Single Shade Makeover in Posterior Restoration

Do you believe in aesthetics in one shot? A single shade in direct posterior restorations solves this problem, especially if the selected opacity is correct, this choice becomes extremely easy as the right opacity is found in the most commonly available composites.

Composite Body shades are medium opacity masses, at the very beginning of the history of aesthetic materials, these were almost the only choice, dentin or enamel shades did not exist, or they were extremely difficult to find. Little by little complementary masses started appearing.

When composite stratification became a common method, body shades became the “lazy” alternative and many colleagues were commonly criticized for “not being refined” for using these shades. It was in fact that thousand of colleagues learned by experience that in many cases layering composites was just counterproductive. The perfect example are the posterior teeth.

Body shades are different among them, even if two shades share the exact same opacity, they may be different while transmitting and blocking light, with different light scattering features, making one more effective while masking. Optical features are vast and we will discuss them in following articles.

The author and many of the fellow members of this group agree with the following statement. “Many of the best posterior restorations I have seen in my life, to my surprise were single shades”.

Fig.1

Preoperative view of the third quadrant, proximal caries in the distal of 36, medial of 37 and penetrating sulci in the occlusal of the 38.

Fig.2

Isolation details with 26N clamp.

Fig.3

Details of the isolation from an occlusal view, note how the rubber dam must be clean and invaginated.

Fig.4

Before removing the decay we protect the rubber dam, retract the papilla and separate teeth with a wooden wedge under the contact area. This step is done routinely whenever treating proximal lesions.

Fig.5

Details of the inter proximal caries of 36 and 37.

Fig.6

To help in removing completely the decayed tissues, a caries detector can be used with a brush.

Fig.7

After its application we have to rinse it and the decayed tissues remain colored.

Fig.8

This can be helpful in removing all the decay.

Fig.9

Details of the occlusal prep of 38.

Fig.10

Details of the preps of 36, 37, 38 after the cleaning and the disinfection of the dentin.

Fig.11

Application of sectional matrices and a wooden wedge.

Fig.12

Details of the sealing of the cervical margin.

Fig.13

A Universal Adhesive System is chosen (Scotchbond Universal 3M ESPE). It was used with a selective etching technique of the enamel.

Fig.14

Details of the etchant (Scotchbond etching gel).

Fig.15

Application of the Universal Adhesive on 36 and 37.

Fig.16

Details of the application, the bonding must be scrubbed for 20 seconds and let it act for at least an extra 20 seconds.

Fig.17

Details of the conversion of the adhesive after the light curing procedures. Cavity must look varnished after curing, if it is not the case, we must review our procedure.

Fig.18

Details of the glossy appearance after the light curing procedures.

Fig.19

Details of the conversion of the adhesive from yellow to transparent after the curing procedures for 40 seconds.

Fig.20

In the centripetal build up technique, we build up the proximal walls and this to have a class one cavity instead of a class two. Before the removal of the matrix we fix the composite wall with a small amount of flowable composite.

Fig.21

Details of the build up done with Filtek Supreme Flow A3.

Fig.22

Details of the restorations done with Filtek Supreme Body A3.

Fig.23

Details of the restorations done with Filtek Supreme Body A3.

Fig.24

Details of the restorations done with Filtek Supreme Body A3.

Fig.25

Before the application of the stains and before the finishing and polishing procedures.

Fig.26

Details after the application of the brown stains.

Fig.27

Details after brown staining of grooves.

Fig.28

Details after the application of the brown stains.

Fig.29

Details before finishing and polishing procedures.

Fig.30

Finishing procedures of the interproximal wall with a Soflex disc.
soflex abrasive disc proximal finishing

Fig.31

Finishing procedures of the interproximal wall with a Soflex disc, this is of outmost importance in order to obtain a clear, visible and solid margin with an optimal shiny surface.
composite polishing with spiral wheel

Fig.32

First step of the polishing with a brown Spiral.
composite polishing with spiral wheel

Fig.33

Second step of the polishing procedures with a white Spiral.
composite restoration on lower molars

Fig.34

Details of 36, 37, 38 after the finishing and polishing procedures.
composite filling on lower molars

Fig.35

Details of 38.
details of composite filling

Fig.36

Details of 37.
composite restoration on lower molars

Fig.37

Details of 36.
posterior composite with rubber dam

Fig.38

Details of the contact area and of the little composite overhang.
composite restoration under rubber dam isolation

Fig.39

Details of the restoration on 38.
occlusal check on composite restorations

Fig.40

Occlusal check with articulation paper.
composite restoration on lower molars

Fig.41

One month check-up.
composite restoration on lower molars

Fig.42

One month check-up.
composite restoration on lower molars

Fig.43

One month check-up from an occlusal view, the distal overhang of 36 was removed.
before and after restoration

Fig.44

Before and after.

Conclusions

A modern conservative approach for direct posterior restorations help us in creating the correct shapes both for preps and for morphology which can be reached just with the commodity of one body mass. The use of stains is not mandatory but can help in increasing the depth of those restorations. 

In posterior teeth, shape is of outmost importance, shade is not a trouble anymore when choosing the right opacity.

Choose very well your composite, all composites brands are different and even though many of them share the same “name” they have very different characteristics. In other words some body shades are closer to a dentin while others to the enamel.

Bibliography

1.  Spreafico R. Direct and semi-direct posterior composite restorations. Pract Periodontics Aesthet Dent 1996;8:703–712.
2. Sieber C. Voyage–Visions in Color and Form. Chicago: Quintessence, 1994.
3. Kataoka S. Nature’s Morphology: An Atlas of Tooth Shape and Form. Chicago: Quintessence, 2002.
4. Winter R. Visualizing the natural dentition. J Esthet Dent 1993;5:102–117.
5. Manauta J. Salat A. Layers, An atlas of composite resin stratification. Quintessence 2012.