We originally had used a silicone key for guidance when closing the diastema between the patient’s maxillary central incisors. No tooth preparation was carried out; the composite was merely bonded to the tooth structure.
When the patient came back, the restoration’s surface showed only slight discolorations, which were removable by polishing. The shape of the teeth was adequate, but not perfect. We decided to retreat her using a non-prep, single-shade approach. The main goal was to create a more natural shape. This time, we used a contoured posterior sectional matrix to facilitate the process, as a matrix offers more guidance than a palatal silicone key.
Fig.1
Close-up view of the central incisors. Midline diastema closure was desired for aesthetic reasons.
Fig.2
Image of the non-prep previous direct composites treatment, after 15 years. The restorations are still intact, but there is room for improvement, in particular the shape of the vestibular area.
Fig.3
Roughening of the surfaces as well as removal of discolorations and debris using 3M™ Sof Lex™ Extra-Thin Contouring and Polishing Discs. This measure is required for two reasons to ensure proper aesthetic results and to create favorable conditions for bonding.
Fig.4
Cleaned and slightly roughened surface ready for etching and bonding. Again, the selected treatment approach works without tooth preparation. There is no reason for the entire replacement of the existing restorations.
Fig.5
Etching of the enamel using 3M™ Scotchbond™ Universal Etchant for 15 seconds. Afterwards, the etchant was removed by rinsing with water and 3M™ Scotchbond™ Universal Adhesive was applied according to the instructions for use.
Fig.6
Material selection: The picked material for the single-shade technique for the present case is 3M™ Filtek™ Universal Restorative in the shade A1. The composite is available in an universal opacity and shows a beneficial chameleon-like effect.
Fig.7
Appearance after the application of the first composite layer. The idea was to cover the vestibular surface for improving surface texturing and reducing the space between the teeth. This enabled to place two contoured posterior sectional matrices.
Fig.8
A week later, the restoration shows to be aesthetically well-integrated with surrounding tooth structure, with some feint incisal edge effects. At this appointment the restoration was finally polished using sof-lex polishing discs, Premier Diamond Paste, and finalized using the wheel polishing system.
Fig.9
Palatal view of the two posterior sectional matrices placed in an upright position to facilitate the creation of a natural tooth shape.
Fig.10
Frontal view of the two posterior sectional matrices placed in an upright position. It is generally advisable to utilize a matrix with a contrasting color.
Fig.11
Lateral view: the composite material is applied to fill the space between each central incisor and the adjacent matrix. The shape of the matrix facilitates the establishing of a tight contact point and the desired anatomical morphology.
Fig.12
View after light-curing and the removal of both matrices.
Fig.13
Polishing of the restoration surface using the beige Spiral Wheel of 3M™ Sof-Lex™ Diamond Polishing System
Fig.14
Polishing of the restoration surface using the pink Spiral Wheel of 3M™ Sof-Lex™ Diamond Polishing System
Fig.15
Noteworthy is the natural surface texture of the central incisors including the new composite restorations.
Fig.16
Close-up view of the maxillary incisors. The restorations are virtually indistinguishable from the natural tooth structure. As expected, the composite blends in perfectly with the color of the surrounding teeth.
Conclusions
This time, we used a contoured posterior sectional matrix to facilitate the process, as a matrix offers more guidance than a palatal silicone key. Even if the management of such procedure could be difficult, using the bulk fill composite, FiltekTM Universal Restorative in one single shade has helped to simplify the treatment. Moreover, the placement of the flowable resin composite in the palatal area under the high viscosity resin composite allow the dental clinician to detect the filling of all margin.
Bibliography
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[2] R. Hirata, W. Kabbach, O.S. de Andrade, E.A. Bonfante, M. Giannini, P.G. Coelho, Bulk Fill Composites: An Anatomic Sculpting Technique, J. Esthet. Restor. Dent. Off. Publ. Am. Acad. Esthet. Dent. Al. 27 (2015) 335–343. doi:10.1111/jerd.12159.
[3] W. Devoto, M. Saracinelli, J. Manauta, Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth, Eur. J. Esthet. Dent. Off. J. Eur. Acad. Esthet. Dent. 5 (2010) 102–124.
[4] G. Gürel, Predictable, precise, and repeatable tooth preparation for porcelain laminate veneers, Pract. Proced. Aesthetic Dent. PPAD. 15 (2003) 17–24; quiz 26.
