Double-mold Technique

Recent progress in composite materials, aesthetic outcome and modern chair-side techniques, have generated renewed interest in direct restoration techniques, mainly because of their advantages over indirect veneers. However, direct anterior restorations represent a real challenge for dentists, linked to the required clinical competence and manual skills. This case shows a new clinical approach based on the direct impression of two silicone transparent guides onto resin- based composite material. This procedure, called the “Double Mold Technique”, involves the fabrication of two silicone molds, one for the dentin shade, and the other for the enamel one. Furthermore, to better manage the contact point, a metal sectioned matrices were inserted inside the silicone mold.

smile with misaligned teeth and an old composite restoration styleitaliano style italiano

Fig.1
A 30-year-old female wanted to restore and improve her smile due to traumatic injuries happened she was younger.

Close up of old composite restoration on central incisor styleitaliano style italiano

Fig.2
Clinical exploration shows a deteriorated old composite restoration on 11 and 21. Furthermore, the gingival profile is modified, appearing unsightly.

upper central incisors with unaesthetic composite restorations styleitaliano style italiano

Fig.3
This close-up highlights the old restorations on the upper central incisors.

smile before esthetic restorations styleitaliano style italiano

Fig.4
Initial situation of the patient’s smile.

side view of smile before aesthetic enhancement styleitaliano style italiano

Fig.5
Right side of the patient’s smile.

side view showing misaligned teeth styleitaliano style italiano

Fig.6
Left side of the patient’s smile.

teeth after removal of old composite restorations styleitaliano style italiano

Fig.7
After removal of the old restorations.

palatal shell with silicone index styleitaliano style italiano

Fig.8
A palatal shell was built as the shade layers will involve the buccal part of the tooth, so the silicone molds will be more precise on the buccal side.

provisional composite palatal shell under rubber dam isolation styleitaliano style italiano

Fig.9
After building the palatal wall, the field was isolated with the rubber dam.

acid etching before direct composite veneering styleitaliano style italiano

Fig.10
The etching step was performed using 3M™ Scotchbond™ Gel on the entire enamel surface for 20 seconds. The adhesive system was applied and then polymerized after gentle air-blowing.

transparent silicone indices for mold technique restorations styleitaliano style italiano

Fig.11
These two clear silicone molds were fabricated to press two different shades of composite resin, one for the dentin shade, and the other for the enamel shade.

metal matrices embedded into transparent silicone mold styleitaliano style italiano

Fig.12
Furthermore, to better manage the contact points, metal matrices were been inserted inside the silicone mold. This way, the entire restoration can be directly produced in one single press.

mold try in before mold stamp composite restorations styleitaliano style italiano

Fig.13
The insertion of the dentin shade silicone mold. It is important to try it first, to verify its insertion, avoiding moving or damaging the metal matrices. It is noteworthy that, in this technique, all restorations are performed simultaneously, in one single step.

first composite layer stamped in double mold technique styleitaliano style italiano

Fig.14
The dentin shade final restorations, with the clearly visible mamelons. This layer will then be covered by the enamel shade.

second silicone mold in double mold composite restoration styleitaliano style italiano

Fig.15
The insertion of the enamel shade silicone mold. Also in this step, try it first, to verify its insertion. Furthermore, it is essential to press on the silicone mold in the cervical margin area of the teeth, to avoid extrusion of excess composite, and to obtain the best precision restorations.

light curing through transparent silicone styleitaliano style italiano

Fig.16
During polymerization, it is essential to press on the silicone mold in the cervical area of the teeth, to avoid extrusion of excess composite and to obtain the best precision restorations.

unpolished composite restorations performed with the double mold technique styleitaliano style italiano

Fig.17
Final restoration immediately after the press of the enamel shade composite.

direct stamped composite restorations styleitaliano style italiano

Fig.18
Final result before the finishing and polishing procedure.

polishing composite veneers styleitaliano style italiano

Fig.19
The brown spiral wheel used for finishing step provides a smooth surface to improve the aesthetic outcome.

second step polishing veneers with spiral wheel styleitaliano style italiano

Fig.20
The purple spiral wheel used for the polishing step provides a glossy surface to improve the aesthetic outcome.

polishing composite restorations with lucida star felt and polishing paste styleitaliano style italiano

Fig.21
This paste and the star felt from the Lucida™ Composite Gloss System by Styleitaliano allow to improve the gloss retention to achieve a enamel-like surface.

polished composite restorations styleitaliano style italiano

Fig.22
The result after finishing and polishing procedure.

composite esthetic restorations on upper incisors styleitaliano style italiano

Fig.23
Final result of the direct composite restorations. The patient’s gingival profile, once the restoration has just been completed, seems to have a different, more aesthetic appearance. however, it must be monitored over time to verify its correct repositioning.

smile after composite restoration styleitaliano style italiano

Fig.24
The aesthetic outcome of the patient’s new smile.

composite esthetic improvement without tooth preparation styleitaliano style italiano

Fig.25
At 1-week follow-up. The patient is satisfied with her new smile.

close up of composite veneers styleitaliano style italiano

Fig.26
Note the glossy surface and the natural aspect of the dentin-enamel shade appearance.

surface texture with double mold composite restorations styleitaliano style italiano

Fig.27
Lateral view highlighting the surface texture.

surface texture of direct composite restorations styleitaliano style italiano

Fig.28
Lateral right view.

before and after composite restoration with double mold technique styleitaliano style italiano

Fig.29
Before and after.

Conclusions

Once integration of the restorations is complete, soft tissue levels will be managed to further enhance the esthetics of the patient’s smile. This technique allows the clinician to simplify direct anteriors restorations, including veneering, with appropriate width proportions based on a previous wax-up, obtaining a successful result in just one single visit.

Bibliography

1. Diaz Guzman E. Full-mouth rehabilitation with the flowable injection technique. QTD International 2018
2. Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite shade guides and color matching. Int J Esthet Dent. 2014 Summer;9(2):164-82.
2. Perrin P, Zimmerli B, Jacky D, et al. The stamp technique for direct composite restoration. Revue Mensuelle Suisse D’odontostomatologie. 2013 ;123(2):111-129. PMID: 23512289

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