Memoirs of a student - An early composite of mine, 9 years later
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Time runs, that's for sure!
It was 2008, and I was a 4th year student at the Siena University. Direct composite restorations were my first love, a long lasting one. Professor Simone Grandini called me and offered me the chance to restore a central incisor to a female patient; she had an old composite restoration she was no longer satisfied with. Of course I was really excited and, let's admit it, a little bit scared! It was not my first anterior restoration, but obviously I was suffering from a great lack of experience.
Prof. Grandini guided me through all the procedure (I really have to thank him), and it was really fun! I had the confirmation that direct anterior restorations really were my favourite part of dentistry.
In 2012 I had the chance to publish this case on styleitaliano website, as a community case, so before becoming a member of this amazing group.
A couple of months ago, meaning after almost 9 years from the first appointment, I had the chance to see once again the patient, and this happened just when I was trying my brand new MDP tool by Louis Hardan... so, what better time to test my new photografy "toy"?
I really would like to analize this case with you, trying to understand how would I manage it now, if I had to do it once again after 9 years.
Img. 1 - 2008, the "before picture". In the first article I described it like this: " 36 year old woman, with an old resin composite restoration she’s no longer satisfied with. Among other things is clinically noticeable the pigmentation, the color mismatch even with a big bevel over the sound tissue and most of all, the lack of anatomy and incisal correspondence." One of my first observations was on the long bevel: nowadays we like much shorter ones. It can be harder to manage the color and opacity matching at the beginning, but a restoration with a short bevel is more stable overtime.
Img. 2 - After the removal of the old composite and the adhesive procedures, the first palatal layer was made with a translucent resin. Nowadays, after this step, I always stop and I change my point of view. It's really helpful to understand if I made some mistakes in creating the shape and orientation (it's easy for a right handed dentist to make "left-bended" teeth). If I need to correct something, I do it immediately; once the frame is properly completed, we just have to fill it!
Img. 3 - A first layer of dentin resin was applied, trying to imitate the anatomy and leaving the proper space for characterizations and enamel.
Img. 4 - Some white spots were inserted using a white stain. Let's be honest, maybe she didn't need them, but for a 4th year student using a supercolor seemed quite exciting!
Img. 5 - The final layer of enamel was then applied. We can see the layering is not very precise, but I didn't have the chance to use a brush at that time (now CompoBrush Anterior is my best friend for composite layering).
Img. 6 - After finishing and polishing with a red ring flame bur and a colpete set of silicone tips and diamond pastes, this was the immediate post-op situation.
Img. 7 - And this was the 7 days control picture; I was really satisfied with the result and so was the patient.
Img. 8 - As I said before, almost 9 years later I had the chance to try my MDP while taking a picture of this patient. The restoration was the same, with no re-finishing nor re-polishing procedures. From the picture, we can appreciate that both color and shape are still good, and the resin maintained a good surface; no margin stains are visible, and the tooth is both vital and asymptomatic. Of course we can also appreciate the great quality of Prof. Hardan's MDP!
Img. 9 - Even under cross polarization MDP we can appreciate a good color match
Img. 10 - A closer look at the restoration.
ConclusionsNowadays, I would of course change some steps: I would pay much greater attention in checking the shape of the first palatal shell before starting layering the dentin; or I would choose different tools for the polishing and finishing procedures (the Finishing Style kit is really quick and efficient). But I also have to say that I'm really happy with the result and its stability over time. It was really nice to remember how exciting this case was for me as a student; I actually have to admit, I'm still really enthusiastic every time I have to make an anterior direct restoration... as I said these are my first love!
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