modelling of direct restoration on central incisor

Single incisor direct composite challenge

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.

old infiltrated restoration on upper incisor

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.

close-up of decayed upper incisor

Fig.2

Close-up picture shows the improper filling.

silicone index fabrication inside the mouth

Fig.3

The old restoration was used to fabricate a silicone index.

prepared cavity of upper central incisor

Fig.4

Rubber dam isolation is mandatory to perform adhesive procedures.

sandblasting a tooth

Fig.5

After cavity preparation, the tooth was sandblasted with 27-micron aluminum oxide particles.

etching gel on tooth

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.

etched enamel

Fig.7

The etchant is rinsed off for at least 15 seconds, while dentin is kept moist for adequate bonding.

composite palatal shell

Fig.8

The palatal shell is built with the aid of the palatal silicone key.

proximal composite build up with sections matrix

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.

composite build up of direct central incisor restoration

Fig.10

The posterior sectional matrix is secured with a wedge, which also allows for the creation of a good contact point.

outline of composite restoration of central incisor

Fig.11

After creating the proximal surfaces, the tooth is ready to be filled with the inner masses.

dentin and white composite layering

Fig.12

A dentin layer was created and a few white characterizations were added for a more natural look.

LM arte solo anterior instrument spreading composite mass

Fig.13

The buccal enamel layer was adapted using the Solo Anterior instrument, moving from cervical towards the incisal first.

multipurpose solo anterior instrument by styleitaliano

Fig.14

Then towards the proximal, distal and mesial.

unrefined composite restoration

Fig.15

After application of the final enamel layer, before finishing.

finished direct composite restoration

Fig.16

Primary finishing by using enhance burs.

pencil marks for finishing of composite filling

Fig.17

Transitional line angles were marked using a pencil to create the right surface reflectiveness.

bur finishing composite restoration

Fig.18

Highlighting transition lines. Their direction can be adjusted by using diamond burs or abrasive discs.

lucida paste for composite polishing

Fig.19

The DiaShine Lucida™ Paste is completely water soluble. These two allow for a single-step polishing of composite restorations.

star felt for lucida polishing system

Fig.20

The star felt allows to reach the inter proximal areas.

finished and polished single incisor composite restoration

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