Challenge with single tooth using unica anterior matrix

A clinical case by our Community member Dr Bounab Abdelkader

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Restoring a single central incisor is always difficult since dentists must emulate nature by reproducing not only color, but also shape and texture. Knowledge is required to be able to apply dependable methods and master dental products while always considering the least invasive option. Direct composites are usually the answer that the clinician chooses because they are minimally invasive.
Can the clinicians repair quickly while achieving a predictable yet excellent result with only one shade? The answer is yes in more circumstances than you would expect. In this article, a great direct veneer was created in a short and satisfying approach by using Unica anterior matrix and polar eyes filter.

Unica Matrix dentistry banner style italiano styleitaliano
Unica Matrix dentistry banner style italiano styleitaliano
styleitaliano style italiano Initial situation

Fig.1
Initial pre-operative situation (smile view).

styleitaliano style italiano Retracted view of the initial situation

Fig.2
Retracted view of the initial situation.

styleitaliano style italiano Initial pre-operative situation

Fig.3
Initial pre-operative situation with contrasted view (black matte background Flexipalettes, Smile Line). Discolored central with old restoration and color mismatch were clearly seen in this picture.

style italiano styleitaliano smileline dental photography flexipalette
style italiano styleitaliano smileline dental photography flexipalette
styleitaliano style italiano Shade evaluation

Fig.4
Shade evaluation with polar eyes filter. Small amounts of composite are applied and light-cured (without bonding agent) in an attempt to select the right shade of composite.
This picture could be taken either by the Smile Lite MDP (Smile Line, Switzerland) or by a digital single lens reflex (DSLR).

style italiano styleitaliano smileline mdp dental photography
style italiano styleitaliano smileline mdp dental photography
styleitaliano style italiano Rubber dam in action

Fig.5
Rubber dam in action.

styleitaliano style italiano Rubber dam in action

Fig.6
Inversion for rubber dam isolation was done by blowing the air around the cervical area and, at the same time, delicately pushing the rubber sheet into the sulcus with a spatula.

styleitaliano style italiano Rubber dam in action

Fig.7
Absolute isolation.

styleitaliano style italiano Protection of the adjacent tooth

Fig.8
Protection of the adjacent tooth to avoid any accidental damage during preparation.

styleitaliano style italiano Limit of the bevel marked

Fig.9
Mark with a pencil the limit of the bevel.

styleitaliano style italiano Bevel creation

Fig.10
1.5-2 mm bevel was created using a yellow-band flame diamond bur.

styleitaliano style italiano Preparation

Fig.11
Teeth were now ready for adhesion procedure.

styleitaliano style italiano Enamel etching

Fig.12
Enamel etching was done with 35% phosphoric acid on both teeth #12 and #11.

styleitaliano style italiano bonding

Fig.13
The surfaces were bonded with a brushing motion using a universal adhesive (Scotchbond Universal, 3M), and light-cured for 1 minute.

style italiano styleitaliano 3m
style italiano styleitaliano 3m
styleitaliano style italiano Silicon key application

Fig.14
Silicon key application for creating the palatal enamel shell; LM Fissura Instrument (LM Dark Diamond) is used to create a landmark of the area to be restored.

styleitaliano style italiano LM Arte Dark Diamond instruments
styleitaliano style italiano LM Arte Dark Diamond instruments
styleitaliano style italiano Palatal enamel shell

Fig.15
Palatal enamel shell applied with enamel shade.

styleitaliano style italiano Proximal walls reconstruction

Fig.16
Proximal walls reconstruction with the help of Unica matrix by Polydentia (Enamel shade).

styleitaliano style italiano Solo anterior in action

Fig.17
Solo anterior in action. The new all-in-one, multipurpose instrument known as the LM Solo Anterior Instrument (LM, powered by Styleitaliano) was specifically designed for composite veneers and anterior composite restorations. In this case, it was used for modeling the composite in an easy way.

LM arte solo banner style italiano styleitaliano
LM arte solo banner style italiano styleitaliano
styleitaliano style italiano Enamel shade on the palatal and proximal walls

Fig.18
The palatal shell with the proximal walls were created using enamel shade.

styleitaliano style italiano Dentin build-up

Fig.19
Dentin build-up (dentin shade from 3M), from cervical to incisal was done with one shade.

styleitaliano style italiano Application of opalescent effect shade at incisal third

Fig.20
Application of opalescent effect shade at incisal third (clear enamel shade from 3M).

styleitaliano style italiano The compo-brush Smile Line modeling the last layer of composite

Fig.21
The compo-brush (Smile Line, Switzerland) was used for modeling the last layer of composite.

smileline compobrush banner style italiano styleitaliano
smileline compobrush banner style italiano styleitaliano
styleitaliano style italiano Follow-up

Fig.22
Second appointement for checking the shade.

styleitaliano style italiano Shape contouring and pre-polishing with coarse disc soflex 3M

Fig.23
Shape contouring and pre-polishing with a coarse disc Soflex from 3M.

style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
styleitaliano style italiano Final post-operative situation after full rehydration

Fig.24
Final post-operative situation after full rehydration.

styleitaliano style italiano Final post-operative situation after full rehydration

Fig.25
Final post-operative situation after full rehydration (smile view).

styleitaliano style italiano Final post-operative situation after full rehydration

Fig.26
Final post-operative situation after full rehydration.

styleitaliano style italiano Follow-up after 6 months

Fig.27
Final shade evaluation with polar eyes filter. Good color match with lateral incisor after 6 months.

styleitaliano style italiano Before and after

Fig.28
Before and after.

Conclusions

Thanks to these new materials (polar eyes filter to check the shade and Unica anterior matrix for the shape) and reliable techniques, restoring a single central with a direct restoration has become possible, fast, and predictable.

Bibliography

  1. https://www.styleitaliano.org/four-levels-of-inversion-for-rubber-dam-isolation/
  2. Manauta J, Salat A. Layers: an atlas of composite resin stratification. Quintessence 2022
  3. Fahl JR, N. Mastering Composite Artistry to Create Anterior Masterpieces – Part 2. Journal of Cosmetic Dentistry, 2011; Winter 42-55.
  4. Báez Rosales, De Nordenflycht Carvacho, Schlieper Cacciutolo, Báez Rosales. Conservative Approach for the Esthetic Management of Multiple Interdental Spaces: A Systematic Approach. J Esthet Restor Dent. 2015 Nov-Dec;27(6):344-54.
  5. https://www.styleitaliano.org/single-shade-approach/
  6. Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, Haikel Y, Cuevas-Suárez CE. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021;13(5):814.
style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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