Stabilizing complex cases with single shade composites 3M style italiano

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.1

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.2

A digital project was proposed to the patient. It highlighted the need of crown lengthening.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.3

Gingival parables were measured in the untouched model according to the project.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.4

Aspect after the bone surgery.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.5

Detail of the central incisors

Stabilizing complex cases with single shade composites 3M style italiano

Fig.6

Healing after 1 month.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.7

Healing after 3 months.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.8

Healing after 3 months.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.9

Healing after 3 months, patient is ready for the restorative appointment.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.10

Color selection was done with a direct mock-up, the same day of the restorative appointment. Look at the distal of tooth 1.1.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.11

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.12

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)

Stabilizing complex cases with single shade composites 3M style italiano

Fig.13

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.14

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)

Stabilizing complex cases with single shade composites 3M style italiano

Fig.15

Once the cervical part is satisfactory, we will focus on the mesio-distal dimensions.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.16

Before moving forward, dimensions from the project are double checked with a caliper.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.17

Other detail of the intra-operative measurements.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.18

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.19

After matrix removal, both distal and mesial contours are int he way of being optimal.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.20

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.21

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.22

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.23

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.24

The same instrument is used for all purposes, hardly other instruments are needed.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.25

Detail of a curved profile of the instrument, specifically designed for cervical and contoured areas.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.26

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).

Stabilizing complex cases with single shade composites 3M style italiano

Fig.27

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.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.28

Situation after finishing and rubber dam removal. At this stage, before the final gloss, occlusal adjustment and fine corrections are done.

Stabilizing complex cases with single shade composites 3M style italiano

Fig.29

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.

Conclusions

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.

Bibliography

1.-www.styleitaliano.org/the-front-wing-technique/
2.-www.styleitaliano.org/single-shade-everyday/
3.- Styleitaliano Pillar Article
4.- Vargas M, A step-by-step approach to a diastema closure, a dual-purpose technique that manages black triangles. Volume 26, No. 3, Fall 2010. Journal of Cosmetic Dentistry.
5.- Devoto W, Saracinelli M., Manauta J.Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur. J. Esthet Dent 2010; 5: 102-124.
6. Opdam NJ, Roeters JJ, de Boer T, Pesschier D, Bronkhorst E. Voids and porosities in class I micropreparations filled with various resin composites. Oper Dent. 2003 Jan-Feb;28(1):9-14.
7. Hirata R. Shortcuts in esthetic dentistry: a new look into TIPS, 1st ed, Sao Paulo: Quintessence Editiora,2017, 358-367.
8. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012.
9. Leclaire CC, Blank LW, Hargrave JW, Pelleu GB Jr. Use of a two-stage composite resin fill to reduce microleakage below the cementoenamel junction. Oper Dent 1988 Winter;13(1):20-3.