Perfecting aesthetic techniques for replacing anterior ...€¦ · A 30-year-old female patient...
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1 3M SM Health Care Academy Perfecting aesthetic techniques for replacing anterior class IV restorations. Dr. Monteiro is a member of the StyleItaliano TM group. In this case he describes the use of a simple direct composite resin layering technique and shares some clinical hints and tips to achieve highly aesthetic natural results. Application of the StyleItaliano TM technique demonstrates the key steps including, shade selection, correct use of opacity and shade choice in layering composite resin to achieve predictable aesthetic results. 3M SM Health Care Academy About the case A 30-year-old female patient visited the dental surgery, saying she did not like the appearance of restorations on teeth 11 and 21 because of a margin between the restoration and sound dental tissue and the colour and surface texture which had a lot of porosities. She was interested in ceramic veneers, believing they would provide optimum aesthetics and durability, and we also explored using composite resins, stressing the importance of preserving the natural tooth structures. To ensure the patient could make an informed decision, we discussed the advantages and disadvantages of both treatment options. In the end, the patient chose composite restorations. We firstly took impressions of the two central incisors, then made a wax-up that was used for a silicone index model. Central incisors with old restorations. by Dr. Paulo Monteiro Previously published: January 2016 - Styleitaliano.org May 2016 - NSW Dentist (ADA)
Transcript of Perfecting aesthetic techniques for replacing anterior ...€¦ · A 30-year-old female patient...
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Perfecting aesthetic techniques for replacing anterior class IV restorations.
Dr. Monteiro is a member of the StyleItalianoTM group. In this case he describes the use of a simple direct composite resin layering technique and shares some clinical hints and tips to achieve highly aesthetic natural results. Application of the StyleItalianoTM technique demonstrates the key steps including, shade selection, correct use of opacity and shade choice in layering composite resin to achieve predictable aesthetic results.
3MSM Health Care Academy
About the caseA 30-year-old female patient visited the dental surgery, saying
she did not like the appearance of restorations on teeth 11 and
21 because of a margin between the restoration and sound
dental tissue and the colour and surface texture which had
a lot of porosities. She was interested in ceramic veneers,
believing they would provide optimum aesthetics and durability,
and we also explored using composite resins, stressing the
importance of preserving the natural tooth structures. To
ensure the patient could make an informed decision, we
discussed the advantages and disadvantages of both treatment
options. In the end, the patient chose composite restorations.
We firstly took impressions of the two central incisors, then
made a wax-up that was used for a silicone index model.
Central incisors with old restorations.
by Dr. Paulo MonteiroPreviously published: January 2016 - Styleitaliano.org May 2016 - NSW Dentist (ADA)
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We used this model to design the new restorations. To ensure predictability of the final aesthetic result, as with all
concepts applied through Styleitaliano™, we determined the shade using a Vita Classic shade guide, allowing
several shade combinations to be identified before the treatment began. As a final shade of A1 was needed, a shade
combination of A1 dentine and A3 enamel (3M™ Filtek™ Supreme XTE) was chosen. After shade selection, we
placed the rubber dam and removed the old restorations. To ensure that only enamel was etched and not dentine, a
selective enamel etching technique was implemented using Scotchbond™ Universal Adhesive from 3M Oral Care.
Shade selection with Vita Classical shade guide.
Marking of extents of old restoration for easier detection.
Isolation of operating field with rubber dam.
After removing old restorations, we prepared labial and inter-proximal bevels.
Use of the silicon guide previously obtained from a wax-up.
Selective enamel etching using Scotchbond™ Universal Etchant.
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Implementing the composite layering techniqueWe began the layering procedure on the palatal surface using 3M™ Filtek™ Supreme XTE Universal
Restorative. To achieve a higher level of translucency on the incisal third, we used a translucent shade of
enamel. The layering was approached using achromatic enamel and a controlled thickness technique.
We then applied the next layer of enamel to the interproximal walls. Again, Filtek Supreme XTE was used and the
shade was A3 enamel. To achieve anatomic shape, we applied the composite very thinly to the interproximal walls
using a posterior matrix. Due to its convex shape, we could apply the enamel much more simply. When layering
the incisal edge, we used very thin increments, this time with a flowable white restorative. To achieve the level of
opacity that the patient required, we also applied dentine opacity composite resin to the central incisors. Once
the dentine was layered, it was compressed and compacted. To create space for the final enamel layer, we used a
Misura instrument which had been co-developed by LM and StyleItalianoTM. Once the dentine layer thickness
was calibrated, the incisal portion of the dentine was shaped according to the silicone index model and wax-up.
Applying Scotchbond™ Universal Adhesive After air drying for approximately 5 seconds,we light cured for 10 seconds with Elipar™ DeepCure-S LED Curing Light.
Creating the palatal walls using Filtek Supreme XTE CT.
Placing a thin convex posterior matrix in a vertical position to create a natural and anatomic surface.
The interproximal enamel layer was made with Filtek Supreme XTE A3E.
For the incisal halo, Filtek Supreme XTE Flowable W was used.
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After applying the final enamel layer, we initiated Filtek Supreme XTE A3E light curing for 10 seconds with Elipar™ DeepCure-S LED Curing Light.
Restorations before final finishing and polishing.
Marking the primary anatomy (vertical texture) with pencil.
Sof-Lex™ Discs are used to define the outline of the restoration and create secondary anatomy
Polymerisation of the dental composite resins was conducted using a 3M™ Elipar™ DeepCure LED Curing Light
from 3M Oral Care. To achieve extra translucency, we filled the space between the dentine and incisal edge with
translucent enamel. After additional light curing, a final A3 layer of enamel and another round of light curing, we
covered the central incisors with glycerine gel. After one last light cure for 40 seconds, we conducted the final
stage of polishing. The last hurdle was to ensure that the mesial and distal line angles and macrotexture were
correct. The angle lines were achieved with 3M™ Sof-Lex™ Finishing and Polishing Discs, combining the use
of different abrasive grades and various burs to ensure the correct macrotexture. We then removed the rubber
dam and excess material. The patient was extremely happy with the outcome and the conservative nature of the
treatment. By using quality equipment and simple, predictive techniques, we achieved the desired aesthetic result.
Light curing for 10 seconds with Elipar™ DeepCure-S LED Curing Light.
Applying the dentine layer using Filtek Supreme XTE A1D. For volume control, the Misura instrument was used to calibrate the dentine and leave a 0.5-mm space for the labial enamel.
Creation of the dentine incisal anatomy (mamelons) with the LM Arte Fissura.
To increase translucency at the incisal edge, a small portion of Filtek Supreme XTE CT was applied between the dentine layer and incisal halo.
Pre-polishing of restoration with Sof- Lex™ Pre-Polishing Spiral.
Polishing with Sof-Lex™ Diamond Spiral to create a smooth high-gloss polish.
Aesthetic appearance with natural shine of the enamel surface after polishing.
Natural integration of the composite restorations with the dental tissue, giving the restorations a very natural look.
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Contact: Dr. Paulo Monteiro [email protected]
For more information on the 3M materials utilised in this case, please visit 3M.com.au or 3M.co.nz, or contact your local 3M Product Specialist.
Dr Paulo Monteiro DMD, MSc (Lisbon, Portugal)“My passion for aesthetic dentistry began when I attended the last year of
the Dental Medicine course in 1998 at the Institute of Health Sciences Egas
Moniz in Portugal. In 2005, I completed my specialisation in Aesthetic and
Restorative Dentistry at the ISCSEM, Lisbon, Portugal. In 2010, I finished
a Master’s degree in Dental Medicine and I’m currently taking a PhD in
Dentistry at Universidade de Santiago de Compostela, Spain.” Paulo is author
and co-author of many clinical publications and has lectured in more than
200 international courses and congresses in aesthetic dentistry and is a
member of the Styleitaliano™ Group.
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Disclaimer: Application and Technique guides used in this case on 3M products may not always align with 3M Product Instructions for Use. Please always follow the 3M Product Instructions For Use for best clinical results.
