Restoring the natural beauty with direct CompoSite

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

An ideal smile depends on the symmetry and balance of facial and dental characteristics such as color, shape, and teeth position, considering that shape determines function and that the anterior teeth play a critical role in the patient’s oral health.
Moreover, shape and texture are key to restoring the natural beauty while integrating the restoration with the remaining natural teeth and smile of the patient. In this article we will see how we can restore the natural teeth beauty by using direct compoSite to enhance the shape of the teeth and the patient overall smile.

smile with dental jewellery and bad restorations style italiano styleitaliano

Fig.1
A 20-year-old female came to the dental clinic complaining of her smile appearance, wishing to get a solution to smile more confidently.

intraoral picture showing multiple diastemas and old composite restorations style italiano styleitaliano

Fig.2
Retracted view of upper arch showing multiple defective old composite restorations. After discussing the treatment plan with the patient, we decided to do direct compoSite closure of multiple diastemata as a minimally invasive approach. Here we will use enamel shade only that’s enough to close the small diastemas, modify the shape and also to increase the brightness of the teeth a little, which will take the color of the teeth to more natural appearance.

solation of teeth with rubber dam before removing old restorations styleitaliano style italiano

Fig.3
Rubber dam is placed for isolating the teeth. Floss ligation retract the papillae laterally and enable better control over the emergence profile of the future restorations.
If the papillae are not laterally retracted the result is the presence of an interdental black triangle.

clean dental surfaces under rubber dam isolation style italiano styleitaliano

Fig.4
After removal of old defective restorations and cleaning the surfaces, no need for further preparation was found, so the approach was completely additive, except for the cavity on the upper right lateral incisor.

etching of the enamel surfaces styleitaliano style italiano

Fig.5
Enamel etching for 30 seconds and then carefully rinsing for 60 seconds to remove all etchant remnants.

etched chalky surfaces style italiano styleitaliano

Fig.6
White chalky appearance after good enamel etching.

bonded enamel surfaces before composite restoration style italiano styleitaliano

Fig.7
Multiple coats of bonding agent are applied and then air blown after 30 seconds to let the solvent evaporate. Light curing for 60 seconds for each surface.

design of the diastema closure styleitaliano style italiano

Fig.8
The first step of Front Wing technique is creating the buccal wings freehand as precisely as possible, in this case using the Enamel shade (White Dental Beauty).

matrices and wedge in place for diastema closure styleitaliano style italiano

Fig.9
After building the from wings, it is time to focus on sealing the restorations and on the achievement of a tight contact point, by placing two sectional matrices with a wedge. A composite increment is then placed to fill the palatal part and condensed until excess material stops flowing from the buccal.

composite diastema closure between central and lateral incisor style italiano styleitaliano

Fig.10
We did the same on the left lateral, building the labial wing then adapting the matrix to fill the palatal part using the Enamel shade (White Dental Beauty).

LM solo spatula for anterior composite modeling style italiano styleitaliano

Fig.11
Then we add a layer Enamel shade (White Dental Beauty) on the labial surface to modify the shape and increase the brightness. Composite can be easily adapted by using the Solo instrument (LM arte powered by Styleitaliano).

LM solo intrudente adapting composite on the surface of a canine styleitaliano style italiano

Fig.12
The same procedure was used to restore the canine.

composite restorations before finishing procedures style italiano styleitaliano

Fig.13
The same exact procedure was used on the right side. All restorations will be finished and polished at the same time.

perio bur for composite finishing styleitaliano style italiano

Fig.14
The perio diamond bur from the Styleitaliano Finishing kit is ideal to even the surface at low speed, and to correct shape and contour.

3M Soflex spiral wheel for composite polishing style italiano styleitaliano

Fig.15
The SofLex™ spiral wheel (3M™) polisher is ideal for pre-polishing, thanks to its flexible shape which adapts to all tooth surfaces.

Lucida star felt and polishing paste for direct veneer glossiness styleitaliano style italiano

Fig.16
The Lucida™ Star Felt is a disposable polishing device. Latch mandrels for the Lucida Star Felt may be autoclaved and reused. The DiaShine Lucida™ Paste is completely water soluble. These two allow for a single-step polishing of composite restorations. After applying the paste on the teeth surfaces and then starting polishing.

restored smile right after removing the rubber dam styleitaliano style italiano

Fig.17
immediately after removal of rubber dam

surface texture of composite veneers styleitaliano style italiano

Fig.18
Side view shows surface texture and gloss. The polishing paste can dissolve in water and easily washed by rinsing.

smile of satisfied patient after direct diastema closure style italiano styleitaliano

Fig.19
The final situation, the patient is satisfied with the result.

Conclusions

The simplest treatment option should always be considered, especially if it’s the one meeting the patient’s needs and wishes. The simplest option can sometimes restore the natural beauty as we did here using only one enamel shade to close small diastemas, modify the shape of the teeth, and increase the brightness while staying minimally invasive.

Bibliography

1. Bolivar MA, Mariaca PM. The smile and its dimensions. Revista Facultad de Odontologia Universidad de Antioquia. 2012; 23(2)
2. Monteiro P. The step by step in finishing and polishing: anterior direct composite restorations. 2017 styleitaliano.org
3. 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(1):102-24
4. Fahl Junior N, The direct/indirect composite resin veneers : a case report. Pract Periodontics Aesthet Dent 1996 ; 8 : 627-638.3- Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr. Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 2011;23(2):73-87.
5. Davis NC. Smile design. Dent Clin North Am 2007; 51(2): 299-318.
6. Manauta J, Salat A. Layers, An atlas of composite resin stratification., Quintessence Books, 2012.

RELATED CASES

Unesthetic restoration of a previously endodontically treated tooth

For patients under the age of 18, anatomical landmarks creation on the restoration is crucial as the restoration should mimic the adjacent tooth as much as possible.