Composite Bonding in the Esthetic Zone
Simplified system facilitates restoration of function and esthetics with a single shade
Dimple Desai, DDS
Treating patients with damaged or chipped incisors can be challenging, especially from an esthetic perspective, and these challenges only increase for patients who are bruxers or who tend to be "rough" on their teeth. This case report illustrates how a systematic approach to repairing teeth using a restorative with a simplified shade system can yield results that are both strong and esthetically pleasing in a highly efficient manner.
The 37-year-old male patient in this case had just completed clear aligner therapy, but he was still unhappy with the overall esthetics of his teeth. More specifically, tooth No. 8 had an incisal Class IV chip, and tooth No. 25 also had a Class IV chip. In addition, he was dissatisfied with the shape of tooth No. 7, which was not symmetrical when compared with teeth Nos. 8 and 10 (Figure 1 through Figure 3). The patient was presented with treatment options to rectify these issues, and he opted for a treatment plan involving composite bonding.
The first step was to bleach the patient's teeth. Then, after a period of a week and a half to allow his teeth to rehydrate, the patient was recalled for the bonding procedure. While the patient's teeth were rehydrating, models were printed (Sprint Ray Pro 95 S, SprintRay) and postprocessed (ProWash S and ProCure 2, SprintRay), a wax-up was prepared manually, and a lingual putty shelf was created (Pala® lab Putty, Kulzer).
On the day of bonding, a rubber dam (True™ Dental Dam, Clinicians Choice) was placed to isolate the teeth, and the fit of the wax-up and lingual putty matrix for teeth Nos. 7 and 8 was confirmed (Figure 4). After confirmation, the treatment began with tooth No. 8, which was beveled and then air abraded (PrepStart™, Zest Dental Solutions) (Figure 5). The tooth was then isolated with kidney bean-shaped matrices, etched with a 35% phosphoric acid etchant (Vococid, VOCO) for 20 seconds, and rinsed (Figure 6). A white frosty appearance was confirmed. Next, a bonding agent (Adhese® Universal, Ivoclar) was placed, the solvent was air-dried, and the bonding agent was light cured (Bluephase® G4, Ivoclar). The lingual putty matrix was then loaded with composite (Venus® Pearl Pure [Light Shade], Kulzer), and a lingual shelf was created (Figure 7). This tooth was restored with just a single shade of composite, which was verified prior to achieving isolation by placing a small amount onto the tooth, curing it, and verifying that the shade matched prior to dehydration. Next, the facial surface was layered with composite (Figure 8 and Figure 9), and then the composite was smoothed and packed down with a resin wetting agent (ResinBlend LV, Clinician's Choice), which ensured that the composite could be contoured well with an instrument (Composite Ninja, Clinician's Choice) (Figure 10). After contouring, the restoration was polished, and teeth Nos. 7 and 25 were treated using a similar protocol (Figure 11 through Figure 13).
One of the challenges that this case presented was shade matching. Tooth No. 7 was a lot higher in value when compared with tooth No. 10, which also had a little more chroma along the midfacial to the cervical aspect. Nonetheless, the same shade of composite that was used to restore tooth No. 8 was able to be used to restore tooth No. 7 and tooth No. 25 as well. The simplified shade system of the chosen composite made it easy to match, saved time, and provided esthetically pleasing results that were also strong enough to reduce the likelihood of fracture in the future, which was reassuring for this case.
Dimple Desai, DDS
Accredited Member
American Academy of Cosmetic Dentistry
Luminous Smiles
Newport Beach, California
