Esthetic and functional integration with direct composite

A clinical case by our Community member Dr. Ali Almasoudi

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.

Modern dentistry enables us to rely on fast and simple protocols to reach a satisfying result. Proper planning and observation will help in choosing the best technique and the right composite material.

broken upper incisor style italiano styleitaliano

Fig.1
A young patient came to the clinic with a fractured central incisor, asking to restore it.

rubber dam isolation before restoring central incisor style italiano styleitaliano

Fig.2
The rubber dam was placed in order to isolate the teeth from any contamination and for better focus.

enamel etching of prepared cavity style italiano styleitaliano

Fig.3
Orthophosforic acid was applied for 20 seconds to etch the enamel. After thoroughly rinsing for 20 seconds, the tooth was dried completely.

frosty etched enamel surface style italiano styleitaliano

Fig.4
Tooth surface after etching.

microbrush carrying bonding agent style italiano styleitaliano

Fig.5
A universal adhesive was used on enamel and dentin (Scotchbond Universal, 3M). It is important to lay the adhesive more than once, and to blow it until it doesn’t move on the surface anymore. Then light cure.

palatal composite shell built freehand style italiano styleitaliano

Fig.6
The palatal shell is modelled freehand, supporting a mylar strip with the finger. The enamel shade was layered as thin as possible.

layering dentin mass to restore incisor style italiano styleitaliano

Fig.7
A small amount of dentin was applied, because of its opacity.

white stain composite for natural restoration style italiano styleitaliano

Fig.8
A white composite was applied using the Fissura instrument (LM Arte kit, powered by Styleitaliano). A very small brush can also be used in a tapping motion to distribute and absorb excess material.

layered composite before finishing styleitaliano style italiano

Fig.9
After application of the final enamel layer, before finishing.

pencil marks for line angles style italiano styleitaliano

Fig.10
The next step is getting your transition lines.

surface texture scheme for composite finishing styleitaliano style italiano

Fig.11
Shape and texture is a necessary step, as important as all the other steps in the restorative process. With a pencil, the primary anatomy was marked (vertical texture).

application of lucida polishing paste style italiano styleitaliano

Fig.12
Lucida polishing paste was used to give the final glistening look.

lucida polishing paste on tooth style italiano styleitaliano

Fig.13
The DiaShine Lucida™ Paste is completely water soluble.

Lucida star felt from lucida composite polishing system style italiano styleitaliano

Fig.14
This paste and the star felt from the Lucida™ Composite Gloss System by Styleitaliano allow to get a final glossy, enamel-like surface.

finished composite incisor restoration before removal of rubber dam style italiano styleitaliano

Fig.15
Aesthetic appearance after polishing.

result after restoring upper left central incisor with composite resin style italiano styleitaliano

Fig.16
Final situation. Note the natural integration of the composite resin with the dental tissue.

Conclusions

The main goal of performing direct restorations with composite resins is to handle an easy workflow that allows the clinician to have a predictable, natural, functional and long lasting result. A continuous evolution of the adhesive systems and dental materials allow professionals to achieve aesthetic results for long term restorations.

Bibliography

1. Shaalan O. The Power of Incisal Embrasures. Styleitaliano.org
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012
3. Juneja A. Invisible Margins in Anterior Composites, Tips&Tricks. Styleitaliano.org
4. Shaalan O. Simplifying direct veneering with the right tools and materials. Styleitaliano.org

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