Grey margins: 4 mistakes to avoid
I am still seeing that grey line. My restoration is visible. What can we do when our anterior restorations keep failing aesthetically? By following a couple of simple actions, we will change the way we perform everyday dentistry. These actions are actually nothing elaborated or complicated: on the other hand, they are extremely simple, and the only thing they require is constancy.
Take your vita shade guide and then take your syringe with the same name (e.g. A2) printed onto its label. I had the opportunity to be in touch with dentists from all around the world and I frequently see that is usual to use vita shade guide to choose the color when performing direct composites. What happens if an A3 color from the vita shade guide is chosen and then you pick up an A3 syringe from the composite system you have in that moment? Is more than sure that you are committing a mistake. (1,2)
An A3 from one brand is completely different from another brand. In this image we can see 8 syringes named A3 dentin on their labels. Different brands, same names, and completely different properties. Different hue, chromaticity and opacity. It’s impossible to have predictable results if you believe that A3 are all the same.
Sharp margins must be finished and polished: trying to restore sharp margins just like these will most probably end up in aesthetic failure.
Issue: some dentists don’t even know the enamel thickness they used. It is crucial to reproduce the precise enamel thickness to obtain the right color. We prepared composite discs, different enamel thicknesses, to better understand the behavior of composite. We prepared discs from different composite brands, and, in general, when using 0,3 mm enamel on dentin, the enamel effect is almost imperceptible. 0,5 mm is the right compromise because it modifies the dentin but without lowering value; 0,7 mm enamel thickness is usually too much because restorations become grey. When 0,9-1 mm thicknesses were used, the enamel hid the dentin and lowered the value.
Keep in mind that:
– VITA color is not what you get in your material
– All composites have different color and opacity
– Margins should be beveled and thoroughly cleaned
– The thickness of your enamel has to be 0,5 mm, or very very close to that value
The margin error rate in anterior restorations will tremendously decrease, with no fancy equipment and no complicated techniques.
1. Browning WD, Contreras-Bulnes R, Brackett MG, Brackett WW. Color differences: polymerized composite and corresponding Vitapan Classical shade tab. J Dent. 2009;37 Suppl 1:e34-9.
2. Kim HS, Um CM. Color differences between resin composites and shade guides. Quintessence Int. 1996 Aug;27(8):559-67.
3. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: a new concept in composite layering–Part II. Odontostomatol Trop. 2014 Sep;37(147):5-13.
4. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: a new concept in composite layering Part I. Odontostomatol Trop. 2014 Jun;37(146):5-16.
6. Kahng L. Custom shade matching: fine-tuning and patient communication lead to success. Compend Contin Educ Dent. 2011 Oct;32(8):68-70, 72-4, 76.)
7. Salat A, Devoto W, Manauta J.Achieving a precise color chart with common computer software for excellence in anterior composite restorations. Eur J Esthet Dent; 2011;6(3):280-96.
8. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012.