Single body shade posteriors

Translucency, value and chroma are intimately correlated in direct composite resin restoration. These optical properties can be affected by any variation during layering. In case of a single-shade technique the esthetic outcome of the restoration is influenced by the stratification design.

When optical properties like hue, translucency, opacity, chromaticity, saturation, value and opalescence are restored, dental restoration may prove to be even more realistic. The optical parameters of a composite restoration primarily are affected by the composite resin composition. The effectiveness of optical scattering depends on the size of the filler. As the filler is smaller the efficiency of the optical scattering is higher. In the same time light scattering and gloss retention depends on how the filler is arranged and distributed within the resin matrix. The combination of larger and smaller fillers or filler clusters has a major influence on the shades and levels of translucency of a natural tooth-like restoration.

The most recent innovations are the nanofilled composite resins. Their mechanical and physical properties are similar to the microhybrid composite resins, above all presents an increased polishability and long term gloss retention.

Nanofilled composite resins can be found in many translucencies. The most opaque shades are dentin shades, but translucency increases when comparing body shades to dentin shades. Translucency of chromatic enamel shades is in-between the translucency of body shades and achromatic enamel shades. The wide range of opacities makes this composite resin ideal for dual-shade or multi-shade technique. The 3M ESPE expanded the range of Filtek Ultimate Body shades to provide more options for an ideal single-shade match.

The evaluation of the optical properties outcome can be carried out once the restoration is finalized and polished. In case the importance of a more esthetic outcome is higher, a translucent external layer should be applied.

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Fig.1
Detail of the matrix adaptment

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Fig.2
Custom ring repositioning. It fits perfect on the wedge. Custom ring adapts the matrix to the walls.

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Fig.3
Buccal view.

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Fig.4
An extremely thin base liner polymerized for extended time (40 seconds).

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Fig.5
The premolar’ distal wall is constructed with 3M Filtek Ultimate A3 Body shade.

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Fig.6
Detail on perspective.

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Fig.7
The custom ring and the matrix removed. Now the shape can be seen precisely. Marginal ridge reconstructed. Only minimal excess was obtained.

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Fig.8
Layers imitating dentin are oblique bulk of 1 mm. Same material was used, 3M Filtek Ultimate A3 Body shade. The color is ideal.

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Fig.9
Last layer built cusp-by-cusp, approximately 0,5-0,8 mm with the same material 3M Filtek Ultimate A3 Body shade. Important to achieve a perfect anatomy in posterior region as well.

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Fig.10
Increments growing by 1mm aprox.

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Fig.11
Occlusal surface in modeling stage.

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Fig.12
The occlusal surface modeled and ready for stains.

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Fig.13
Lateral view.

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Fig.14
Morphology details.

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Fig.15
Morphology details.

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Fig.16
Morphology details.

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Fig.17
Morphology details.

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Fig.18
The stain technique: stain goes trapped superficially in the fossae and sulcus. Long polymerization time for a good surface hardness.

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Fig.19
Stain details.

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Fig.20
Stain details.

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Fig.21
Morphology details.

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Fig.22
Ready for finishing.

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Fig.23
Finishing and polishing.

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Fig.24
Finishing and polishing details.

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Fig.25
Prior to isolation removal.

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Fig.26

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Fig.27
Finishing and polishing details.

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Fig.28
Finishing and polishing details.

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Fig.29
Immediately post operation. Restoration should look slightly darker than the remaining tooth structure.

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Fig.30

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Fig.31

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Fig.32
Occlusal check after rubber dam removal. Polishing was done before this step.

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Fig.33

Conclusions

Bibliography

1. Fernando Rey Duro, Joana Souza Andrade, Sillas Duarte Jr. Fluorescence: Clinical Evaluation of New Composite Resins. QDT 2012;35: 145-156.
2. Campbell PM, Johnston WM, O’Brien WJ. Light scattering and gloss of an experimental quartz-filled composite. J Dent Res 1986;65:892-894.
3. Mitra SB, Wu D, Holmes BN. An application of nanotechnology in advanced dental materials. J Am Dent Assoc 2003;134:1382-1390.
4. Sillas Duarte Jr, Neimar Sartori, Jin-Ho Park. Achieving the Ultimate Optical Properties of Composite Resin. QDT 2013;36:38-57.
5. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012

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