A clinical case by our Community member Dr. Gilbert Jorquera
This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.
The replacement of an anterior tooth fragment, whether due to a recent trauma or the fracture of an old restoration, is always a clinical challenge for the dentist, especially when there is no predictable protocol to work in these situations. When choosing how to carry out the restoration, questions like what matrix to use, what resin opacities to employ, how to reproduce the emergence profile, and lastly how to mimic the shape and the texture of the original tooth are usually questioned. In this case, the use of a single anterior matrix and a simplified anatomical layering technique will be highlighted. Further, a step by step protocol with all the tips to achieve functional and aesthetic results in the anterior region will be shown.
Fig.1
A young patient came to the dental office and requested a solution for an old restoration fractured in tooth 11. To select the color, the first thing to do is to use a personalized color guide for the brand of composite resins that will be used in the restoration. In this case, the best color match was the Filtek Z350 A2 (3M) layering personalized guide. This should be done with a proper lighting condition and before any procedure that dehydrates the teeth.
Fig.2
The clinical examination revealed:
A fracture of the mesial area of the old restoration.
A presence of a large part of the restoration in the distal area, but with color changes.
Fig.3
Prior to starting the process of removing the old restoration, the modified isolation approach for anterior teeth was carried out.
To remove and prepare the tooth surface, D6 dental bur from Style Diretto Kit (Intensiv) was used.
Fig.4
In situations where a silicone guide was not accomplished, the introduction of a matrix that can assist in recreating the emergence profile at the same time as the shape, is highly beneficial. The Unica Anterior Matrix System (Polydentia) was the ideal option in this situation.
Fig.5
To fix the matrix in the correct position, a gingival barrier was used. With the matrix already located, the layering technique begins with the enamel increments for the proximal walls (Filtek Z350 A3 Enamel, 3M) light-cured with the multi-wave Curing Pen device (Eighteeth).
Fig.6
To continue the layering technique, a dentin increment (Filtek Z350 A2 Dentin, 3M) was used.
Fig.7
A thin layer of enamel (Filtek Z350 A3 Enamel, 3M) was used to complete the palatal surface.
Fig.8
In this stage, a thin layer of body (Filtek Z350 A2 Body, 3M) was applied using a compo-brush (Smile Line) to achieve a perfect integration between the layers.
Fig.9
The last increment used was the vestibular layer of enamel (Filtek Z350 A3 Enamel, 3M), applied with the Solo Anterior instrument (LM-Arte). At the end of this stage, differences in size, shape, and texture are observed.
Fig.10
The basic shape of the tooth and the primary anatomy (refraction lines) were obtained using an abrasive disc (Sof-lex disc, 3M).
Fig.11
The secondary anatomy (V shapes) was obtained using F1 and F4 dental burs from Style Finale Kit (Intensiv). It is always important to evaluate the depth and the extension in the neighboring tooth so as not to exaggerate its presence.
Fig.12
Now that the primary and secondary anatomy have been established, a basic shape can be discerned, but the restoration appears opaque, without texture, and without shine.
Fig.13
To achieve a very smooth tertiary anatomy like the one the patient had, a Twist polisher was used.
Fig.14
For a natural gloss and a perfect integration of the restoration, the LUCIDA Gloss System (DiaShine) was implemented.
Fig.15
Perfect integration of the shape and the color of the new restoration.
Fig.16
Before and after. The patient was happy and satisfied.
Conclusions
A simplified layering technique can resolve most of the daily anterior restorations if the clinician understand the anatomical concept behind each composite increment. Reproducing the shape and the texture of a natural tooth with a direct restoration is only achieved by using the right tools and predictable protocols that allow dentists to achieve good aesthetic results.
Bibliography
- Baratieri LN, Araujo E, Monteiro S Jr. Color in natural teeth and direct resin composite restorations: Essential aspects. Eur J Esthet Dent. 2007;2:172-86.
- Devoto W, Siracinelli M, Manauta J. Composite in every day practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent. 2010 Spring;5(1):102-24.
- Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentin shade and predefined thickness of enamel: A new concept in composite layering – Part 1. Odontostomatol Trop. 2014; 37:5-16.
- Atria P, João Barbosa, Sampaio C, Jorquera G, Hirata R, Mahn G. Comparison of a non-destructive technique using threedimensional imaging and histoanatomical chemical dissolution for dental morphology analysis. Int J Esthet Dent 2019;14(1):76-85.
- Manauta J, Salat A, Devoto W, Putignano A. Layers 2: Direct Composites: The Styleitaliano Clinical Secrets. Milan: Quintessence, 2023
