White lesion removal with simplified composite system

30 Dec 2015 - 21789

The layering technique or stratification is a modern concept allowing the dentist to achieve high aesthetic restorations using new systems of resin composites. It reproduces the shade and the color of the tooth using the optical properties of dentine and enamel shades, and color modifiers. It allows optimal light transmission within the restoration providing a more realistic depth of color and surface characteristics of the tooth.

The application of a layering concept through the use of separate composite resin masses that mimic the natural tooth anatomy presents clear advantages for the clinician and makes the entire procedure more efficient and predictable.
Clinicians continued shade selection using shade guide developed by Vita. Shade selection was based only on hue and chroma (eg, A2, B2, C1) without taking value in to consideration. This resulted in restorations that were flat, lacked luminosity.
Recent product developments combined with clinical research on stratification make it now possible to utilize new composites that have excellent opalescence and fluorescence characteristics and provide an excellent color range to choose from.

A new composite system (essentia) from GC used which is an innovative and simplified shade concept, breaking away from traditional monochromatic shades and focusing on reproducing the characteristics of enamel and dentin.
The base chroma (hue and chroma) is given by the dentine which dominates the chromatic nature on the tooth. The enamel is primary responsible for regulating value or tooth brightness and characterized by high translucency. It is possible to develop less chromatically complex teeth in a simple way using fewer colors while maintaining high esthetic results.
Dentine as a rule shows low chromaticity when teeth are young and increases the chromaticty with age. When value determined three conditions age, degree of mineralization and enamel surface texture is important considerations. The value of natural teeth is high in the teeth of young people and low in the teeth of older people. (5)

Essentia is designed to use just three dentins (light, medium and dark) with increasing chroma and decreasing opacity in order to match the natural aging process. Enamels act in a very similar way, with whiter and more opaque enamel on young teeth and more translucent and chromatic on older teeth. Essentia uses just two enamel shades, one with high value (light) and another one with lower value (dark).

 

Fig. 1

Young female patient, 12 years old, with hypomineralized lesions at incisal thirds of upper right central incisor. The patient was seeking esthetic solution.

Fig. 2

Initial pre-operative situation enhanced digitally by increase the contrast and decrease the brightness to evaluate the extent of the lesion.

Fig. 3

Button try 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. 4

The image enhanced by increase the contrast and decreases the brightness for shade evaluation.

Fig. 5

Polar eye used to evaluate the shade with same procedure.

Fig. 6

Black and white image used to evaluate value.

Fig. 7

Isolation with rubber dam.

Fig. 8

Microabrasion with Opalustre (Ultradent); after 8 applications due to the depth of the lesions.

Fig. 9

Preparation finished.

Fig. 10

Etching (37% Phosphoric Acid) with teflon for adjacent tooth.

Fig. 11

Bonding agent applied.

Fig. 12

Medium dentine applied.

Fig. 13

Light Dentine applied to highlight the halo effect.

Fig. 14

Final light enamel applied.

Fig. 15

Immediate final after removal of rubber dam.

Fig. 16

Final picture.

Fig. 17

Close-up on the final aspect of the restoration.

Fig. 18

One week check-up.

Fig. 19

6 months check-up.

Fig. 20

6 months check-up.

 

Conclusions

It very easy to achieve a natural color match with nicely polished surface with this new simplified composite system

Bibliography

1. Vanini L,. light and color in anterior composite restorations, in: Pract. Periodont. Aesthet. Dent. 1996, 8 (7), 673-682. 
2. Dietschi D, Ardu S, Krejci I. A new shading concept based on natural tooth color applied to direct com- posite restorations. Quintessence Int 2006; 37:91–102.
3. Lorenzo Vanini , Francesco M. Mangani. Determination and communication of color using the five color dimensions of teeth. Pract Proced Asthet Dent 2001; 13(1): 19-26.
4. Walter Devoto?, Monaldo Saracinelli , Jordi Manauta. 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. 
5. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 2, Quintessence Books, 2012.