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.

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.

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.

Fig.3

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

Fig.4

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

Fig.5

Etching of the enamel. Dentin was not etched.

Fig.6

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

Fig.7

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

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/

Fig.9

Both matrices removed.

Fig.10

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

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)

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.

Fig.13

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

Fig.14

Essential Shape protocol was used for the finishing stage.

Fig.15

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.

Fig.16

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

Fig.17

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

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.

Fig.19

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

Fig.20

Final situation.

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.

Fig.22

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

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.