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.
Fig.1
A 30-year-old female wanted to restore and improve her smile due to traumatic injuries happened she was younger.
Fig.2
Clinical exploration shows a deteriorated old composite restoration on 11 and 21. Furthermore, the gingival profile is modified, appearing unsightly.
Fig.3
This close-up highlights the old restorations on the upper central incisors.
Fig.4
Initial situation of the patient’s smile.
Fig.5
Right side of the patient’s smile.
Fig.6
Left side of the patient’s smile.
Fig.7
After removal of the old restorations.
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.
Fig.9
After building the palatal wall, the field was isolated with the rubber dam.
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.
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.
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.
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.
Fig.14
The dentin shade final restorations, with the clearly visible mamelons. This layer will then be covered by the enamel shade.
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.
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.
Fig.17
Final restoration immediately after the press of the enamel shade composite.
Fig.18
Final result before the finishing and polishing procedure.
Fig.19
The brown spiral wheel used for finishing step provides a smooth surface to improve the aesthetic outcome.
Fig.20
The purple spiral wheel used for the polishing step provides a glossy surface to improve the aesthetic outcome.
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.
Fig.22
The result after finishing and polishing procedure.
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.
Fig.24
The aesthetic outcome of the patient’s new smile.
Fig.25
At 1-week follow-up. The patient is satisfied with her new smile.
Fig.26
Note the glossy surface and the natural aspect of the dentin-enamel shade appearance.
Fig.27
Lateral view highlighting the surface texture.
Fig.28
Lateral right view.
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
