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.

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.

Fig.3
Lateral views of the composite.

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.

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.

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.

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

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, the etch is thoroughly rinsed off with water spray for 20 seconds under suction.

Fig.9
A bonding adhesive is applied and light cured according to the instructions of use.

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.

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.

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.

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.

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

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

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

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.

Fig.18
The composite is polished using the second sequence, emphasizing the importance of sufficient water cooling throughout the process.

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.

Fig.20
End of polishing before removing operative field.

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.

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.

Fig.23
Before and after treatment.

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.

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.