Direct composite following planning

A clinical case by our Community member Dr Giovanna Borelli

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.

The current clinical article emphasized a case of a patient displeased with the old resin composite and the size of her teeth. Smilecloud Biometrics was used to select the final tooth design based on the patient’s facial profile, and then a plan across the palatal barrier was made to guide the design and assure higher predictability.

styleitaliano style italiano Initial situation and rubber dam isolation before direct composite restoration

Fig.1
After clinical examination, an absolute isolation with free latex rubber dam was done. The W2A clamps were used on teeth 14 and 24. Next, the inversion of the rubber dam was made.

styleitaliano style italiano adhesion

Fig.2
Unsatisfactory old resin was removed before the isolation with a multi blade drill. The phosphoric acid Potenza Attaco 37% and the Universal bond from Tokuyama were used for the bonding procedure.

styleitaliano style italiano test of the palatal barrier

Fig.3
Test of the palatal barrier that will guide the sculpture. This is done to evaluate the insertion and the stability of the guide. It is crucial to use a rigid silicone to avoid distortion.

styleitaliano style italiano creation of the palatal barrier

Fig.4
Palatal barrier in position after removing excess and polymerizing. This layer is one of the most important, it will guide the volume of dentin, enamel and also give the final design that was chosen for the patient.

styleitaliano style italiano A1 dentin on the transition line

Fig.5
Layer of dentin in the transition line in the same color as the dental substrate. In this case, A1 dentin was used. This layer will hide the link between the palatal layer and the tooth.

styleitaliano style italiano A1 dentin on the transition line

Fig.6
In this layer of dentin, clinicians have to make sure that the volume of dentin utilized is sufficient and that have space for the following layer of enamel, so it does not ends up with excessive volume.

styleitaliano style italiano Mamelons creation

Fig.7
Drawing the mamelons before enamel layer. In this case, an A1 dentin and the LM Arte Fissura (LM, powered by Styleitaliano) were used.

styleitaliano style italiano Mamelons creation

Fig.8
Drawing the mamelons before enamel layer.
In this case, an A1 dentin and the Twist LM Arte spatula (LM, powered by Styleitaliano) were used.

style italiano styleitaliano lm arte anterior instrument
style italiano styleitaliano lm arte anterior instrument
styleitaliano style italiano White color pigment

Fig.9
White color pigment diluted in flow resin color A1 was used with the help of a brush. This was done to make the opaque halo and to give some nature to the case.

styleitaliano style italiano Mixture of flowable composite and white pigment

Fig.10
This is how the clinician can mix the A1 flow resin with the white pigment and make it soft.

styleitaliano style italiano Enamel layer creation

Fig.11
In the enamel layer, White enamel was used. The interproximal walls were created with polyester strip and by visualizing the model printed to see the details that can be done in this time.
Always following what was planned.

styleitaliano style italiano Before old unsatisfactory resins

Fig.12
Before old unsatisfactory resins.

styleitaliano style italiano after direct composite restoration

Fig.13
After following the planning.

styleitaliano style italiano before and after direct composite restoration

Fig.14
Before and after.

Conclusions

The clinician might arrange the direct anterior cases by using pictures and scanning, and then employ Smilecloud Biometrics artificial intelligence to select a tooth design based on the patient’s facial profile.

Bibliography

  1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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