Memoirs of a student – An early composite of mine, 9 years later

Shadeguides - Direct anteriors
29 Jun 2017

Time runs, that's for sure! 

It was 2008, and I was a 4th year student at the Siena University. Direct composite restorations were my first love, a long lasting one. Professor Simone Grandini called me and offered me the chance to restore a central incisor to a female patient; she had an old composite restoration she was no longer satisfied with. Of course I was really excited and, let's admit it, a little bit scared! It was not my first anterior restoration, but obviously I was suffering from a great lack of experience.

Prof. Grandini guided me through all the procedure (I really have to thank him), and it was really fun! I had the confirmation that direct anterior restorations really were my favourite part of dentistry. 

In 2012 I had the chance to publish this case on styleitaliano website, as a community case, so before becoming a member of this amazing group. 

A couple of months ago, meaning after almost 9 years from the first appointment, I had the chance to see once again the patient, and this happened just when I was trying my brand new MDP tool by Louis Hardan… so, what better time to test my new photografy "toy"?  

I really would like to analize this case with you, trying to understand how would I manage it now, if I had to do it once again after 9 years.

Fig. 1

Img. 1 – 2008, the "before picture". In the first article I described it like this: " 36 year old woman, with an old resin composite restoration she’s no longer satisfied with. Among other things is clinically noticeable the pigmentation, the color mismatch even with a big bevel over the sound tissue and most of all, the lack of anatomy and incisal correspondence." One of my first observations was on the long bevel: nowadays we like much shorter ones. It can be harder to manage the color and opacity matching at the beginning, but a restoration with a short bevel is more stable overtime.

Fig. 2

Img. 2 – After the removal of the old composite and the adhesive procedures, the first palatal layer was made with a translucent resin. Nowadays, after this step, I always stop and I change my point of view. It's really helpful to understand if I made some mistakes in creating the shape and orientation (it's easy for a right handed dentist to make "left-bended" teeth). If I need to correct something, I do it immediately; once the frame is properly completed, we just have to fill it!

Fig. 3

Img. 3 – A first layer of dentin resin was applied, trying to imitate the anatomy and leaving the proper space for characterizations and enamel.

Fig. 4

Img. 4 – Some white spots were inserted using a white stain. Let's be honest, maybe she didn't need them, but for a 4th year student using a supercolor seemed quite exciting!

Fig. 5

Img. 5 – The final layer of enamel was then applied. We can see the layering is not very precise, but I didn't have the chance to use a brush at that time (now CompoBrush Anterior is my best friend for composite layering).

Fig. 6

Img. 6 – After finishing and polishing with a red ring flame bur and a colpete set of silicone tips and diamond pastes, this was the immediate post-op situation.

Fig. 7

Img. 7 – And this was the 7 days control picture; I was really satisfied with the result and so was the patient.

Fig. 8

Img. 8 – As I said before, almost 9 years later I had the chance to try my MDP while taking a picture of this patient. The restoration was the same, with no re-finishing nor re-polishing procedures. From the picture, we can appreciate that both color and shape are still good, and the resin maintained a good surface; no margin stains are visible, and the tooth is both vital and asymptomatic. Of course we can also appreciate the great quality of Prof. Hardan's MDP!

Fig. 9

Img. 9 – Even under cross polarization MDP we can appreciate a good color match

Fig. 10

Img. 10 – A closer look at the restoration.

 

Conclusions

Nowadays, I would of course change some steps: I would pay much greater attention in checking the shape of the first palatal shell before starting layering the dentin; or I would choose different tools for the polishing and finishing procedures (the Finishing Style kit is really quick and efficient). But I also have to say that I’m really happy with the result and its stability over time.
It was really nice to remember how exciting this case was for me as a student; I actually have to admit, I’m still really enthusiastic every time I have to make an anterior direct restoration… as I said these are my first love!

Bibliography

Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 4 and 5, Quintessence Books, 2012.
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;6:280–296.
Devoto W1, Saracinelli M, Manauta J.Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.Eur J Esthet Dent. 2010 Spring;5(1):102-24.
Vichi A, Fraioli A, Davidson CL, Ferrari M. Influence of thickness on color in multi- layering technique. Dent Mater 2007;23:1584–1589