Aesthetic composite restorations in the posterior region means functional composite restorations. Function=Aesthetic
Creating cusps, groves, pits in your restoration is not a trend or a “cool” way of doing composite restorations but a must have procedure for a functional restoration.
More often dentists use brown stains to create a more natural looking restoration in the posterior region. The question is – this is mandatory for a aesthetic posterior restoration?
The beauty is in the eye of the beholder, this is why sometimes the patients appreciate to be beautiful and natural and more often they complain about unpleasant brown spots on their restoration. On the other hand dentists are very happy and exciting with brown stains on composites in the posterior region.
The staining procedure itself is not a label or a certificate for an aesthetic and correct composite posterior restoration. In my opinion staining procedure define and enhance the 3D perception of the occlusal morphology. As a perception for the patients very often they appreciate the detailed work (if the doctor explain why he used the stains) and also the different way of doing a posterior composite restoration.
The intensity of the brown stain should be chosen very carefully regarding to the natural stained adjacent or homologue teeth.
If the stain and morphology copy of the natural teeth is good, the unpleasant perception of the patient disappears because the restoration is integrated into the arch. More often the patients complain if the intensity of the stain is more than that the neighbor teeth while they don’t if the stain is more delicate.
In this article two ways of staining procedure is described:
– staining after the morphology is finished – external staining
– staining during the morphology design
Fig.1
The first technique, also called the external staining technique, is done after the last layer of composite or after the contouring procedure. As a step by step procedure – a small quantity of brown stain applied at in pits and groves with a sharp instrument (fine probe, Fissura, 10 k-file, etc) or using an ultra-fine needle tip applied directly to the stain syringe – before light curing, the stain excess is removed with a microbrush. If needed additional layers can be used until the desired characterization is obtained.
Fig.2
Initial situation of the case.
Fig.3
Cavities prepared on the 46 and 47.
Fig.4
Tooth 47 is restored. The morphology design is the foundation to a natural looking brown characterization.
Fig.5
Modeling of the composite on 46 and 47.
Fig.6
The aspect of the morphology after the modeling. At this stage I prefer to be more delicate with the excess material. This fact save me a lot of time for contouring and finishing procedure. Up to this point I have spent 62 minutes with the patient (hello, anesthesia, isolation, cavity preparation, adhesion, layering).
Fig.7
After the layering I applied a brown stain at the level of the grooves. The stain amount at this moment is not so important. To have a very good control of the staining procedure, apply it on quite smooth composite surface. That’s why, if the composite surface is too rough, I will first do a finishing procedure and after that I will stain.
Fig.8
Another way to applied the tint is using a very sharp instrument, such as Fissura from LM Arte
Fig.9
Removing the stain excess with a microbrush.
Fig.10
The aspect after staining procedure before finishing and polishing.
Fig.11
After finishing, polishing and occlusal check. The final time after polishing is 95 minutes.
Fig.12
2. The SECOND TECHNIQUE that can be used for staining is carried out during the occlusal morphology design. The initial aspect of the case.
Fig.13
The aspect of cavity preparation.
Fig.14
As a preparation for staining procedure I reconstruct first the vestibular part of the cavity.
Fig.15
A small quantity of the stain is applied on the BASE (into the cavity) of the vestibular cusp. BEFORE light curing the stain I applied the composite for the oral cusp. Pushing the composite against the cured vestibular cusp the stain will flow up to the surface, following the groves and pits.
Fig.16
Also as in the first technique with a microbrush, the excess of the stain can be removed. A very natural aspect can be achieved with this technique. The aspect after the last layer.
Fig.17
The same technique for the second molar. The vestibular cusps are already designed and the stain that is NOT light cured placed at the base of the cavity.
Fig.18
One of the buccal cusps and the appearance of the stain on the surface. The advantage of this technique is that the stain line is more delicate and well defined.
Fig.19
The disadvantage of this technique is that you are forced to defined your morphology very well. This why this technique is more operator sensitive.
Fig.20
The final aspect of the restorations after finishing polishing and occlusal check.
Conclusions
Is staining actually needed in posterior composite restoration?
From a medical point view, it’s absolutely not.
Maybe some dentist can say that this is a time consuming procedure. If they feel this way, it’s better not to do it, and I respect that. Yes we can say that we should do everything for the patient, but also I think that we need to do also for ourselves! I am doing this because I feel more, I create more, I keep the passion in every restoration or at least from time to time.
Changing things in your daily practice, even is they are very small, can keep your passion a long time also for big and important thing!
Bibliography
Csikszentmihalyi, Mihaly (2014). Flow and the Foundations of Positive Psychology: The Collected Works of Mihaly Csikszentmihalyi. Dordrecht: Springer, 2014. ISBN 978-94-017-9087-1
