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.

style italiano styleitaliano dentistry

Fig.1
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.

style italiano styleitaliano dentistry

Fig.2
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.

style italiano styleitaliano dentistry

Fig.3
Distal composites were removed from both buccal and palatal, while mesials involved only the palatal area.

style italiano styleitaliano dentistry

Fig.4
Open cavities, displaying deep caries and one deep margin. Caries detector was used to remove all the decay, stained dentin was respected.

style italiano styleitaliano dentistry

Fig.5
Etching of the enamel. Dentin was not etched.

style italiano styleitaliano dentistry

Fig.6
Application of a universal adhesive (Scotchbond Universal Plus,3M, USA) conditioning at the same time enamel and self-etching the dentin.

style italiano styleitaliano dentistry

Fig.7
Polymerization was done close to the tooth and making sure time is extended in order to avoid lack of polymerization.

style italiano styleitaliano dentistry

Fig.8
Mesial cavity of tooth 11 was completed and its matrix pulled after Polymerization as described in previous article https://www.styleitaliano.org/synchro-matrix/

style italiano styleitaliano dentistry

Fig.9
Both matrices removed.

style italiano styleitaliano dentistry

Fig.10
Securing the cervical area by providing a correct contour and feather edge sealing. Composite material used was Filtek Universal Restorative (3M, USA)

style italiano styleitaliano dentistry

Fig.11
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)

style italiano styleitaliano dentistry

Fig.12
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.

style italiano styleitaliano dentistry

Fig.13
After clamps are removed, we can start the finishing stage.

style italiano styleitaliano dentistry

Fig.14
Essential Shape protocol was used for the finishing stage.

style italiano styleitaliano dentistry

Fig.15
testo sotto immagineAs 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.

style italiano styleitaliano dentistry

Fig.16
Slow speed burs are used for secondary anatomy (Finishing Style Kit, Komet, Germany)

style italiano styleitaliano dentistry

Fig.17
Firstly the rounded bur and then the diamond flame bur to smoothen the transition of the buccal depressions.

style italiano styleitaliano dentistry

Fig.18
A fine grit rubber abrasive Spiral (Sof-Lex Spiral, 3M, USA) was used for microfinishing, and afterwards an ultra fine spiral (pink) was applied for high gloss.

style italiano styleitaliano dentistry

Fig.19
For ultra high gloss, LUCIDA diamond paste was applied with a LUCIDA felt wheel.

style italiano styleitaliano dentistry

Fig.20
Final situation.

style italiano styleitaliano dentistry

Fig.21
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.

style italiano styleitaliano dentistry

Fig.22
Occlusal vision, highlighting the new thickness of the central incisors. Note that the lateral incisors will be treated in a next appointment.

style italiano styleitaliano dentistry

Fig.23
Patient will be given an appointment for the treatment of the lateral incisors and correct any defect of the previous restorations.

Conclusions

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.

Bibliography

https://www.styleitaliano.org/the-front-wing-technique/
https://www.styleitaliano.org/synchro-matrix/
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.

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