Despite many material choices available today, conservative cosmetic adhesive dentistry can achieve exceptional, long term success and also provides a means to prevent tooth loss in the future. A lifelike restorations are a “target” of clinicians and patients. Therefore, layering techniques and the systematic control of layer’s thickness and opacity are an essential step to obtain a great result. For anterior layering a lingual matrix was described for many authors and this is a powerful tip to perform a multi-layering approach. However, to produce this classical matrix an impression and wax a model of the desired restoration is necessary. This article proposed a new technique called “BRB” (Bertholdo/Ricci/Barrotte) like a simple way to produce the lingual matrix without laboratory steps needed.
Fig.1
The most commonly recommended materials for construction of the lingual matrix have been silicone putty impression materials.
Fig.2
After perfect mixture the silicone is placed covering slightly the incisal angles
Fig.3
Occlusal view.
Fig.4
The silicon stent after removal should show perfect copying. The matrix should extend just below the gingival margin on the lingual aspect of the teeth and should cover at least one tooth on either side of the tooth to be restored to provide a solid seat.
Fig.5
When forming the matrix, on the facial contours of the fractured teeth, the matrix should cover the facial fracture line in 2mm.
Fig.6
With a thin mechanical pencil, the anatomic dimensions was marked. Three referentials are very important: The mesio-distal lines and the incisal edge position.
Fig.7
Contour marked with the pencil should be as similar as possible to the hypothetical shape of the tooth.
Fig.8
Removal of the silicon stent already marked.
Fig.9
In the internal part of matrix a line is marked on the palatal cavosurface angle.
Fig.10
With a tungsten carbide cutters (with a cross cut fine and rounded tip) the matrix should be trimmed to the desired anatomic shape.
Fig.11
Trimming is performed carefully not touching beyond the cavo-surface palatal margin.
Fig.12
The incisal edge mark should be as well respected.
Fig.13
Little by little the anatomical shape takes form.
Fig.14
All of the internal excess was trimmed with the bur until the desired anatomic shape was obtained. Any excess matrix on the adjacent teeth can be removed with a scalpel blade.
Fig.15
Finished BRB Matrix. Finally, the restoration can be performed by following a specific layering technique.
Fig.16
A clinical case is presented with a shortened lateral incisor promoting a disharmonious smile.
Fig.17
In the classical approach a wax-up is needed. Many clinicians consider this not to be necessary especially when a case is simple. With this approach, the precision of a waxup is nearly achieved with the simplicity of a freehand technique but with many advantages.
Fig.18
A polyvinyl siloxane quick-set impression material is used to form the matrix.
Fig.19
Once the matrix has been constructed and removed any excess matrix on the adjacent teeth can be removed with a scalpel blade.
Fig.20
The anatomic dimensions was marked providing dental contouring. Note that this step can be done as well inside the mouth to perceive better the length of the restoration.
Fig.21
On the palatal the cavosurface angle was marked.
Fig.22
The matrix was trimmed with a tungsten bur to achieve the final form. Is important that the bur has a rounded tip.
Fig.23
BRB Matrix in mouth.
Fig.24
The resin shell is prepared by layering a thin layer of resin composite against the missing tooth structure area in the matrix. Material selection should typically be light in shade and medium in opacity.
Fig.25
Internal layering and stains.
Fig.26
The final enamel layer.
Fig.27
Result after finishing and polishing.
Fig.28
The restoration integrated with the perioral tissues.
Fig.29
The happy patient.
Fig.30
The “new smile”.
References
1.- Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. The European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry. 2008; 3: 14-29.
2.- Denehy GE. Simplifying the class IV Ligual Matrix. Journal of Esthetic and Restorative Dentistry. 2005; 17: 312-9.
3.- Fahl N, Jr. A polychromatic composite layering approach for solving a complex Class IV/direct veneer-diastema combination: part I. Practical procedures & aesthetic dentistry : PPAD. 2006; 18: 641-5; quiz 6.
4.- Fahl N, Jr. A polychromatic composite layering approach for solving a complex Class IV/direct veneer/diastema combination: Part II. Practical procedures & aesthetic dentistry : PPAD. 2007; 19: 17-22.
5.- Dietschi D. Free-hand bonding in the esthetic treatment of anterior teeth: creating the illusion. Journal of esthetic dentistry. 1997; 9: 156-64.
6.- Vanini L. Light and color in anterior composite restorations. Practical periodontics and aesthetic dentistry : PPAD. 1996; 8: 673-82; quiz 84.
