts":[[2021,10,2]]}}}