Anterior Direct Simplified Technique

Direct anteriors
23 Sep 2013

Working with composite in the anteriors is always challenging, the simplified approach concentrates all efforts in providing the right space for the enamel and dentin, otherwise the characterizations that will be inserted in the middle layer (between the enamel and dentin) can become useless or distract us from our main goal, hiding the restoration margin. In this article we will stress out the importance of balancing the enamel-dentin ratio and how to work with opaque masses in the incisal and proximal area.

Fig. 1

Female patient, 25 years old, came to my attention to remove and old IV class restoration. She did not want to fill her diastema, so it was not touched under her request. We took a chromatic map of 1.1 and 2.1. We choose A2 shade using the Smile Lite (Style Italiano lamp for color check) and took a silicon index from the mockup in order to create a correct palatal wall.

Fig. 2

Removal of the old filling under the dam with a multiblade bur wich is less agressive with the sound enamel and thus, very helpful during this stage where the sound tissue and the material can be confused.

Fig. 3

With a bur that cuts only with its very end (Style Italiano “direct style” preparation set) a 0.5 mm stop was done mesially in order to create the correct support for the restorative material.

Fig. 4

The most intimate part of the old filling was removed with an abrasive disc, after that a new prep was done, with a light chamfer (0.5 mm).

Fig. 5

The whole preparation was polished with a brownie rubber in order to obtain a shiny surface, a surface that lacks of unsupported enamel prisms, which gives an optimal bonding substrate.

Fig. 6

The finalized preparation shows a shiny aspect.

Fig. 7

The silicone guide being tested for the last time.

Fig. 8

With the Fissura Instrument (Style Italiano LM arte) we marked the border of the restoration in order to avoid excess during extraoral stratification over the silicone guide.

Fig. 9

A total etch was done (15 seconds dentin, 30 seconds enamel)

Fig. 10

We applied a primer for 10 seconds and a bonding for 20 seconds in two different steps, polymerized and then create a palatal wall as in the classic build up technique.

Fig. 11

Details of the palatal wall stratified with enamel after the removal of the silicon guide.

Fig. 12

With a small amount of A2 dentin we did at first the mesial vertical wall (1mm) we polymerized and then we did the incisal halo (0.5 mm) in order to have an opaque perimeter both incisally and mesially.

Fig. 13

With the same A2 dentin in a single layer, we did the mammelons, leaving the right place for the incisal edge trasparency and the 0,5 mm for the enamel.

Fig. 14

With an high translucency enamel the incisal edge was finished.

Fig. 15

Then with a gold or ocher pigment the A2 dentin was partially covered in order to add a smooth amber characterization.

Fig. 16

Some white stains were done in order to copy 2.1.

Fig. 17

At the end with a 0.5 amount of A2 enamel all the restoration was covered.

Fig. 18

The last polymerization was done with a glycerine gel in order to eliminate the inhibited oxygen layer caused by air contact that leaves a raw surface.

Fig. 19

Some quick finishing and polishing were done under the dam. A final shiny stage was performed at the control appointment.

Fig. 20

The rubber dam was removed and the young patient left our office.

Fig. 21

After one week we did a chromatic check and only after that a long session of finishing and polishing was done to achieve a good result. The restoration done just with one dentin, one enamel and one translucent, having the right integration and full satisfaction. Less colors many times can mean nice results.