In restorative dentistry, the constant evolution and progress of materials and equipment (adhesive systems, composite resins, spatulas, brushes, etc.) have made it possible to simplify the daily lives of dental surgeons and to improve the treatments that patients benefit from. Nevertheless, composite resin lamination procedures in the anterior sector are often considered complex and time-consuming by the majority of practitioners. How to obtain an “invisible”, lasting restoration in a reasonable time is a recurring question that many dentists ask themselves.
The objective of this article is to demonstrate that by applying the principle of division of tasks to restorative dentistry, the design of composite resin restorations in the anterior sector is only a sum of simple and reproducible actions to be carried out conscientiously, according to a well-defined timeline leading to a predictable and satisfactory result.
A young female patient came to replace composite restorations on her central incisors. On the initial picture, we can see the inappropriate aesthetic adaptation of the two resins on teeth 11 and 21. We decided with the patient to make two new composite restorations.
To match the color, we used the button try technique by putting and curing a little amount of composite resin on the tooth. This step has to be quick to avoid the change of color of the teeth caused by dehydration.
The analysis of a cross polarized picture helps us in creating a color chart of the sound structure. We can observe blue opalescence, some white spots and characterizations.
The first step when performing composite resin restorations is rubber dam isolation. The field has to be large enough so the practitioner can see and use the silicone stent.
The second step consists in removing the old restorations and prepare the teeth with buccal chamfer and flat design on the proximal and palatal surfaces.
The third step (and 1st step of any bonding procedure) is sandblasting with 50um aluminum oxyde.
The fourth step is etching with 37% orthophosphoric acid.
Fifth step. After rinsing the etching gel and drying the surface, we proceed to the application of the bonding agent. In this case we used a universal adhesive.
Now is time to use our tools, brush and the new LM Arte Dark Diamond instrument set. The handling has been improved, the black color creates a contrast and helps while sculpting composite that does not stick on the instrument.
Sixth step. A thin instrument, such as the ErgoSense probe is used to outline the area of the palatal composite. One of the advantages of composite resin stratification is that this procedure, except for the final enamel application, is fully guided.
Seventh step. The palatal walls are layered outside the mouth onto the silicone index and applied to the teeth.
Once the palatal walls are light cured, the silicone is removed and the composite stays on the teeth.
Excess can be removed at this step with a blade or a disc.
Proximal walls after removal of the matrices.
Ninth step. The “boxes” created by the palatal and proximal walls are filled with dentin composite resin. The use of the Condensa tool helps by packing the material so that no bubbles are trapped into the layering.
Several increments of dentin material can be added until the right shape and volume are achieved.
At each step, burs and discs can be used (no water, slow speed). Here, a disc was used to create a lobule on the incisal edge. After this, the surface must be cleaned and bonding agent applied but not light cured.
Some tint can be added to create the characterizations of the incisal edge.
Tenth step. The Modella tool is used to apply enamel composite buccally. This is the only non-guided step. The practitioner has to be careful and has to respect the final shape and volume of the teeth.
Final light curing is done under glycerine gel to avoid the polymerization of last layer of composite to be inhibited by the oxygen.
Eleventh step. The finishing procedure is done at slow speed without water with discs and burs.
Finishing with burs.
The final result shows a highly glossy surface and very natural shape and volume.
Final smile after rubber dam removal.
Before and after comparison.
Before after comparison, 3 months post operative.
Taken one by one, the steps required to design a composite resin laminate restoration in the anterior sector are simple and reproducible. This principle of division of the clinical act must bring confidence and serenity to practitioners carrying out this type of treatment and must lead to satisfactory results both for the dental surgeon but also for the patient.
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