A clinical case by our Community member Dr Rafael Decurcio
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.
Restoring single teeth with discoloration and shape change is a challenge in the day-to-day practice. Reestablishing the color morphology, shape and surface texture, so that the composite resin restoration blends in with the patient’s adjacent teeth is always our objective in these clinical situations.
Frontal image of the upper maxilla demonstrating the Upper Central Incisor on the right side with a large composite resin restoration of the incisal edge extending into the buccal middle third with poor chromatic and morphological appearance.
Close-Up of Upper Central Incisors highlighting deficient aspects of the present composite resin restoration and substrate darkening in the Upper Right Central Incisor. The Upper Left Central incisor shows relevant incisal chromatic characteristics.
Lateral close-up of the upper left central incisor, highlighting the surface characteristics of macro and microtexture, vertical and horizontal.
Aesthetic Diagnostic wax-up for the fabrication of vertical and horizontal silicone indices for dental preparation.
Dental preparation of the buccal middle third, with a high-grained truncated-conical diamond tip , Style Indiretto V2 (Intensiv), carried out by the initial grinding of central depth orientation.
Dental preparation of the incisal third, with a high-grained truncated-conical diamond tip (Style Indiretto V2, Intensiv), in the incisal third, carried out by the initial depth-oriented grinding.
Initial buccal tooth preparation following the three-thirds inclination of the Upper Central Incisor.
Incisal preparation, removing residues from the old composite resin restoration, providing space for the restoration of chromatic characteristics and incisal translucency. Furthermore, insertion of a retractor cord to refine the slightly subgingival cervical preparation due to the darkening of the entire substrate.
Selective etching with orthophosphoric acid, Ultra-Etch, Ultradent, restricted to enamel.
Application of composite resin Filtek Supreme XTE DA1, 3M with cervical extension to the transition from the middle third to the incisal third, offering restorative space to the incisal characteristics of translucency.
Application of Filtek Supreme XTE WB, 3M, in the transition between the middle and incisal thirds for restoration of morphological characteristics of dentin mamelons, with surface irregularity for more natural light reflection.
After application of the chromatic features at the incisal edge using composite resin Filtek Supreme XTE WD, 3M, to mimic an extremely thin opaque halo and incisal white spots, Filtek Supreme XTE A3D, 3M was used to mimic small features. From the incisal edge, Filtek Supreme XTE WE, 3M composite resin was applied with an LM Arte Solo Anterior spatula on the buccal surface, evenly distributing the composite layer, obeying the three thirds of inclination.
After light curing before and after applying an air-block water soluble gel, the retraction cord was carefully removed, and the basic three-thirds of inclination of the upper central incisor were restored.
Still dehydrated, the restoration was ready for morphological refinement procedures, highlighting the importance of establishing the three-dimensional limits in a mesio-distal direction, locating longitudinal ridges.
After all morphological adjustments to the vestibular surface, the finishing and polishing procedure begins with SofLex Spiral Diamond Discs, 3M, using light and constant irrigation to remove residues formed by the abrasion between surfaces, preventing their impaction on the surface of the composite and providing longevity to the polishing result and shine.
After all the morphological adjustments of the vestibular surface, the finishing and polishing procedure begins with SofLex Spiral Diamond Discs, 3M, using light and constant irrigation to remove residues formed by the abrasion between surfaces, preventing their impaction on the surface of the composite and providing longevity to the polishing result and shine.
After finishing and polishing, surface texture was natural and discreet, and natural light reflection was obtained by mimicking the characteristics of the upper left central incisor, used as a morphological and chromatic reference for the restoration.
Frontal image highlighting the morphological and chromatic integration with all the natural substrates present in the restoration performed.
Close-Up of morphological characteristics of surface texture and polishing of the composite resin restoration.
The correct and obedient association of equipment, instruments, materials and restorative technique allows the rehabilitation of dental structures with naturalness and efficiency from the diagnostic and planning stage to the completion of the process, establishing the desired longevity and compatible with contemporary scientific evidence.
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