The esthetic need of patients has become a constant in the clinics, since access to information is much easier nowadays, it can be found in television, printed, on the internet or social medias. Because of that, many times the professionals tend to use books, watch courses, everything in the search of better training and more information in order to meet this demand. To facilitate the life of the professional, which is goal of this blog, an uncomplicated dentistry, we believe that a step-by-step guide can help the professional in their day-to-day activities. In this way, introducing a guide for restoring in anterior teeth, seeking the stratification of the restoration and more natural results that can please our patients.
In this step-by-step guide, you can observe a sequence of photos, that represents the steps to follow as a guide for these specific cases of reconstruction of fractured teeth.
1. Fracture of element 11, loss of incisal edge and part of the middle third. In this step, note all details of the homologous tooth and neighbouring teeth. Assemble a Chroma map of the tooth, noting the colors of cervical, middle and incisal thirds. Also note the areas of translucency. Place the photo in black and white, to note the areas of high and low value. Be sure to observe cracks and stains present, angles of reflection, areas of brightness, horizontal and vertical texture.
2. At this stage, a restoration with diagnostic purpose was placed, without adhesive, in a single increment only to give a shape to the tooth. The objective is shaping this diagnostic restoration to prepare a silicone guide that should guide you in the creation of future restoration. The important thing is that the palatal face of this restoration should well done and adjusted as close as possible to the occlusion of the patient.
3. With the silicone guide done, apply a very light coating of adhesive to the silicone in the area related to future restoration and cure it. The objective is to facilitate the placement of the first layer of the composite on the silicone guide. The color of the resin used in this case should be a effect color, translucent.
4. The guide should be taken into position at the mouth of the patient. Note that the neighbouring teeth are protected with teflon tape. Recalling that the tooth to be restored has been conditioned and is already with adhesive system properly applied. When positioning the guide, try to adapt well this first layer of resin throughout the palatal face and then light cure it. This will prevent the displacement of this thin layer in the act of removing the silicone guide.
5. Note how thin this first layer of translucent composite should be. It usually has some small burrs and excess resin. For this well defined contour of the palatal face, as seen in this figure, it is of great importance to use a scalpel blade.
6. Place the dentin composite, opaque, in this case it was used a Dentin A2. Place it first along the middle third and light cure it. This color of dentin should be brought up to the half of the bevel , in case the professional choose to do it, or slightly on the line of the union if you choose not to make a bevel. Then extend another layer of dentin, separating it into three lobes. Note that the masses of dentin don't invade the proximal area.
7. If you want to achieve the effect of counter-opalescence, use a color of dentin more clear, as A1 or opaque White. This color was also used to construct the incisal halo.
8. Then place between the lobules of dentin and between the lobes and incisal edge, effect colors, translucent. In this case, was placed a translucent orange or amber in the region of central lobule and translucent bluish in the region of proximal lobes. This decision to use resins of translucent effect is based on the color analysis described in the first picture.
9. Observe the translucency after light curing these masses of resin.
10. Whenever possible, look it from two different views before light curing the layers of composite: By incisal view and by proximal view. They are important to make sure that the space for the future enamel layer is being respected.
11. If the professional choose to recreate stains present on the neighbouring teeth, use whenever possible pigments and not masses of resin to create this effect. Masses of resin will occupy a space that can be critical to the placement of the enamel composite.
12. The last layer of resin, should be the enamel. In this case, enamel A2. The use of brushes assists in creating the vertical and horizontal textures. Try to observe the angles of reflection and glare. The more rich in details is this last layer, the lower will be the work in finishing the stage, requiring almost only polishing.
13. Vestibular view soon after the restoration is done, allows the visualization of intrinsic characterization, lobules of dentin and stains.
14. Proximal view, allows a good view of texturing using the twin flash, that was approached by this blog in a past post.
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My purpose is to help you gain autonomy through knowledge, facilitating the dentistry and communication. AND how do I do this?
I put myself in your shoed, I identify what is preventing you from being happy with your results and untie the knots by means of a simple and accessible language! I graduated from UNESP | Araçatuba; did my Master and PhD in Operative Dentistry at UNESP Araraquara | I am a Professor of Operative Dentistry at the Federal University of Pelotas | RS.
Jul, 27th 2015