Modern restorative dentistry is based on the principles of adhesion and minimal invasiveness. Today’s composite materials represent a viable long-term solution, not just as a sealing material, or front or rear restoration, but as a fully-functional restoration.

Until recently the best esthetic outcomes were achieved through complex, time consuming, layering protocols, using many different composite mass combinations, which was rather unpredictable and unteachable.

In this article, I want to propose a simplified method to dramatically improve your success rate. Federica, 32 years old, is a very nice young lady, but she doesn’t smile.

Fig.1

The patient had agenesis of the upper lateral incisors, and the space was closed with an orthodontic treatment. So her canines were moved to replace the lateral incisors, and premolars to replace the canines.

Fig.2

In this picture, you can see the occlusal situation.

Fig.3

Federica also complained about her canines being too yellow, so as a first step, we have to achieve a better, meaning whiter shade. Remember that patients, today, strongly believe that white means healthy.

Fig.4

We chose a home whitening protocol using a 10% carbamide peroxide White Dental Beauty Teeth Whitening gels.

Fig.5

This is the outcome after a hygiene session and two weeks of home bleaching treatment.

Fig.6

Now that the color issue is solved, we have to focus on function.

Fig.7

As you can see from pictures 6 and 7, we don’t have appropriate anterior and left lateral guidance for disclusion.

Fig.8

Nor we have a right lateral guide.

Fig.9

Above all, our goal is to both change color and shape, while also restoring function. On the other hand, we don’t want to prepare the teeth to preserve all sound tissue. This no prep approach maximizes biological preservation of teeth and provides a large area for optimal adhesion on the enamel.

Fig.10

First of all I suggest you select a couple of fresh composite buttons that match the original color quite well, trying to imagine the amount of material you’ll need, to better understand the opacity and color saturation of the future restoration.

Fig.11

The brand new White Dental Beauty CompoSite System features smart-hybrid, chemical bulk fill and intelligent flowable composites.

Fig.12

The buttons you see in the picture are 2 of the 5 specifically selected dentine shades (Si 0.5 and 1). Remember to select the shade before isolating with the rubber dam not to dehydrate the teeth.

Fig.13

Curing the composite buttons is crucial, because sometimes the photo-activator inside it can change the final color, meaning the actual outcome.

Fig.14

Sometimes taking a picture can also help us in color selection.

Fig.15

Use a 5500°K light source, such as the Styleitaliano Smile Lite, with the chair light off, to have the most accurate color perception.

Fig.16

As we’ll be working with and adhesive system, it is mandatory to operate in a well isolated and clean operative field. Isolation included all teeth from the second right premolar to the left one.

Fig.17

The old composite restorations on the canines were removed, revealing their natural shape.

Fig.18

As a first step, we used a total etching protocol with 37% orthophosphoric acid, and a universal bonding agent on all the 6 teeth.

Fig.19

We placed a palatal translucent composite layer on the centrals and canines to lengthen the teeth. On the other hand, we only used a dentine mass on the premolars to better imitate the opacity of the future canines.

Fig.20

The palatal excess material will be removed during the finishing procedure.

Fig.21

The Unica matrix (Polydentia) allows every clinician to achieve a very predictable and simple shape control.

Fig.22

These matrices can be used throughout all the different adhesive and layering steps.

Fig.23

For the first layer we used a single 0.5 dentine shade layer, to also model the inner mamelon anatomy.

Fig.24

A thin space for the final enamel layer helps in adding optical depth to the restorations.

Fig.25

The final restorations immediately improved the patient’s smile, by “very good and simple means of restoring aesthetics”.

Fig.26

The patient’s happy, beautiful smile.

Fig.27

The final result, our patient’s happiness and satisfaction.
Operative techniques and aesthetic composites are today a perfect choice in no prep approaches, thanks to their increasingly sophisticated optical and mechanical properties. Their longevity/price ratio makes them a fantastic solution for many patients, and their dentists.

Conclusions

The White Dental Beauty CompoSite kit is ideal for modelling and shaping thanks to its low sensitivity to ambient light, but still easy to handle in spite of its high fill content. White Dental Beauty CompoSite is durable, and highly polishable, and is also invisible thanks to its natural fluorescence and high color stability resulting in amazing long-term aesthetics.

Bibliography

1. Vichi A, Fraioli A, Davidson CL, Ferrari M. Influence of thickness on color in
multilayering technique. Dent Mater 2007;23: 1854-1859.
2. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to
choose the right material and simplify application techniques in the anterior
teeth. Our J Esthet Dent 2010;5: 102-124.
3. Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite shade
guides and color matching. Int J Esthet Dent 2014;9: 164-182.