Direct composite on composite crown

The purpose of this article is to show a case where the dental and gingival aesthetics were involved. A periodontal treatment was performed aiming to health and gingival aesthetic and teeth were treated with direct composites and this is the main restorative material on this case, which gives treated teeth the same physical and optical properties under different light sources, thus avoiding metamerism phenomenon.

style italiano styleitaliano dentistry

Fig.1
Initial view of the smile before the treatment.

style italiano styleitaliano dentistry

Fig.2
Close-up view of the anterior teeth showing a fractured Class IV restoration on 11, a composite “veneer” on 21, a PFM crown on 22 and gum inflammation and retraction on this zone.

style italiano styleitaliano dentistry

Fig.3
Close-up view of the “Veneer”, the PFM Crown and the gum condition.

style italiano styleitaliano dentistry

Fig.4
The periodontal treatment was performed and a provisional crown was fit on 22.

style italiano styleitaliano dentistry

Fig.5
Close-up view of the provisional and the gum.

style italiano styleitaliano dentistry

Fig.6
A “transitional” veneer was built on 21 after the old restorations removal. Note the aspect and gum profile.

style italiano styleitaliano dentistry

Fig.7
Close-up aspect of the six anterior teeth.

style italiano styleitaliano dentistry

Fig.8
A prepared composite resin crown was cemented in 22 position (U-200 3M) and all composite restorations were removed.

style italiano styleitaliano dentistry

Fig.9
Aspect after blasting with aluminum oxide, etching and the adhesive application (Optibond – FL).

style italiano styleitaliano dentistry

Fig.10
Palatal enamel and dentin stratification.

style italiano styleitaliano dentistry

Fig.11
Removing of the dam and the retraction cords.

style italiano styleitaliano dentistry

Fig.12
After a week, the geometry of the teeth were refined.

style italiano styleitaliano dentistry

Fig.13
Secondary anatomy “map”.

style italiano styleitaliano dentistry

Fig.14
Final aspect of the smile.

style italiano styleitaliano dentistry

Fig.15
Palatal view of the incisal edge alignment before the treatment.

style italiano styleitaliano dentistry

Fig.16
Palatal view of the incisal edge alignment, 6 months after the procedures.

style italiano styleitaliano dentistry

Fig.17
Black and white shot to evaluate the value balance.

style italiano styleitaliano dentistry

Fig.18
Close-up view of the six anterior teeth, a little dehydration can be noted on 12.

Conclusions

This article presents the versatility of application of composite resin, solving a common case in the daily practice. The knowledge of the material properties is very important for solving cases in a simple way, with actual results and benefits for the dentist and patient.

Bibliography

1. Fahl Jr N. The Aesthetic Composite Anterior Single Crown Restoration , Practical Periodontal and Aesthetic Dentistry 1997 – 70, Vol.9 No 1.
2. Aoshima H. A Collection of Ceramic Works – A Communication Tool for the Dental Office and Laboratory. Tokyo,Japan: Quintessence Publishing,1994.
3. Dietschi D. Freehand composite resin restorations: A key to anterior aesthetics. Pract Periodont Aesthetic Dent 1995;7(7):15-25.
4. Fahl N Jr. The direct/indirect composite resin veneers: A case report. Pract Periodont Aesthetic Dent 1996;8(7):627-638.
5. Devoto W. Saracinelli M. Il restauro conservativo estetico nei settori anteriori: come scegliere il materiale composito e semplificare le tecniche di applicazione. Il dentista moderno, 2009; 10: 35-60.
6. Devoto W. Clinical procedure for producing aesthetic stratified composite
resin restorations. Pract Proced Aesthtet Dent. 2002 ; 14 (7): 541-543.
7. Dietschi D, Campanile G Holz J, Meyer JM. Comparison of the color stability of ten new generation composites. An in vitro study. Dent Mater 1994;10(4):353-362.
8. Devoto W., Saracinelli M., Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in anterior teeth. Eur J Esthet Dent. 2010 ; 5 (1) : 102-124.
9. Fahl N Jr., Denehy GE, Jackson RD. Protocol for predictable restoration of anterior teeth with composite resins. Oral Health. 1998;88(8):15-22.
10. Paravina RD, Kimura M, Powers JM. Color compatibility of resin composites of identical shade designation. Quintessence Int. 2006; 37(9):713-9.
11. Friebel M, Povel K, Cappius HJ, Helfmann J, Meinke M. Optical properties of dental restorative materials in the wavelength range 400 to 700 nm for the simulation of color perception. J Biomed Opt. 2009; 14(5):054029.
12. Heymann HO. The artistry of conservative esthetic dentistry. J Am Dent Assoc. 1987;Dec.(Spec. No.):14E-23E.

RELATED CASES

Single-visit diastema closure

How to restore a central incisors large diastema in one single visit with an easy and repeatable direct composite restoration