Aesthetics using characterised single shade

22 Dec 2015 - 15443

Accidents that affect anterior teeth in children and young adults are a common finding in dental practice. In many situations, only one tooth is affected by the trauma and choosing the right treatment option can be complex. The esthetic restoration of the maxillary anterior dentition can be accomplished using direct and indirect techniques. Direct resin composite restorations are a predictable, conservative and reliable chairside procedure that can be characterized as a “life-like” final restoration. This article will demonstrate a simple protocol used to reproduce the aesthetic appearance of a patient using a single shade composite with regards to a Class IV fracture during a sporting event.

Fig. 1

Pre-operative photo. 12 year old un-esthetic restoration on tooth No. 11

Fig. 2

After fabricating study cast we develop a wax-up trying to reproduce as much as possible the contralateral tooth. Keep in mind that the most important aspect of your wax up is the lingual embrasure.

Fig. 3

Shade selection is a critical process but I recommend keeping it as simple as possible. We match the middle portion of our Vita shade tab to the middle portion of the tooth, this is were the body shade of composites best match.

Fig. 4

2-3mm esthetic bevel is completed with an #8888 diamond bur.

Fig. 5

1mm functional bevel is completed in the lingual surface using the same bur.

Fig. 6

Once we prep our esthetic bevel it is best to create and infinite bevel using a sof-lex disc. This will help you create an invisible transition at the tooth/composite interfase.

Fig. 7

Acid etching of enamel for 30 seconds follow by rinsing and drying.

Fig. 8

Apply a Universal bonding system onto enamel and any exposed dentin.

Fig. 9

The putty matrix is seated to make sure it fits well.

Fig. 10

First lingual layer is applied against the matrix and then seated. We selected A2 Body shade to fabricate the lingual layer.

Fig. 11

Mamelons were developed using the same A2 Body shade and Iridescent blue layered in between the mamelons to recreate translucency.

Fig. 12

Opaque white flow was used to create some hypo calcified areas and a halo effect in the incisal third.

Fig. 13

The final facial layer was applied making sure we re-establish the mesial and distal line angles.

Fig. 14

Finishing and polishing was completed using fine and extra fine diamonds and medium, fine and extra-fine sof-lex discs.

Fig. 15

15 days post-op photo shows good Biomimetization.

Fig. 16

Pre-op smile photo

Fig. 17

15 days Post-op photo

 

Conclusions

The high predictability and simplicity of the technique and the improved optical, physical and handling properties of the materials presented in this article make it possible to be used by any experienced clinician and achieve a natural final appearance that can meet, or many times exceed both the patient and professional expectations.

Bibliography

1. Simon JF. Principles of adhesion and bonding. Consideration for making the best clinical choices. Inside Dentistry. Nov 2014;10(11): 88-93 

2. Denehy G. The importance of direct resins in dental practice. Pract Periodont Aesthet Dent 1999;11(5):579-582.

3. Fahl N Jr. Predictable aesthetic reconstruction of fractured ante- rior teeth with composite resins: A case report. Pract Periodont Aesthet Dent 1996;8(1):17-31. 

4. Bello A, Jarvis RH. A review of esthetic alternatives for the restoration of anterior teeth. J Prosthet Dent 1997;78:437–440.

5. Roeters JJ. Extended indications for directly bonded composite restorations: A clinician’s view. J Adhes Dent 2001;3:81–87. 

6. Mondelli RFL, Oltramari PVP, Taveira LAA, Lopes LG, Mondelli J. Multidisciplinary orthodontics-restor- ative dentistry in the establishment of anterior teeth aesthetic harmony. R Clín Ortodon Dental Press 2002;1:49–54. 

7. Denehy GE. Simplifying the Class IV lingual matrix. J Esthet Restor Dent. 2005;17:312-9.

8. Vargas M. Conservative aesthetic enhancement of the anterior dentition using a predictable direct resin protocol. Pratt Periodontics Aesthete Dent 2006;18(8):501-507.

9. Willhite C, Quintessence International, Practically Speaking, vol 36, no 2, 2006.