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3 RESTORATIVE
P
lacing direct composite Creating Proper Esthetics into their protocol that graduates from
restorations in the an- To build a direct restoration, a detailed coarse to fine discsas well as includes
terior region requires shade diagram is developed. Then teeth a variety of tools that complement the
build-up steps similar are minimally prepared and etched, after chemistry of the selected compositethe
to those for fabricating which an appropriate bonding agent is final restorations can demonstrate the
a layered ceramic resto- applied, and composite is incrementally desired luster and polish. Such systems
ration that will replace layered, contoured, and light cured. After should include finishing discs, polishing
dentin, enamel, dentin lobes, and charac- all increments have been placed and paste, points, cups, and wheels.3
teristic colors. Mastering direct compos- cured, the restoration is then finished This article demonstrates the manner
ite build-up techniques enables dentists and polished.3 in which a freehand composite place-
to create lifelike restorations based on Imperative to this process is using and ment technique was used to restore
their artistic abilities and imagination. properly handling materials that interplay severely damaged anterior maxillary
This is especially true when undertaking with light and recreate the hues, chromas, central incisors. A simplified composite
the procedure using freehand bonding and values inherent in the natural tooth system with an advanced filler technol-
methods. structure being replaced.4 Whether on fa- ogy was selected based on its bioactive
Direct restorations require knowl- cial, cervical, or interproximal surfaces, the benefits, optical properties, esthetics, and
edge of and astute attention to the vari- manner in which composite materials are ideal handling. Additionally, the finish-
ous optical and anatomic variances of handled influences the ultimate appearance ing and polishing protocol necessary to
natural teeth. For clinicians to create of composite restorations.3,5 complete the restorations to the desired
an accurate reproduction of a natural Precise and appropriate composite outcome are demonstrated.
tooth, they must layer composite mate- placement facilitates esthetic recreation
rials of different opacities to replicate the of adjacent tooth characteristics, in addi- Case Presentation
tooth structure that was either removed tion to contributing to the finishing and A 42-year-old woman presented with se-
during preparation or lost as a result of polishing process.3,6 After composite res- vere destruction of her maxillary central
disease or trauma.1 Realistic direct com- torations have been anatomically layered, incisors from long-time biologic damage
posite restorations can only be achieved the finishing and polishing sequences then due to sugar and soda consumption, as
through a combination of correct ana- allow dentists to achieve harmony and bal- well as disease. She would not smile, and
tomic form and creative color layering ance in terms of facial contours, texture, she cried emotionally with embarrass-
concepts.2 and tertiary anatomy.6 For example, line ment about how she presented herself
angles, secondary anatomy, and tertiary to the world (Figure 1).
anatomy can be more well defined using a During a comprehensive examination,
Frank Milnar,
DDS, AAACD
logical, sequential, and predictable finish- repairing the damaged teeth was corre-
Private Practice ing and polishing method.3 This will ulti- lated to restorative materials, since suc-
St. Paul, Minnesota mately enable dentists to produce restora- cessful esthetic and functional outcomes
tion surfaces that accept and reflect light, in restorative dentistry require envision-
without voids, defects, stains, or pits.3 ing the restorations prior to initiating
Equally significant, when dentists in- treatment.3,7 By first envisioning the di-
corporate a finishing and polishing system rect composite restoration in the mind,
(6.) Shade A2 of the Beautifil II composite was blended over the A3 layer to create abstract undulations and produce light
diffusing areas. (7.) A final enamel layer in shade A1 of the Beautifil II composite was placed on top of the A3 and A2 buildup.
(8.) An artisans approach to finishing was taken to prepare the restoration surfaces. (9.) The primary anatomy was redefined
by marking the transitional line angles. (10.) Higher luster for light reflecting zones was imparted in appropriate areas of the
restoration morphology. (11.) Transitional line angles, certain aspects of micromorphology, and the center third of tooth No.
9 were properly managed and optimized. (12.) Using water spray and very low torque, larger volumes of composite mate-
rial were carefully and lightly buffed.(13.) The proper value of the adjacent teeth was achieved in the restorations. (14.) The 1:1
postoperative view demonstrates the desired value, outline form, and natural esthetics.
SN207-0314
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