Dr. Romero is an Assistant Professor in the Department of Oral Rehabilitation at GRU College of Dental Medicine; he received his DDS from the University of Guayaquil (Ecuador) School of Dentistry in 1995. He completed a two year Advanced Education in General Dentistry Program at the University of Rochester, Eastman Institute for Oral Health where he was granted the Handleman Award for Excellence. He has over 30 publications in national and international peer reviewed journals. He maintained a private practice with emphasis in Restorative and Esthetic Dentistry for 15 years prior to joining GRU in 2013.
Tooth morphology, our primary goal
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Today’s composite resin systems offer the clinician various enamel and dentin shades to mimic the variations of tooth opacities and translucencies [3,4]. Their main objective is to allow replication of the combined optical properties of dentin and enamel. For small anterior Class III or V restorations, only one shade may be necessary, because composite resin is relatively translucent, allowing the adjacent and underlying tooth structure to reflect or show through the restoration . However, for larger through-and-through Class III and IV restorations, which have no backing tooth structure, a relatively translucent composite may not be able to mask the dark background of the oral cavity . Therefore, the multilayer technique is recommended, in which an opaque material is placed beneath a translucent composite resin in an effort to create depth from within the restoration and to mask the dark background. The decision of when to use this technique involves three considerations. According to Vargas  if the adjacent teeth or the tooth to be restored in a through and through preparation is polychromatic in nature and no incisal halo or translucency is evident, the tooth may be restored with two shades of composite resin, other wise a translucent and white opaque shades are indicated to restore the incisal translucency or a halo effect. Once the decision is made to use more than one shade, the clinician needs to know the level of translucency of the composite resins being used, since in certain brands a 2 mm thickness of the body shade (referred to as Universal) of composite resin may be enough to mask the dark background of the oral cavity .
Finally, it is important before restoration to evaluate the tooth morphology (line angles, developmental grooves and superficial texture) and how to reproduce those details by sculpting the composite and contouring with finishing burs and disks.
The purpose of this article is to describe in detail how one patient’s maxillary central incisors were restored using a direct composite resin technique. The previously placed layered Class IV resin composite restorations on both central incisors were removed, and the patient’s smile was enhanced using a two-shade simplified build-up technique.
Use of the techniques presented will yield highly esthetic resin composite restorations in minimal time. Although more elaborate composite layering techniques exist and may be used in complex esthetic scenarios, a simplified approach combining two body shades and implementing basic dental anatomy concepts often will deliver highly acceptable esthetic results.
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