Direct composite aesthetic makeover

3 Feb 2018 - 22096

Recently, the development of dental composite materials has seen their application not only for the replacement of lost dental tissue, but also more increasingly, for the improvement of smile aesthetics.

Indeed with the usage of composites we can modify shape, color and position.  They can be applied together with ceramic and be used as a complement.

Composites provide the following advantages:

  1. A significant saving of dental tissue, as rarely we have to prepare the tooth
  2. A considerable saving in time as laboratory work is not needed, other than during the diagnosis phase
  3. An economic saving, as chair time decreases, there are lower material cost and cheaper therapy for the patient
  4. The responsibility of the work result lies in the hands of the clinician only; this is, in my opinion, one of the most important choice factors on a personal level
  5. After work completion, it is still possible to carry out follow-up correction or repairs
Fig. 1

Direct mock up To begin with, the patient is subjected to an accurate facial and smile examination; then temporary teeth modification is carried out, using a layering of composite on surfaces, in order to create new shapes.

Fig. 2

In this way we try to achieve a correct orientation of occlusal plane and a correct length of incisal margins of the front teeth. This procedure will help transfer, with a simple mold, important information that the technician will use to make the wax up.

Fig. 3

Indirect mock up. The transfer of the teeth shape from the wax up is done by using a silicone guide correctly molded with a certain thickness that will grant a specific rigidity.

Fig. 4

The indirect mock up can be, in case of necessity, edited and passed to the technician through another mold, or alternatively in a simpler way, by modifying the wax up, creating a new transfer mask in silicone.

Fig. 5

Obtaining a final result that satisfies the right aesthetic and functional parameters and the patient expectations is extremely important.

Fig. 6

Modify isolation, obtained with the dental dam and the usage of gum retraction cords, will grant a good compromise between humidity control (this guarantees the adhesion efficacy) and the emergency profile control of each tooth. This is essential to create the right crown inclination on the sagittal plane.

Fig. 7

Some teeth with an abnormal length axis rotation will need a light crown cut so that a proper and seamless stratification of the composite is achieved. This will also help to attain a chromatic control of the same.

Fig. 8
Fig. 9
Fig. 10

Enamel surfaces were sandblasted and treated with ortho-phosphoric acid (37%). This will enable the adhesive to permeate.

Fig. 11
Fig. 12
Fig. 13
Fig. 14

The silicone index is created with a first layer of composite material that helps build the palatal wall. A highly translucent achromatic enamel resin is used.

Fig. 15
Fig. 16

A body shade will allow the creation of the lower dentinal layer.

Fig. 17

Using a translucent fluid composite in the incisive area will enhance the mamelons and the margin transparency.

Fig. 18

The stratification of high value achromatic enamel in the middle and distant angles, will increase the light reflection quality, increasing the value of the work done.

Fig. 19

The last layer is obtained using chromatic enamel that will allow light transmission within deeper layers, enhancing the given tissue anatomy.

Fig. 20

In progression, after the central incisors, the same stratification process is carried for the lateral incisors and then the canines, considering the space available.

Fig. 21
Fig. 22

Different color pencils are used to highlight lower and higher parts, guiding the subtractive modeling.

Fig. 23

An initial partial polishing session is followed by a second session where detailed anatomical effects are created.

Fig. 24

A glossy surface is created with diamond discs, rubbers and pastes to complete the restoration.

Fig. 25

A successful aesthetic achievement in dentistry is always the result of a proper initial planning agreed and carried out together with the patient.

Fig. 26
 

Conclusions

The great advantage composite materials have against ceramic is that you can achieve a great chromatic quality and gloss surface, through a proper stratification and refinement technique, adding minor details.  This can hardly be accomplished with ceramic.

For the last few years I have used composite also for restorative aesthetics dentistry;  not only does this technique enables me to attain fantastic results, but it also allows me to express my full ability and creativity, something that I can hardly display in any other medical field.

Bibliography