Anterior single mass direct restorations

Yes. Anterior composite restorations can be done with one single mass. Modern restorative dentistry is based on the principles of adhesion and minimal invasiveness. Composite materials in particular have been imposed on the market as a permanent solution, and today there is no treatment plan that does not include their use as a seal, front or rear restoration.
The perfect knowledge of the strengths and techniques of application of these materials is essential for every dentist to get the best results from working time corrected.
The direct restorative approach in anteriors, frequently being a main concern for the clinician, must always constitute the best therapeutic option in terms of minimal invasiveness and possible future correction or substitution, especially in young patients, as it offers an obvious advantage in terms of long-term prognosis for the tooth, making it possible to postpone more invasive, both biologically and economically, prosthetic techniques.

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Fig.1
Pre operative picture.

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Fig.2
Ceram X Universal on 21.

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Fig.3
Ceram X Universal on 11.

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Fig.4
Light curing. No adhesive was used.

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Fig.5
Remember to choose the correct mass based on its thickness, because increasing the thickness increases the saturation as well as the opacity of the color.

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Fig.6
A2 mass was selected.

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Fig.7
Removing composite masses with Styleitaliano LM Arte Eccesso instrument.

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Fig.8
Rubber dam isolation.

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Fig.9
Preparing and cleaning the cavities. Caries detector. Buccal view.

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Fig.10
Caries detector, palatal view.

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Fig.11
Caries detector rinsing.

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Fig.12
Cleaned and finished class IV and III (passing and not passing through), cavities. Vestibular view.

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Fig.13
Palatal view.

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Fig.14
Silicone key done on the initial shape before preparing the teeth.

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Fig.15
Metallic sectional matrices stabilized with a drop of flow composite to manage both the mesial III classes on teeth 11 and 21 at the same time.

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Fig.16
37% phosphoric acid etchant gel on dentin and enamel.

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Fig.17
Etch and rinse, two step adhesive system.

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Fig.18
Adhesive light curing.

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Fig.19
Use of composite tips in small cavities to exploit syringe pressure having less air bubbles and avoiding voids.

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Fig.20
Photo curing both the cavities at the same time.

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Fig.21
Matrices removal with and orthodontic How forcep.

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Fig.22
Mesial third classes filled palatal view.

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Fig.23
Etching the distal 4th class cavity on 11 and protecting 21 with teflon tape.

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Fig.24
Rinsing of phosphoric acid.

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Fig.25
Primer bonding adhesive system. Apply multiple layers.

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Fig.26
60 seconds photo curing.

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Fig.27
Palatal wall aspect after removing the silicone stent.

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Fig.28
Anatomic distal emergency profile due to the transparent sectional matrix.

style italiano styleitaliano dentistry

Fig.29
Correct shape and marginal ridge management in oxygen absence due to perfect matrix collapsing on the tooth.

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Fig.30
Light curing.

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Fig.31
Use of the Styleitaliano LM Arte Modella instrument in managing distal 21 profile.

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Fig.32
Easy finishing with round diamond Ceram X gloss rubber tip.

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Fig.33
Final restorations aspect under the rubber dam. Buccal view.

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Fig.34
Palatal view.

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Fig.35
Final immediate outcome after dental dam removal.

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Fig.36
6 months scheduled check-up.

Conclusions

The evolution of restorative materials, pushed by dental practitioners themselves, has led dental companies to the production of new composite masses with a balanced degree in terms of translucency that, based on the thickness applied, make it possible to appropriately masque both the preparation limit and the restoration itself, without resorting to complex stratification techniques and providing a good esthetic result with a limited number of shades at the same time.
Modern filling materials technologies that have recently come out on the market provide, thanks to shape and dimensions of filler particles, simplified stratification techniques, together with a smooth surface texture and a high degree of glossiness.

Bibliography

1. Martin J, Fernandez E, Estay J, Gordan VV, Mjor IA, Moncada G. Minimal Invasive treatment for defective restorations: five-yerars results using sealants. Oper Dent 2013 Mar-Apr;38(2):125-33.

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. Eur J Esthet Dent. 2010 Spring;5(1):102-24.

3. Betrisey E, Krejci I, Di Bella E, Ardu S. The influence of stratification on color and appearance of resin composites. Odontology. 2015 Feb 5.

4. Khashayar G, Dozic A, Kleverlaan CJ, Feilzer AJ, Roeters J., Devoto W. The influence of varying layer thicknesses on the color predictability of two different composite layering concepts, Clinical procedure. Dent Mater. 2014 May;30(5):493-8.

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