A clinical case by our Community member Dr. Ali Almasoudi
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.
Modern dentistry enables us to rely on fast and simple protocols to reach a satisfying result. Proper planning and observation will help in choosing the best technique and the right composite material.
Fig.1
This 24-years-old male patient came to the office to replace the infiltrated and incongruous class IV direct composite restoration on tooth 21.
Fig.2
Close-up picture shows the improper filling.
Fig.3
The old restoration was used to fabricate a silicone index.
Fig.4
Rubber dam isolation is mandatory to perform adhesive procedures.
Fig.5
After cavity preparation, the tooth was sandblasted with 27-micron aluminum oxide particles.
Fig.6
The tooth is etched and the adjacent teeth are protected with teflon tape. In this case 37%phosphoric acid was used for 30 seconds on the enamel, and 15 seconds on the dentin.
Fig.7
The etchant is rinsed off for at least 15 seconds, while dentin is kept moist for adequate bonding.
Fig.8
The palatal shell is built with the aid of the palatal silicone key.
Fig.9
Proximal walls are made with the same enamel shade, guided by posterior matrices in a vertical position. The Solo Anterior instrument (LM, powered by Styleitaliano) is used for modeling.
Fig.10
The posterior sectional matrix is secured with a wedge, which also allows for the creation of a good contact point.
Fig.11
After creating the proximal surfaces, the tooth is ready to be filled with the inner masses.
Fig.12
A dentin layer was created and a few white characterizations were added for a more natural look.
Fig.13
The buccal enamel layer was adapted using the Solo Anterior instrument, moving from cervical towards the incisal first.
Fig.14
Then towards the proximal, distal and mesial.
Fig.15
After application of the final enamel layer, before finishing.
Fig.16
Primary finishing by using enhance burs.
Fig.17
Transitional line angles were marked using a pencil to create the right surface reflectiveness.
Fig.18
Highlighting transition lines. Their direction can be adjusted by using diamond burs or abrasive discs.
Fig.19
The DiaShine Lucida™ Paste is completely water soluble. These two allow for a single-step polishing of composite restorations.
Fig.20
The star felt allows to reach the inter proximal areas.
Fig.21
Final situation. Note the natural integration of the composite resin restoration with the dental tissue.
Conclusions
The main goal of performing direct restorations with composite resins is to handle an easy workflow that allows the clinician to have a predictable, natural, functional and long lasting result.
Bibliography
1. Camaleonte G. The Right Composite in the Right Place, How to Hack your Anterior Composites. www.styleitaliano.org
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012
3. Juneja A. Invisible Margins in Anterior Composites, Tips&Tricks. www.styleitaliano.org
4. Osama Shaalan. Simplifying direct veneering with the right tools and materials. www.stylelitaliano.org
