The power of the Shape

Shadeguides - Cases - Direct anteriors
2017-07-21

With the Style Italiano recipes and rules, any dentist is able to learn how to create direct restorations that fulfil high aesthetic demands of the patients. The procedure is easily taught and learnt and does not lead to an unpleasant surprise, as the case of a young female patient shows.
The patient had beautiful teeth, but the aesthetics of her smile were somewhat negatively affected by a small, discoloured composite restoration and incorrect shape on her upper right central incisor. The character of the teeth was analysed closely using images taken under different light conditions, including one made with a polarising filter (Smile Lite MDP by Dr. Louis Hardan and powered by Style Italiano). The image shows that it is relatively easy to read the inside of the tooth, which has varying opacities and a clearly visible mamelon structure, but no intensive intrinsic colours. Therefore, it was decided to restore the tooth using a dual-layer technique with one dentin and one enamel shade of Filtek Supreme XTE (3M). The use of additional stains included in the restoration was not necessary.

Fig. 1

Img. 1 – Initial situation. Female patiente whant to improve the aesthetic of the central incisor, with a old restauration and a inadequate shape.

Fig. 2

Img. 2 – Intra-oral view of the initial situation. It's visible the internal details and reach internal anatomy of the natural tooth.

Fig. 3

Img. 3 – When we take a close-up view of the angle-lines of the two central incisors, it's easy to understand the importance de shape correction, in order to achieve a natural aestethetic outcome.

Fig. 4

Img. 4 – Shade selection with a Vita Classical shade guide (A1 Vita shade)

Fig. 5

Img. 5 – After shade selection, a diagnostic restoration was exectuted to give the desired final shape, in order to fabricate a palatal silicone index with a putty silicone material.

Fig. 6

Img. 6 – Removing the old restoration and anterior bevel execution.

Fig. 7

Img. 7 – The bevel allows a better intergration between the composite restoration and the remaining dental tissue. A 3mm minimum bevel extension should be executed. To make a more conservative bevel and polish the angles, a hard grain disk is recommended.

Fig. 8

Img. 8 – Silicone index try-in.

Fig. 9

Img. 9 – Enamel etching.

Fig. 10

Img. 10 – Adhesive application. It was used the Sctochbond Universal, rubbed on the surface for a minumum of 10 seconds (3M).

Fig. 11

Img. 11 – Composite resin layering steps used in this clinical case. The artificial palatal enamel was made with a translucent composite resin (Filtek Supreme XTE CT effect, 3M), the artificial dentin was made with an opaque mass (Filtek Supreme XTE A1 dentin, 3M) and the buccal enamel was made with the Filtek Supreme XTE A3 enamel (3M), following the Style Italiano recipe for the Vita shade A1.

Fig. 12

Img. 12 – Palatal enamel done with the palatal silicone index.

Fig. 13

Img. 13 – With the final palatal shape it is easy to predict the final shape for the final composite resin restoration.

Fig. 14

Img. 14 – The thin interproximal enamel was done with the same enamel used in the buccal surface (Filtek Supreme XTE enamel A3).

Fig. 15

Img. 15 – The thin interproximal enamel (less then 0,5mm) can be shaped with the use of a sectional posterior matrix (ex. Garisson) in order to easily get a convex contour.

Fig. 16

Img. 16 – Interproximal enamel done on the mesial and distal surfaces.

Fig. 17

Img. 17 – The incisal halo was made with an opaque flowable composite resin (Filtek Supreme XTE flowable dentin, 3M).

Fig. 18

Img. 18 – For the dentin control and calibration of the space for the buccal enamel (0,5mm) the LMArte Misura was used.

Fig. 19

Img. 19 – After calibration with the Misura instrument, the dentin was shaped in a similar shape to that of the natural tooth. The LM Arte Fissura was then used for the dentinal anatomy reproduction.

Fig. 20

Img. 20 – Between the dentin mamelons and the incisal halo was applied a translucent enamel (Filtek Supreme XTE CT effect, 3M) in order to increase the translucence in this incisal area.

Fig. 21

Img. 21 – To smoothen the dentin and enamel with a better and faster composite resin modeling phase a brush (Smile Line powered by Style Italiano) was used.

Fig. 22

Img. 22 – Buccal enamel placed after light-curing.

Fig. 23

Img. 23 – Grain discs used for the polishing and finishing procedures and tooth contouring (Sof-Lex discs, 3M).

Fig. 24

Img. 24 – Polishing the buccal surface with a light orange Sof-Lex disc.

Fig. 25

Img. 25 – Smooth the composite resin surface with a Sof-Lex Spiral weel (3M)

Fig. 26

Img. 26 – Polishing the composite resin surface with a Sof-Lex Spiral Diamond (3M). In order to have the best shining surface we should use this disc under water.

Fig. 27

Img. 27 – To get a final enamel-like surface, we recommend the use of a small grain polishing paste (Diashine, US) with a smoothener felt.

Fig. 28

Img. 28 – Final composite resin restoration immediatly after the polishing procedure.

Fig. 29

Img. 29 – Final composite resin restoration.

Fig. 30

Img. 30 – Difference between the shape in the initial situation and the final restoration. A natural outcome was achieved.

 

The described technique is easily taught and learnt. It enables every dentist to obtain highly aesthetic results through a highly efficient procedure. However, these results are only achieved if high-quality materials are used and if the practitioner has developed a thorough understanding of the employed materials. Instead of magic, it is precise preparation and careful planning that leads to the desired, repeatable and therefore predictable outcomes.