Less is more. The single shade approach.

Restoring a single central incisor is always a big challenge because we have to mimic nature by recreating not only color, but shape and texture as well. Knowledge is needed to be able to apply reliable methods and to master our products, always considering what the less invasive approach is. About being minimally invasive, direct composites are, most of the time, the solution that we end up choosing.
Can we restore in a fast way while getting a predictable yet great outcome with only one shade? In more cases than you might think, the answer is yes. In this article, we will see how to do a nice direct veneer with a new composite (Filtek Universal, 3M) in a quick and satisfying procedure.

dark old composite restoration

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.

ugly composite restoration on upper central incisor

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.

ugly composite restoration on upper central incisor

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.

occlusal view for buccal anatomy assessment

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

vita shade matching

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).

rubber dam isolation on central incisor

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.

class 4 cavity preparation and bevel on central incisor

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.

microbrush for enamel bonding

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

palatal shell for class 4 composite filling

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.

vertical metal matrix for proximal incisor composite

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

composite layering for direct veneering

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

composite direct veneering

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

glycerine gel for final light curing of composite

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.

final shaping of direct composite powder

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).

final result before teeth rehydration

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.

composite veneer on left central incisor

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

natural composite restorations

Fig.17
Lateral view of the final smile.

final smile with restored teeth

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

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