Fig.1
This young lady came to our attention to solve an aesthetic issue on her 21. She was asking to get a fast, aesthetic and inexpensive restoration.

Fig.2
In this retracted, contrasted view (black matte background Flexipalettes, Smile Line) shows that not only the composite restoration on 21 failed, but the buccal surface is altered too. The mesial part of 22 will need to be restored as well.

Fig.3
Retracted cross-polarized view with flexipalettes, shows that the color of the teeth is quite homogenous and allows us to think that a one shade restoration will be enough to solve the case.

Fig.4
With the occlusal view we can observe the lack of volume on both 21 and 22.

Fig.5
The color is checked with Vita shade guide and we choose A1. After this step, we know that we will use only one syringe of A1 shade (Filtek Universal, 3M).

Fig.6
For any restorative treatment, the use of the rubber dam is mandatory. A ligature is done to access to whole buccal surface of tooth 21.

Fig.7
The old restoration is removed, a buccal chamfer is done and all the tooth is carefully polished. Tooth 22 is only polished to remove aprismatic enamel to improve adhesion.

Fig.8
The teeth are sandblasted, etched and an universal bonding (Scotchbond Universal, 3M) is brushed and light cured for 1 minute.

Fig.9
Even in single-shade approaches, the layering technique we used was the classic one. First, the palatal wall is built with the aid of a silicone stent.

Fig.10
Then proximal walls are made by using curved metal posterior matrices and wooden wedge (My Custom Ring kit, Polydentia)

Fig.11
The whole surface is covered with an A1 shade (Filtek Universal, 3M). To smooth the surface Compobrush (Smile Line) is used.

Fig.12
A small spacing was left to add some white tints to mirror the white spots on tooth 11.

Fig.13
A final layer of A1 shade is added to cover the stains and to restore 2. The final light curing cycle is done during 1 minute, under glycerine gel to prevent the outer polymerisation to be inhibited the oxygen inhibited.

Fig.14
The last step is actually the most important one in the Single Shade approach.
Contouring and 3D shaping are even more crucial, and will give the restoration a seamless, natural look. Three are the steps we must follow:
– Contouring, to remove overhangs and give the restoration its final shape
– Finishing, by correctly placing the transition lines and create texture
– Polishing, to get the perfect final gloss
All these steps are done by using Style Italiano Finishing Style bur kit (Komet), 3M Soflex discs, and a goat brush with polishing paste (Enamel Shiny kit, Bisico).

Fig.15
The final outcome after rubber dam removal shows more chromatic restorations.
That’s good news, actually, because when teeth will rehydrate, the shade will probably match. A check-up is scheduled a few days later and some more finishing and polishing steps will be done to improve the result.

Fig.16
2 days after, we have improved the shape and texture and the color is satisfying.

Fig.17
Lateral view of the final smile.

Fig.18
Final smile of our happy patient. One shade, one material, one session, low price!

Conclusions

Thanks to these new materials and reliable techniques, restoring a single central with a direct restoration has become possible, fast and predictable.

Bibliography

1. Manauta J, Salat A. Layers: an atlas of composite resin stratification. Quintessence 2012.
2. Devoto W, Saracinelli M, Manauta J. Composites in every day practice: How to choose the right material and simplify application techniques in the anterior teeth JEAD, Jan. 2010