Easy way to enhance aesthetics with simplified composite shades

A clinical case by our Community member Dr Laura Mokhtari

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.

In this case, the emphasis lies on the seamless enhancement of aesthetics using simplified composite shades. The approach begins with a comprehensive initial aesthetic analysis, assessing the situation to determine if simplified shade solutions can effectively match the adjacent teeth. This analysis lays the groundwork for the procedure, highlighting the importance of meticulous planning in achieving desirable outcomes.
Furthermore, maintaining a clean operative field throughout the procedure is essential. This ensures optimal conditions for precise placement of the composite material, facilitating the attainment of an aesthetically pleasing result.
Moreover, the pivotal role of polishing and finishing techniques in refining the final outcome is underscored.

styleitaliano style italiano Initial situation smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.1
The patient came to the office to replace her old composite on tooth 2.1.
She doesn’t like the form and color of the composite.

styleitaliano style italiano Initial situation smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.2
A difference in length and proportion between the two central incisors can be observed. The composite seems too short and the color of the restoration does not match the rest of the tooth.

styleitaliano style italiano Lateral views of the composite smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.3
Lateral views of the composite.

styleitaliano style italiano Shade selection smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.4
Beginning of the composite bonding session : composite shade is chosen before setting up the operative field to avoid dehydration of the teeth and shade modification.
The simplification of composite shades allows to chose only 1 shade for the full restoration.
Here, the shades tried are Venus Pearl Light and Venus Pearl Medium from kulzer company. The Venus Pearl Light shade was selected.

style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
styleitaliano style italiano isolation smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.5
The operative field is prepared with a thick rubber dam, ensuring precise isolation. Despite focusing solely on tooth 2.1, a comprehensive dam covering the six anterior teeth is employed. This broader perspective aids the operator in maintaining symmetry and proportions accurately.

styleitaliano style italiano Removal of the old composite smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.6
Removal of the old composite. A chamfer is created on the limit of the previous restoration. This chamfer will help light transitioning and shade matching of the new composite with the natural tooth.

styleitaliano style italiano Protection of adjacent teeth smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.7
Protection of adjacent teeth is necessary for the treatment of the tooth to prevent composite from bonding to adjacent teeth.

styleitaliano style italiano Etching smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.8
The tooth surface is prepared by etching with 35% orthophosphoric acid. It is applied for 30 seconds on enamel and then, after a 15-second interval, for an additional 15 seconds on dentin. Subsequently, iBond Etch by kulzer is thoroughly rinsed off with water spray for 20 seconds under suction.

styleitaliano style italiano Adhesive application smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.9
iBond Universal adhesive by Kulzer is applied and light cured according to the instructions of use.

styleitaliano style italiano Palatal shell smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.10
For small restorations, constructing the palatal shell can be easily achieved using a transparent matrix held by the operator’s thumb. This straightforward technique facilitates the rapid recreation of a basic form, which can then be refined during polishing. The composite is applied in layers of up to 2 mm, with light curing between each layer.

styleitaliano style italiano Palatal shell created smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.11
A close-up view of the palatal shell reveals its irregular form, which serves as a basic pattern for composite build-up. The simplified light shade composite is utilized for this purpose.

styleitaliano style italiano Composite placement smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.12
The build-up continues using the same light composite shade. The pencil aids in gently shaping the composite, ensuring it conforms smoothly to the tooth surface and minimizing irregularities and bubbles.

styleitaliano style italiano Complete composite placement smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.13
The composite build-up is now complete, achieving the desired shape. However, further polishing and finishing will be necessary to attain a more natural-looking result.

styleitaliano style italiano Finishing and polishing smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.14
Starting the polishing sequence with pop on discs that will correct the form and surface texture.

styleitaliano style italiano Finishing smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.15
The discs are used on the incised edge and buccal area of the tooth.

styleitaliano style italiano polishingsmile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.16
Polishing of the composite with the Venus Supra polishing kit by Kulzer: first bur to polish the buccal surface and create reliefs, always to be used with sufficient water cooling (at least 50 ml/min).

styleitaliano style italiano polishing smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.17
The buccal side is polished using a Twist Brush, which features a different shape. It is essential to ensure sufficient water cooling during this process.

styleitaliano style italiano polishing smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.18
The composite is polished using the second sequence of the Venus Supra polishing kit by Kulzer, emphasizing the importance of sufficient water cooling throughout the process.

styleitaliano style italiano polishing smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.19
Using a strip to polish the proximal areas of the composite. This step is crucial to obtain a soft proximal surface and prevent inflammation of the papilla.

styleitaliano style italiano End of polishing before removing operative field smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.20
End of polishing before removing operative field.

styleitaliano style italiano Immediate post-op result smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.21
Following polishing and removal of the operative field, the immediate post-operative result is satisfactory. However, it is important to note that the clinician must wait for teeth rehydration to fully assess the outcome.

styleitaliano style italiano Final result at 1 month smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.22
Final result at 1 month : Patient is happy with her new smile and the composite integration is correct.
At the one-month follow-up, the patient expresses satisfaction with her new smile, and the integration of the composite is deemed correct. The use of simplified composite shades has provided a pleasing and expedient outcome.

styleitaliano style italiano Before and after treatment smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.23
Before and after treatment.

styleitaliano style italiano Before and after treatment smile aesthetics with simplified composite shades Kulzer Venus Pure composite direct restoration composite restoration

Fig.24
Before and after treatment.

Conclusions

An initial aesthetic analysis is crucial for planning a direct composite rehabilitation. This analysis helps to predict whether simplified shade solutions can seamlessly match the adjacent teeth. Additionally, maintaining a clean operative field is critical for achieving a good aesthetic result. Furthermore, thorough polishing and finishing are essential, as they contribute to both immediate and long-lasting outcomes.

style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering

Bibliography

  1. Devoto W.Clinical Procedure for producing aesthetic stratified composite resin restorations. Pract Proced Aesthete Dent 2002, 14:541-543.
  2. DIestchi D. Free-hand bonding in the aesthetic treatment of anterior teeth : creating the illusion. J Esthet Dent 1997;9:156-164.
  3. Frank AC. Comparison of the bleaching efficacy of different agents used for internal bleaching: a systematic review and meta-analysis. Journal of Endodontics, 2022.

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