Reinforcing aesthetics and structure
In worn and eroded teeth, adding adhesive material to the buccal enamel makes the tooth thicker incrementing resistance of the dental structure, added to this, the possibility of hiding margins, aesthetic defects and improving shape, increase dramatically. Additive dentistry is a must for a successful dental practice.
Apparently healthy incisors, when observed with attention, we can see besides the failed restorations, wearing of the incisal edges and ﬂattening of the buccal surface.
Filtrated restorations are visible in all four anteriors. Besides the restorations, we can appreciate in this occlusal view, that central incisors are quite thin. As the secondary caries in the centrals is suspected to be big, we decided to treat in a ﬁrst appointment, leaving the laterals for a second intervention.
Distal composites were removed from both buccal and palatal, while mesials involved only the palatal area.
Open cavities, displaying deep caries and one deep margin. Caries detector was used to remove all the decay, stained dentin was respected.
Etching of the enamel. Dentin was not etched.
Polymerization was done close to the tooth and making sure time is extended in order to avoid lack of polymerization.
Both matrices removed.
Because of the lack of structure in the distal, instead of building up with a matrix, we used the front wing technique (https://www.styleitaliano.org/the-front-wing-technique/) In order to apply the composite in such wide cases, a speciﬁc instrument for veneers was used (SOLO Anterior, LM Instruments, Finland)
Creation of the distal contour of 11 with a black matrix (Lumicontrast, Polydentia, Switzerland), only after solving the proximal walls we can add material in the inside of the cavity and the buccal respectivley.
After clamps are removed, we can start the ﬁnishing stage.
Essential Shape protocol was used for the ﬁnishing stage.
As indicated in the protocol, most of the ﬁnishing procedure (basic and primary anatomy) are developed with a coarse or medium-coarse disc (Sof-Lex, 3M, USA). Reversible discs are a must in order to access every area.
Slow speed burs are used for secondary anatomy (Finishing Style Kit, Komet, Germany)
Firstly the rounded bur and then the diamond ﬂame bur to smoothen the transition of the buccal depressions.
Detail of the polished surface. Very few materials in the market that oﬀer such high gloss and gloss retention for long time are at the same time resistant.
Occlusal vision, highlighting the new thickness of the central incisors. Note that the lateral incisors will be treated in a next appointment.
Patient will be given an appointment for the treatment of the lateral incisors and correct any defect of the previous restorations.
Single shade strategy allows the clinician to focus on caries removal, shape optimization and speciﬁc details of build-up. Composite restorations are extremely easy to correct.
Devoto W, 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; 5: 102-124.
Manauta J, Salat A. Layers, An atlas of composite resin stratiﬁcation. Quintessence Books, 2012.