AustinJournalofDentistry

Case Report
Aesthetic Restoration of Maxillary Incisors with
Composites: Case Report
Correia AMO1, Vieira VM1, Rocha DM2 and Mendona AAM1*
1Department of Dentistry, Federal University of Sergipe, Aracaju, Brazil

2Department of Dentistry, Federal University of Sergipe, Lagarto, Brazil

*Corresponding author: Mendona AAM, Departament of Dentistry , Federal

University of Sergipe UFS, Rua Claudio Batista, s/n, Bairro Santo Antnio,
Aracaju/SE, CEP: 49060-100, Brazil
Received: September 22, 2014; Accepted: January 12, 2015; Published:
January 15, 2015
Abstract
The increasing demand for esthetic restorations motivates the dentist to develop
special skills and knowledge of dental restorative materials. The success in
restoring teeth within the aesthetical zone results in positive effect on patients
self-esteem and quality of life. The direct composite resin layering techniques
allow greater preservation of sound tooth structure than indirect restorations. The
main difficulties encountered by clinicians, have involved contamination due to
improper isolation, individual patient characteristics, and the provision of
restorations with acceptable strength, durability, and esthetics. Composite resin
has become an integral part of contemporary restorative dentistry and the
material of choice for Class IV restorations due to improvements in materials,
conservative concepts in restorative dentistry and clinical successes. This article
shows a case report of an esthetic rehabilitation of the two maxillary incisors
using composites.
Keywords: Composite resin; Class IV; Esthetic dentistry
Introduction
Theincreasingdemandforestheticrestorationsmotivatesthedentisttodevelopspecial
skillsandknowledgeofdentalrestorativematerials.Restorationsintheanteriorregionof
themouthespecially,shouldmeethighestheticdemands[1].Itisespeciallythesmile
thatinfluencestheappearanceofthefaceasabeautifulsmileseemstoconveyserenity,
safety,andsuccessinthebeholder[2].
Thesuccessinrestoringteethwithintheaestheticalzoneresultsinpositiveeffecton
patientsselfesteemandqualityoflife[3].Thewishesandneedsofpatientshavetobe
consideredinthesamewayasestheticguidelinesknownfromthescientificliterature[4].

Estheticdentistryrequiresminimallyinvasivetreatmentswithrestorationsthatmimicthe
surroundingdentition[57].Thedirectcompositeresinlayeringtechniquesallowgreater
preservation
ofsoundtoothstructurethanindirectrestorations.Themaindifficultiesencounteredby
clinicians,haveinvolvedcontaminationduetoimproperisolation,individualpatient
characteristics,andtheprovisionofrestorationswithacceptablestrength,durability,and
esthetics[8,9].
Compositeresinhasbecomeanintegralpartofcontemporaryrestorativedentistryand
thematerialofchoiceforClassIVrestorationsduetoimprovementsinmaterials,
conservativeconceptsinrestorativedentistryandclinicalsuccesses[10].
Case Report
A25yearsoldmalewasreferredtotheclinicofdepartmentofdentistryoftheFederal
UniversityofSergipepresentingestheticrequestsinthemaxillarycentralincisors.
Followingthemedicalinterviewanddatacollectionofgeneralandoralhealth,clinical
andradiographicexaminationswereconducted.Aphotographicprotocolwassetfor
assisttheplanningandexecutionofthecase.
Intheclinicalexamination,facialaspects,smile,gingivalarchitectureanddental
characteristicswereanalyzed.Intherightmaxillaryincisor,extensivecariouslesionwas
observedwithinvolvementofthemesialsideandtheallthreethirdsofthedental
element,featuringaclassIVcavity.Theleftmaxillaryincisorpresentedanextensive
compositeresinrestorationshowingroughaspectandcolorchange(Figure1).
Radiographically,therewasaradiolucentareaontheproximalsurfaces(Figure2).
Theclinicalplanningsuggesteddirectcompositerestorationsforbothmaxillarycentral
incisors.
Inthefollowingappointment,theinitialshadewasmeasuredwiththeaidofaVITA
shadeguide(VITAPANClassical).Thenincrementsofcompositewereplacedonthe
buccalsurfaceofthetooth,dentinshadecompositeinthecervicalregionandenamel
shadeinthemiddlethird,toensurethecorrectshademeasurement.

Figure 1: Initial aspect of the patients smile. Caries lesion in the right maxillary
incisor and poor composite restoration in left maxillary incisor. A Smile. B- Intraoral frontal view. C- Right side view. D- left side view.
Rubberdamisolationwasperformedthentherestorationwasremovedwithadiamond
burNo.1014(KGSorensen,Brazil)21andtheinfecteddentinexposed.Theinfected
dentinwasremovedwithcarbidebur#6(KGSorensen,Brazil)atlowspeed(Kavo,
Joinville,SantaCatarina,Brazil).Abevelonthebuccalsurfacewasmadewithatapered
burNo.2200(KGSorensen,Brazil)(Figure3).
Duetoathinremainingdentin,calciumhydroxidecementbased(HydroC,Dentsply,
Brazil)wasinsertedinthepulpalwallofeachelementasaprotectiveagentforthepulp
dentincomplex.Glassionomercement(RMaxxion;FGM,Joinville,SC,Brazil)was
appliedoverthecalciumhydroxidecement,actingascavitybase(Figure4).
Thesurfacesweretreatedaccordingtothetotaletchtechnique,37%phosphoricacid
(Condac37;FGM,Joinville,SC,Brasil)for30s(enamel)and15s(dentine),rinsedfor
20s,driedbyairsprayandexcesswaterwasremovedwithabsorbentpaper.Theadhesive
(Ambar,FGM,Joinville,SC,Brazil)wasappliedwithdisposabletips(Cavibrush;FGM,
Joinville,SC,Brazil),followedbyairspraytoevaporatethesolventand10sphoto
activation(RadiiplusSDIAustralia1,500mW/cm2)(Figure5).
Apolyesterstripwasplacedbetweenthedentalelementstoseparateandassistinthe
restorationofthelingualfaceofbothelements.
IncrementsofenamelshadecompositeAT,(FiltekZ350XT,3M/ESPE,St.Paul,MN,
USA)wereplacedforrebuildthelingualenamel,firstintherightincisor,andphoto
activatedbytimeof20seconds.Thesameprotocolwasfollowedintheleftincisor.
Layersofdentinshadecomposite,A3D(FiltekZ350XT,3M/ESPE,St.Paul,MN,
USA)andbodyshadeA2B(FiltekZ350XT,3M/ESPE,St.Paul,MN,USA)were
appliedandlightcuredfor20seconds.ResineffectshadeBT(XTFiltekZ350,3M/

ESPE,St.Paul,MN,USA),wereplacedbetweentheincisaledgeanddentinal

mammelonsinordertorepro
ducetranslucencyand
opalescenceofthisregion.AnenamelshadecompositeA2E(XTFiltekZ350,3M/
ESPE,St.Paul,MN,USA)wasplacedasthelastincrement(Figure6).

Figure 2: Radiographic aspect of radiolucent areas.

Figure 3: Rubber dam isolation. A- Frontal view. B- Caries exposure. C- End of

teeth preparation. D- Teeth prepared in a left side view. E- Teeth prepared in a
right side view.

Figure 4: Pulp-Dentin complex protection. A- Calcium-Hydroxide cement. BGlass ionomer cement.

Figure 5: A- 37% acid etching B- Adhesive system.

Figure 6: A- Restoring palatal enamel with an enamel composite shade AT. BRestoring dentin with a shade A3D composite. C- Using a body composite shade
A2B. D- Restoring buccal enamel with a shade A2E composite.
Glycerinbasedgel(KY;Jonhsonn,SoJosdosCampos,SP,Brazil)wasplacedonthe
surfaceofcompositeresinforbetterconversiondegreeofmonomersandthesetwas
photoactivatedfor20seconds.Thegelwasrinsedandthesurfacewasairdried.
Therubberdamwasremoved,andtheoclusaladjustmentperformedwithfineandextra
fineflameshapeddiamondburs,3168Fand3168FF(KGSorensen,Brazil).
Restorationsfinishingandpolishingwereperformedfordentalcontouring
regularization;sandingdiscsSofLexPopOn(3MESPE,USA)wereemployedfollowed
bymultilaminatebursonthebuccalsurfaceforsmoothingresin.Abrasivesiliconebased
rubberswereusedforsurfacesmoothness.Buccalcharacterizations(primaryand
secondaryanatomy)werepreparedwithadiamondburathighspeedno3195(Kavo,
Joinville,SantaCatarina,Brazil)(Figure7).

Figure 7: Final restoration after finishing and polishing

Discussion/Conclusion
Theaccuratediagnosiscombinedwithanestheticdesignandwellexecutedrestorative
stepaimtoimproveandrestorethenaturalappearanceofteeth.Thereby,knowledgeof
dentalmorphologyisessential,aswellasaspectsregardingopticalanddynamic
propertiesofdentalstructures.
Compositeshavebeenwidelyusedincosmeticprocedures,duetodiversityofshadesand
effectsthatallowdetailingthedentalstructures.
Inthereportedcase,themaxillarycentralincisorshadinadequaterestorations,besides
thepresenceofactivecarieslesioncompromisinghealth,functionandesthetics.
Directrestorativeprocedurewaspresentedasaneffectiveandsafealternativefororal
rehabilitation.Manyfactors,suchasplanningstage,knowledgeandmasteryoftechnique
andfinishandpolishingmaterialsdecidethesuccessoftherestorations;monitoringand
maintenanceensurethetreatmentlongevity.

AustinJournalofDentistry

Laporan Kasus
Restorasi Estetik dari Insisivus Rahang Atas dengan
Komposit: Laporan Kasus
Correia AMO1, Vieira VM1, Rocha DM2 and Mendona AAM1*
1Department of Dentistry, Federal University of Sergipe, Aracaju, Brazil
2Department of Dentistry, Federal University of Sergipe, Lagarto, Brazil
*Corresponding author: Mendona AAM, Departament of Dentistry , Federal
University of Sergipe UFS, Rua Claudio Batista, s/n, Bairro Santo Antnio,
Aracaju/SE, CEP: 49060-100, Brazil
Received: September 22, 2014; Accepted: January 12, 2015; Published: January 15,
2015

Abstrak
Meningkatnyapermintaanuntukrestorasiestetikmemotivasidoktergigiuntuk
mengembangkanketerampilandanpengetahuankhusustentangbahanrestoratifgigi.
Keberhasilandalammemulihkangigidalamzonaestetikmenghasilkanefekpositifpada
diripasiendankualitashidupnya.Teknikteknikpelapisanpadaresinkompositdirect
memungkinkanpelestarianyanglebihbesardaristrukturgigidaripadarestorasiindirect.
Kesulitanutamayangdihadapiolehdokter,telahterlibatkontaminasiakibatisolasiyang
tidaktepat,karakteristikindividupasien,danpenyediaanrestorasidengankekuatanyang
baik,dayatahan,danestetika.Resinkomposittelahmenjadibagianintegraldari
kedokterangigirestoratifkontemporerdanbahanpilihanuntukrestorasiKelasIVkarena
perbaikandalambahan,konsepkonservatifdalamkedokterangigirestoratifdan
keberhasilanklinis.Artikelinimenunjukkanlaporankasusrehabilitasiestetikdaridua
gigiserirahangatasmenggunakankomposit.
Katakunci:resinkomposit;kelasIV;kedokterangigiestetik
Pendahuluan
Meningkatnyapermintaanuntukrestorasiestetikmemotivasidoktergigiuntuk
mengembangkanketerampilandanpengetahuankhusustentangbahanrestoratifgigi.
Restorasidiwilayahanteriormulutsecarakhusus,harusmemenuhituntutanestetika
yangtinggi[1].Haliniterutamasenyumyangmempengaruhipenampilanwajahsebagai
senyumyangindahtampaknyauntukmenyampaikanketenangan,keamanan,dan
keberhasilandalammelihatnya[2].

Keberhasilandalamrestorasigigidalamzonaestetikmenghasilkanefekpositifpadadiri
pasiendankualitashidup[3].Keinginandankebutuhanpasientelahdipertimbangkan
dengancarayangsamasebagaipedomanestetikadiketahuidariliteraturilmiah[4].
Kedokterangigiestetikmembutuhkanperawataninvasifminimaldenganrestorasiyang
menirugigisekitarnya[57].Teknikteknikpelapisanresinkompositdirect
memungkinkanpelestarianstrukturgigiyanglebihbesardaripadarestorasiindirect.
Kesulitanutamayangdihadapiolehdokter,keterlibatankontaminasiakibatisolasiyang
tidaktepat,karakteristikindividupasien,danpenyediaanrestorasidengankekuatanyang
baik,dayatahan,danestetika[8,9].
Resinkomposittelahmenjadibagianintegraldarikedokterangigirestoratifkontemporer
danbahanpilihanuntukrestorasiKelasIVkarenaperbaikandalambahan,konsep
konservatifdalamkedokterangigirestoratifdankeberhasilanklinis[10].

Gambar1:aspekawaldarisenyumpasien.Lesikariesdiinsisivusrahangataskanandan
restorasikomposityangkurangbaikdiinsisivusrahangataskiri.ASenyum.BTampilan
frontalintraoral.Csisitampilankanan.Dsisitampilankiri.

LaporanKasus
Seoranglakilakiberusia25tahundirujukkeklinikdepartemenkedokterangigidari
FederalUniversityofSergipemenyajikanpermintaanestetikdalamgigiserisentralatas.
Setelahwawancaramedisdanpengumpulandatakesehatanumumdankesehatanmulut,
pemeriksaanklinisdanradiografidilakukan.Sebuahprotokolfotografiditetapkanuntuk
membantuperencanaandanpelaksanaankasusini.
Dalampemeriksaanklinis,aspekwajah,senyum,arsitekturgingivadankarakteristikgigi

dianalisis.Digigiserirahangataskanan,lesikariesluasdiamatidenganketerlibatansisi
mesialdantigapertigadarielemengigi,menampilkanronggakelasIV.Insisivusrahang
ataskiridisajikanrestorasiresinkompositekstensifmenunjukkanaspekkasardan
perubahanwarna(Gambar1).Radiografi,adadaerahradiolusenpadapermukaan
proksimal(Gambar2).

Gambar2:Aspekradiografidaerahradiolusen.

Gambar3:Isolasidenganrubberdam.ATampilanfrontal.BGambarankaries.CAkhir
peparasigigi.DPreparasigigipandangansisikiri.EPreparasigigipandangansisikanan.

Perencanaanklinismenyarankanrestorasikompositdirectuntukkeduagigiserisentral
atas.
Dalamkunjunganberikutnya,warnaawaldiukurdenganbantuanVITAshadeguide
(VITAPANClassical).Kemudianpenambahankompositditempatkanpadapermukaan
bukaldarigigi,shadedentinkompositpadadaerahservikaldanshadeenameldi
sepertigatengah,untukmemastikanpengukuranwarnayangbenar.
IsolasirubberdamdilakukandanrestorasidilakukandenganburdiamondNo.1014(KG
Sorensen,Brasil)21danmenunjukkandentinyangterinfeksi.Selanjutnya,dentinyang

terinfeksidikeluarkandenganburcarbide#6(KGSorensen,Brasil)padakecepatan
rendah(Kavo,Joinville,SantaCatarina,Brazil).Sebuahbevelpadapermukaanbukal
dibuatdenganburtaperedNo.2200(KGSorensen,Brazil)(Gambar3).
Karenadentinyangtersisatipis,basissemenkalsiumhidroksida(HydroC,Dentsply,
Brazil)dimasukkandidindingpulpadarisetiapelemensebagaiagenpelindunguntuk
kompleksdentinpulpa.Semenionomerkaca(RMaxxion;FGM,Joinville,SC,Brazil)
diaplikasikandiatassemenkalsiumhidroksida,bertindaksebagaibasiskavitas(Gambar
4).

Gambar4:Perlindungankompleksdentinpulpa.ASemenKalsiumHidroksida.BSemen
ionomerkaca.

Permukaandiperlakukansesuaidengantekniktotaletch,37%asamfosfat(Condac37;
FGM,Joinville,SC,Brasil)selama30detik(enamel)dan15detik(dentin),dibilas
selama20detik,dikeringkandengansemprotanudaradankelebihanairtelahdambil
dengankertaspenyerap.Perekat(Ambar,FGM,Joinville,SC,Brazil)diaplikasikan
dengantipsekalipakai(Cavibrush;FGM,Joinville,SC,Brazil),diikutiolehsemprotan
udarauntukmenguapkanpelarutdanaktivasifotoselama10detik(RadiiplusSDI
Australia1,500mW/cm2)(Gambar5).

Gambar5:A37%etsaasamBSistemadesif.

Sebuahstrippoliesterditempatkanantaraelemengigiuntukmemisahkandanmembantu
dalamrestorasipermukaanlingualkeduaelemen.
PenambahanwarnakompositdienamelAT,(FiltekZ350XT,3M/ESPE,St.Paul,MN,

USA)ditempatkanuntukmembangunkembalienamellingual,pertamadigigiserikanan,
danaktivasifotoselama20detik.Protokolyangsamadiikutidalamgigiserikiri.Lapisan
dentinwarnakomposit,A3D(FiltekZ350XT,3M/ESPE,St.Paul,MN,USA)danbody
shadeA2B(FiltekZ350XT,3M/ESPE,St.Paul,MN,USA)yangditerapkandandilight
curedselama20detik.WarnauntukefekresinkompositBT(XTFiltekZ350,3M/
ESPE,St.Paul,MN,USA),ditempatkanantaratepiinsisaldanmammelonsdentinuntuk
mereproduksitranslusensidankeopakandaridaerahini.Sebuahwarnakompositbagian
enamelA2E(XTFiltekZ350,3M/ESPE,St.Paul,MN,USA)ditempatkansebagai
lapisanterakhir(Gambar6).

Gambar6:ARestorasipalatalenameldengankompositwarnaenamelAT.BRestorasidentin
dengankompositwarnaA3D.CMenggunakanbodyshadekompositA2B.DRestorasienamel
bukaldenganwarnakompositA2E.

Gliserinberbasisgel(KY;Jonhsonn,SoJosdosCampos,SP,Brazil)ditempatkanpada
permukaanresinkomposituntukderajatkonversiyanglebihbaikdarimonomerdan
dilakukanaktivasifotoselama20detik.Geldibilasdanpermukaandibiarkankering.
Rubberdamdikeluarkan,danpenyesuaianoklusaldilakukandenganburflamediamond
finedanextrafine,3168Fdan3168FF(KGSorensen,Brasil).Restorasifinishingdan
polishingdilakukanuntukregularisasikonturgigi;lalupenggunaansandingdiscsSof
LexPopOn(3MESPE,USA)diikutiolehbursmultilaminatepadapermukaanbukal
untukmenghaluskanresin.Silikonabrasifberdasarkaretdigunakanuntukmenghaluskan
permukaan.Karakterisasibukal(anatomiprimerdansekunder)dipreparasidenganbur
diamonddengankecepatantinggi3195(Kavo,Joinville,SantaCatarina,Brazil)
(Gambar7).

Gambar7:Restorasiakhirsetelahfinishingdanpolishing.

Diskusi/Kesimpulan
Diagnosisyangakuratdikombinasikandengandesainestetikdanlangkahrestorasiyang
baikdialakukanuntukmeningkatkandanmengembalikanpenampilanalamigigi.Dengan
demikian,pengetahuantentangmorfologigigisertaaspekmengenaisifatoptikdan
dinamisdaristrukturgigiadalahpenting.
Komposittelahbanyakdigunakandalamprosedurkosmetik,karenakeragamanwarna
danefekyangmemungkinkanmerincistrukturgigi.
Dalamkasusyangdilaporkan,gigiserisentralatasmemilikirestorasiyangtidak
memadai,selainkeberadaanlesikariesaktifmempengaruhikesehatan,fungsidan
estetika.
Prosedurrestoratifsecaradirectdisajikansebagaialternatifyangefektifdanamanuntuk
rehabilitasioral.Banyakfaktor,sepertitahapperencanaan,pengetahuandanpenguasaan
teknikbahanfinishingdanpolishingmenentukankeberhasilanrestorasi;pemantauandan
pemeliharaanmemastikanketahanansebuahperawatan.