When restoring anterior teeth with composite, we should stay minimally invasive while meeting our patient’s needs. For a successful treatment, following a protocol is mandatory, as in aesthetic, extensive restorations, time and focus are of utmost importance. So how we can minimize chairside time while providing the patient excellent quality treatment?

Fig.1

A young lady came to the clinic complaining of bad aesthetics of her anterior teeth. The restorations she had a couple years earlier needed to be replaced due to discoloration, infiltration, and unaesthetic shape and appearance.

Fig.2

Rubber dam isolation is mandatory to have a clean environment and to prevent contamination.

Fig.3

Right view of the defective composite restorations.

Fig.4

Left view of the defective composite restorations.

Fig.5

After removal of the old composite restorations and of carious tissue, the enamel was selectively. Always make sure that all enamel margins surrounding the restoration are be clean and intact to obtain a perfect seal. As you can see in the picture, the shape of the teeth, especially the canines, needed an improvement. In the next few slides, you will see which instrument to use in these cases, and how to do it.

Fig.6

For this specific case the simplified CompoSite system by White Dental Beauty and Styleitaliano was used. These composites can be used both alone (generally dentin shades) or combined with enamel shades.

Fig.7

When recontouring a tooth or when veneering with direct composite restorations, the right instrument and movements can make the difference. Here is an example of composite layering with a narrow, commonly found instrument. As we see from the picture, a narrow active tip concentrates the pressure force on the composite underneath it during the layering, thus easily creating grooves, and, hence, an uneven surface.

Fig.8

The new all-in-one SOLO Anterior instrument by LM dental, was specifically designed by the Styleitaliano team for composite veneers and anterior composite restorations. It features two wide active tips, with different angulations to facilitate spreading of composite layers.
Its wide active tip allows for a smoother spreading and and easier manipulation of the composite, while creating a very even surface requiring quick finishing and polishing only.

Fig.9

As you can better appreciate from this side view the shape of a canine can be divided into two halves, a mesial and a distal one.

Fig.10

With this division in mind, it’s clear how easily a nice shape can be obtained with the Solo instrument, on half at a time, adapting the composite from cervical to incisal, and toward the proximal side (distal or mesial, respectively).

Fig.11

And here’s an illustration for the distal modeling. Gingival towards the incisal, and then distal.

Fig.12

And the same can be done for the laterals.

Fig.13

The concave shape of the tip is very useful, especially when working on the left side.

Fig.14

After layering dentin and enamel for canines and lateral using White Dental Beauty CompoSite, B4 clamps are used for the central to retract the papilla.

Fig.15

As mentioned earlier, we needed to close the black triangle between the centrals, so the Front Wing technique was chosen for a predictable and periodontally-safe contour.

Fig.16

After having eliminated the median embrasure, and having restored the small cavities, the finishing and polishing procedures can begin.

Fig.17

A simplified protocol is ideal when polishing multiple restorations. First, a diamond perio bur is used to smoothen the composite and to adjust the anatomy. Then, a pop-on disc is used to define he angle lines and for further smoothing.

Fig.18

As a third step, a beige spiral wheel (3M) is used to safely polish thanks to its flexible shape which adapts to all tooth surfaces.

Fig.19

As a last step, the Lucida™ Composite Gloss System by Styleitaliano was used. The disposable Lucida Star Felt is mounted on the autoclavable latch mandrel to buff the DiaShine Lucida Paste (completely water soluble).

Fig.20

Immediately after polishing, before removal of the rubber dam.

Fig.21

One week follow-up.

Fig.22

Side view at one week follow-up.

Fig.23

The patient’s satisfied smile.

Conclusions

By the introduction of new simple techniques, materials, and tools, we can simplify our daily work and make it predictable and repeatable, as in the Styleitaliano philosophy. Simple recipes can help decrease chair-time for the dentist and the patient, and make our treatments affordable and minimally invasive.

Bibliography

1. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
2. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37(47): 5-13
3. Mangani, A. Cerutti, A. Putignano, R. Bollero, L. Madini, Clinical approach to anterior adhesive restorations using resin composite veneers, Eur. J. Esthet. Dent. Off. J. Eur. Acad. Esthet. Dent. 2 (2007) 188–209.
4. 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.