Stabilizing complex cases with single shade composites
One of the main indications for using a single shade strategy, is when shape primes over any other factor. Focusing on the shape, allows us to do more versatile construction techniques, uniform color and a strong material thanks to less gaps or air bubbles.
Patient came to our attention after failed attempts with ortho and restorative therapy in other office. After the diagnostic stage, aesthetic planning was carried out.
A digital project was proposed to the patient. It highlighted the need of crown lengthening.
Gingival parables were measured in the untouched model according to the project.
Aspect after the bone surgery.
Detail of the central incisors
Healing after 1 month.
Healing after 3 months.
Healing after 3 months.
Healing after 3 months, patient is ready for the restorative appointment.
Color selection was done with a direct mock-up, the same day of the restorative appointment. Look at the distal of tooth 1.1.
Same procedure was done in the tooth 2.1, this strategy, differently to the button try-in, simulates much better the thickness, opacity and color of the material that will be used. Remember to do this without letting teeth dehydrate.
The success of these restorations resides on a proper retraction that a rubber dam clamp can perform much better that other retraction aids. This allows to improve the cervical contour and emergency profile in a very efficient way. In order to keep the old restoration, it has to be conditioned by sandblasting (29 micron, Aluminium Oxyde, AquaCare, Velopex)
After conditioning the old composite with sandblasting and the sound enamel surface with Orthophosphoric acid, a Universal Bonding system (Scotchbond Universal Plus, 3M, USA) was applied for 20 seconds, rest for 20 seconds, blown air gently and polymerized perfectly.
Front wing technique was used for creating the cervical contour, emergency profile and tooth dimensions. A low stress, high polishing universal composite was used for the restoration (Filtek Universal Restorative, 3M, USA)
Once the cervical part is satisfactory, we will focus on the mesio-distal dimensions.
Before moving forward, dimensions from the project are double checked with a caliper.
Other detail of the intra-operative measurements.
Backfilling with Flowable composite is done with the help of a anatomical posterior matrix (Lumicontrast, Polydentia, Switzerland) once the buccal situation is ideal. (Filtek XTE Flowable, 3M, Germany), a new technology for dispensing the flowable creates no bubbles.
After matrix removal, both distal and mesial contours are int he way of being optimal.
Pre-finishing of the composite is extremely helpful before starting the construction of the neighbor teeth. You can see very small surface defects with are easily corrected at this stage.
Corrections can be done either with packable composite or with flowable. In our experience, small defects are more easily corrected with flowable, while bigger defects are easier to correct with packable composite.
When applying the etchant in the neighbor tooth, a matrix was used to protect an area which is highly undesired to condition. Note well, that these matrices placed for protection, will not suffer deformation, hence, they are used again for wall construction.
After solving the cervical area, and proximal areas, the buccal was modeled. Using a very wide instrument specific for Direct veneers (SOLO Anterior, LM instruments, Finland), we can limit our full line-up of instrument to only one.
The same instrument is used for all purposes, hardly other instruments are needed.
Detail of a curved profile of the instrument, specifically designed for cervical and contoured areas.
Backfilling of the front-wing is done, if the space is very narrow, please choose a two stage consistency strategy (flow and paste simultaneously, Snow-Plough technique).
Detail after removal of the matrix and before the pre-finishing. Restoration of left canine and premolar were performed in the same way as described with the centrals, focusing mainly on shape and contours.
Situation after finishing and rubber dam removal. At this stage, before the final gloss, occlusal adjustment and fine corrections are done.
Final gloss was achieved with two easy steps, Soflex Spiral Beige (3M, USA) from micro finishing and Soflex Spiral Pink (3M, USA) for high gloss in few minutes.
Further controls will be done. Future treatments are still possible thanks to the fact that restorations are done with composite materials.
Single shade strategy allows the clinician to focus on shape and on specific details of build-up that enhance the quality of the material. Composite restorations are extremely easy to correct.
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