Shape and layer
An Article by Giuseppe Marchetti
Before and after. Shape is sometimes as important as color.
Preoperative: the patient, female 45 years, asks for an esthetic improvement, not expensive not invasive.
A direct approach is proposed and accepted.
Color was taken with the aid of Smile Lite and Smile Capture in order to notice the delicate nuances.
Isolation of the operative field with rubber dam.
With a diamond bur, fine grain, (Direct Style, Bur 4, Komet by Style Italiano) the unsupported enamel has been removed and the previous filling too, in order to clean the secondary decay.
With a soflex disc the little bevel done previously is smoothened.
A palatal view of the prep.
A silicon guide done from the wax up is tried.
Two posterior matrices (Hawe Blue Adapt Sectional Matrix) are customized in order to fit the silicon index, which has been cut partially in order to hold the matrices.
Etch and rinse technique: orthophosphoric acid on the enamel for 30 seconds and to dentin for 15, then rinse for at least 30 seconds.
Primer and bonding are applied in two steps.
With the fissura instrument (LM kit powered by Style Italiano) the limits of the prep are marked in order to be precise during enamel mass placement.
Enamel mass is placed on the silicone near the mark and matrices are inserted into the cuts on the silicone.
In one movement everything (Silicone, matrices and composite) are placed back in the operatory field, the composite material is then adapted to the tooth.
After polymerization the silicon guide is removed, with the aid of the matrices still in place, proximal walls are constructed.
Matrices are removed only after proximal walls are built and polymerized.
A very small amount of flow is used over the bonding to have a better conversion of the adhesive and cover possible little gaps.
A first a3 dentine mass is placed over the prep and palatal wall, mamelons can be sculpted at his stage.
A second small layer of dentin covers the prep line.
A translucent enamel is placed between the mamelons and the incisal edge, then little white spots are placed to mimic the neighbor tooth.
The final layer is done with 0.5 mm of medium value enamel.
Final polymerization with an oxyguard to inhibit the presence of oxygen, as known it hinders the conversion of the last layer of the material.
With a pencil the texture of the secondary anatomy is drawn.
So with the bur 4 of the finishing kit (Finishing Style, Komet by StyleItaliano) the three lobes of 1.1 are reproduced at low speed.
With the same bur texture is done.
And the restoration is polished. Following a progressive polishing procedure.
Immediately after the dam has been removed. We have to wait for the rehydration.
The III class of 1.2 was intervened as well.
After one week: a good integration of shapes and colors, we can see the details of the white spots reproduced, and the translucency of the disto-buccal enamel thats has been copied quite well.
A happy patient and her nice smile .
Details, in a lateral view.