Hello. I'm Dr. Richard Gangwisch. In this video we'll be performing a cosmetic bonding procedure bonding isn't used very much anymore for purely cosmetic results since porcelain laminates are much more durable and longer-lasting however there's an occasional case where its use is appropriate. The gums tend to shrink as we age and this tendency is most pronounced before the age of 25. If you place porcelain laminates on too early in life, the edges will show within a shorter period of time but for some laminates, a small amount tooth structure is removed, whereas, cosmetic bonding is done on the tooth surface without any preparation. Thus, it's best used bonding until the gum height stabilizes in a patient's mid-20s. Our patient is a college student and so you can see she's congenitally missing a left lateral incisor and she would like her smile improved. So, we go ahead and make a mockup of her teeth and the way we would like them to be and we use that model to make the teeth in her mouth. So, what we do is we make a little putty mold there and that mold will be used to shape the teeth. That initial mock-up was what we'll do here. We're going to apply some acid solution to this tooth and there's no tooth preparation on that at all. The reason for that is that later on we're going to want to do something a little more permanent, so we don't want to do anything that will make any permanent changes for now. The acid will eat away just a little microscopic surface of the tooth, enough to make some little tiny crevices in the enamel surface and that's what's going to be used to retain that the bonded restoration. It's not really an adhesive bond; it's a mechanical retention from liquid plastic that we'll be putting on and that liquid plastic will harden inside those little crevices and that's what holds the holds that bond on. You must desiccate that tooth quite a bit to have no moisture whatsoever on it. You notice the plumbers tape kind of separates the teeth so that we don't go on to other teeth and we go ahead and place the bonding agent. This is the material; it'll harden and hold the hold the veneer in place. Now we're going to go ahead and place some. This is actually filling material; tooth colored filling material that we use a daily basis and in her particular case, she wanted pearly white teeth. I wanted a nice natural-looking tooth with lots of different colors to give as much lifelike look to it but she rejected that, so we have to listen to the boss. That's up to the patient and so we'll still use a couple of colors in here. This is a cervical shade. Notice we're putting with some little striations in there to try to break up the light a little bit so that we get as natural appearance to it as we can, and replace the mold over the top of that so that we can get the initial shape pretty close to what we had with the mock up. And we go ahead and apply the incisal shade now. It's a lighter color and I'll give a little more lifelike look to the teeth with a little more natural appearance on that. She wanted pearly white, so that's what she's going to get and same thing we use that mold constantly to try to make sure that we can stay within the same look that we had come up with in the lab. That light will cure the material. It's photocured material so that's what makes it harden. So, you can play with it all day and when we're ready to get it to harden, we just zap it with the light and that works fantastic. So now we go ahead and contour everything. This contour up along the gum line is extremely important. Remember we didn't do any preparation on the teeth, so we got to make sure we don't have anything overhanging into the gums which would cause constant irritation to the gums. And we'll go ahead and contour the tooth; make it look a little nicer; get those edges finished down. Okay, check the size; make sure that we're dealing with the same thing in the mock-up. And, of course, we don't want to give the patient an excuse not to floss. To make sure that works, so we'll go on to the next tooth and do the same thing. We'll speed this up a little bit more so that you've already seen the how we do that same thing. Apply the liquid bonding plastic there to harden into that for their retention. Place the cervical shade along the gum line and the incisal shade over that and then go ahead and harden that with the curing light. And the same thing; go ahead and get in there and contour things; get those edges finished; make sure that the edge along the gum is just perfect. Don't want anything that's going to cause chronic irritation on those gums. And constantly measuring; making sure we get everything perfect before we go on to the next. Here we go. So now we've got a good start; got those two teeth taken care. Now, this will be where the art comes in. This is a canine tooth and we need to make it look like a lateral incisor. Now lateral incisors have a squared off appearance and canine has got the pointed end so we've got to change that plus a canine is much wider than the lateral incisor is so we've got our work cut out for us on that. So, we'll go ahead and do the same thing just build up the different layers to give the different colors and place our mold into place since we've already got a good start on that, but we will stay with that and get it cured. Again, same thing, contour that up. Notice how we've squared that off. That's still a lot of flash on there but you know it's starting to look a little bit more like a like an actual lateral incisor. Now we've got to make sure it's functional. Have to make sure we're not hitting too heavy on the material we're putting on. Now we have to work on the other tooth. This is an actual lateral incisor. You see how much smaller that is compared to that canine. So, we've taken the canine and tried to make that less wide in this. We're going to have to add some and make it wider so that by the time we're done, then they'll both match in the width. The central or the lateral incisor that we made out of that canine we've made that smaller by adjusting the edge of it to make it give the optical illusion that it's not as wide. So that helps quite a bit and you know making sure we get a beautiful smile at the end. And same thing, get back in their contour get all that flash off the edges. And notice we've got an instrument there to try to protect the gums so we can keep that from being an issue. You notice we put these lines on there; allows us to see where the contours are; make sure that everything is nice and even. And you know this is a very important to have way light bounces off everything and I've got to put some anatomy in the surface of the tooth. The teeth are not flat, so we want to add some lifelike things in there. And what that does is breaks up the light; keeps them from just flashing straight back at you. And put that final polish on there so we can give her a dazzling set of teeth. And she'll be pleased with that once we get done. So, that's what we started with and look at the look at the change here. Remember this is only temporary. We'll be able to do better with porcelain laminates, but we end up with a very happy patient at the end