Single shade makeover

Shadeguides - Direct posteriors
2 Dec 2015

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. 26 N 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 3.6 and 3.7

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 3.8

Fig. 10

Details of the preps of 3.6 3.7 3.8 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 3.6 and 3.7

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 polymerisation, if it is not the case, we must review our procedure

Fig. 18

Details of the shiny 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

The centripetal build up technique: we build up the inter 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 the application of the brown stains

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