Mamelons and rehydration

11 Jun 2017 - 14768

Restoration of anterior teeth with special features like mamelons is always one of the most challenging situations for dentists, because of the difficulty in matching of color and creation of texture, but with correct shade selection and layering of composite we can get excellent aesthetic results.

Fig. 1

Initial situation , A 9-year old boy suffering from fracture of the upper right central incisor due to trauma.

Fig. 2

Button try technique used for shade taking by using small piece of composite 1.5mm (without etching and bonding) on cervical third for dentine (light, medium, dark) and enamel (light, dark) on the incisal third and polymerized.

Fig. 3

Enhanced by increase the contrast and decreases the brightness for shade evaluation.

Fig. 4

Black and white image used to evaluate value.

Fig. 5

Isolation.

Fig. 6

All sharp edges were rounded up by diamond rugby ball bur.

Fig. 7

A 2 mm bevel was placed.

Fig. 8

Etching (37% Phosphoric Acid) for 30 seconds with teflon protection for the adjacent tooth.

Fig. 9

Rinsing for 30-40 seconds with water spray.

Fig. 10

The surfaces were dried with gentle stream of air and a universal bonding agent was applied with brushing motion at least 20 seconds, then dried for 5 seconds in order to evaporate the solvent, aiming to get shiny surfaces until no motion of adhesive on the tooth was visible.

Fig. 11

Polymerization for 30 seconds.

Fig. 12

Palatal shield was made by 0.5 mm layer of light enamel (done directly by finger tip).

Fig. 13

Posterior sectional band used to create the proximal wall.

Fig. 14

Posterior sectional band fixed by wooden wedge to get anatomical proximal wall of the tooth.

Fig. 15

The palatal key is ready to receive the dentin.

Fig. 16

Medium dentin mass is applied and should follow the anatomy of  the adjacent tooth to create the mamelons.

Fig. 17

Dark dentin applied over the medium one.

Fig. 18

Adding some white stain to mimic the natural look of the adjacent tooth.

Fig. 19

Stratification of last layer of composite enamel mass.

Fig. 20

Air block (Glycerin) in order to minimize the presence of an oxygen – inhibited layer.

Fig. 21

TIP: By using articulating paper, lightly scrub the two central incisors at the same time to copy the texture from the adjacent to the restored one.

Fig. 22

Using the extra-fine diamond bur to create the texture .

Fig. 23

Polishing paste with goat brush.

Fig. 24

Felt Wheel.

Fig. 25

Immediately finished after rubber dam removal.

Fig. 26

Final result immediately after procedure.

Fig. 27

Frontal view to show the symmetry of two central incisors.

Fig. 28

Frontal view showing the rehydration and super chameleon effect of restoration after 34 days control.

Fig. 29

Close up view after rehydration.

Fig. 30

Comparison before and after.

 

Conclusions

With simple techniques  and protocol and basic rules we can easily overcome the challenges of such cases in aesthetic areas , so just follow the anatomy of the adjacent tooth; when the teeth dehydrates, the air replaces the water between the enamel rods, changing the refractive index that makes the enamel appear opaque and white. If the correct shade color is selected before isolation with rubber dam, don’t worry, just trust rehydration.

Bibliography

1.Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent 2010;5(1):102-24.
2.Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite shade guides and color matching.Int J Esthet Dent. 2014 Summer;9(2):164-82.
3.Devoto W1, Saracinelli M, Manauta J.Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.Eur J Esthet Dent. 2010 Spring;5(1):102-24.
4.http://styleitaliano.hime.host/white-lesion-removal-with-simplified-composite-system.
5.http://styleitaliano.hime.host/basic-rules-for-class-iv-restorations.