composite resin layering on central incisors

Aesthetics & Function – A No Prep Direct Composite Case

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.

upper arch with missing lateral incisors

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.

occlusal view of missing upper incisors

Fig.2

In this picture, you can see the occlusal situation.

giving instructions about dental bleaching

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.

dental home bleaching kit

Fig.4

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

result after home bleaching before composite restoration

Fig.5

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

occlusal guide check

Fig.6

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

right canine guide

Fig.7

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

left canine guide

Fig.8

Nor we have a right lateral guide.

project for incisor lengthening

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.

composite button try on central incisors

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.

composite shade button try

Fig.11

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

incisors with composite shade button try

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.

curing of the button try

Fig.13

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

dental photography position

Fig.14

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

smile lite light for shade 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.

rubber dam isolation of upper arch

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.

canines before being reshaped into lateral incisors

Fig.17

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

palatal composite shells for dental reshaping

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.

detail of color shade selection for shape modification

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.

occlusal view after shape modification

Fig.20

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

total etching technique with unica matrix

Fig.21

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

composite resin layering on central incisors

Fig.22

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

mamelon composite layering with unica matrix

Fig.23

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

enamel mass composite layering

Fig.24

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

final composite no prep restorations

Fig.25

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

new smile after single session at the dentist’s

Fig.26

The patient’s happy, beautiful smile.

happy smile after dental makeover

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

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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.