Resolving Facial Decalcification with a Nanohybrid Composite
Achieve conservative, esthetic, life-like restorations even in the anterior
Composite materials are increasingly being used to restore teeth in the esthetic zone in a predictable and minimally invasive way. The increased use of composites for highly esthetic cases can be attributed largely to the enhanced optical and physical properties they now demonstrate. Among the classifications of direct composites are macrofills, microfills, and nanohybrids.1-3
Nanohybrids and nanofilled direct composites are the most recently introduced direct restorative materials. Nanohybrid composites contain diversely sized nanometer particles and fillers.3-5 Previous generations of direct composites, the macrofills, demonstrated limitations in polish sustainability and strength. As a result, their use was often limited to certain areas. Nanohybrids demonstrate characteristics and properties—including high strength, low wear, and excellent polishability—that make them appropriate for indications throughout the mouth.
One such nanohybrid composite is IPS Empress® Direct (Ivoclar Vivadent, www.ivoclarvivadent.com). This light-curing material demonstrates ideal handling properties that enable dentists to consistently achieve anterior esthetics comparable with ceramics. Because the composite is used directly, however, practitioners can facilitate change immediately.
Further contributing to the on-demand nature of this nanohybrid composite is the manner in which it is formulated. Restorations created using the IPS Empress Direct demonstrate gloss retention akin to that of a microfill or nanofill, but they also exhibit the high strength and a modulus of elasticity that are ideal for posterior indications.
To achieve the esthetics required for restorations in the anterior, the composite is available in a broad range of dentin and enamel shades, as well as in different translucencies and opacities. The material also is considerably less sensitive to light than other composite materials, allowing adequate time for sculpting the ideal restorative anatomy.
Case Presentation
A 24-year-old man who had worn braces during high school presented with classic facial cervical decalcification caused by poor oral hygiene during orthodontic therapy (Figure 1). A few spots ultimately broke through into the dentin, requiring restoration.
Following a complete oral examination, it was decided to remove the remainder of the decalcification, which would prevent the development of any future high-risk areas on the teeth with decay, which included No. 7, No. 10, and No. 11. As the patient indicated that he was not bothered from an esthetic perspective by the white spots on his other front teeth, treatment focused only on these affected teeth.
Clinical Protocol
The appropriate shades of direct composite were then selected for use in a stratification technique. The IPS Empress Direct Dentin shade guide was used to select the ideal shade of dentin composite for the restoration (Figure 2). Then, the IPS Empress Direct translucent shades were assessed (Figure 3). Finally, the IPS Empress Direct enamel shade was selected using the shade guide (Figure 4).
Given the nature of the lesions, the decay was removed and the affected teeth prepared without the need for anesthetic, which was particularly pleasing to the patient. Overall, the treatment would be conservative and yield esthetically pleasing results as an alternative to veneers (Figure 5).
The preparations were etched wtih 37% phosphoric acid (Total Etch, Ivoclar Vivadent) (Figure 6), rinsed, and air-dried. The bonding agent (ExciTE® F, Ivoclar Vivadent) was applied to the preparations using a VivaPen (www.vivapen.com) (Figure 7) and light cured for 10 seconds using a Bluephase Style (Ivoclar Vivadent) LED curing light.
The dentin shade A1 IPS Empress Direct composite was placed (Figure 8). This dentin composite layer was then smoothed with a sable brush (Figure 9) and light cured for 10 seconds.
The enamel composite in shade A1 was then applied (Figure 10), after which it was contoured and smoothed with a sable brush (Figure 11). This layer also was light cured for 10 seconds.
Finishing and polishing were completed on the IPS Empress Direct composite restorations using rubber points, cups, and disks (Astropol® Finishing and Polishing System, Ivoclar Vivadent). When the definitive restorations were complete, the patient was pleased with the esthetic, functional, and minimally invasive results (Figure 12).
Conclusion
In the case presented here, the use of a nanohybrid direct composite (IPS Empress Direct) allowed the dentist to create conservative, esthetic, and life-like restorations that enhanced the patient’s smile. This demonstrates the manner in which today’s nanohyrbid composites, including IPS Empress Direct, enable dentists to mimic natural tooth structure and achieve undetectable treatments, even in the anterior.
References
1. Minguez N, Ellacuria J, Soler JI, et al. Advances in the history of composite resins . J Hist Dent. 2003;51(3):103-105.
2. Sensi LG, Strassler HE, Webley W. Direct composite resins . Inside Dentistry. 2007;3(7):76.
3. LeSage BP. Aesthetic anterior composite restorations: a guide to direct placement . Dent Clin North Am. 2007;51(2):359-378.
4. Yesil ZD, Alapati S, Johnston W, Seghi RR. Evaluation of the wear resistance of new nanocomposite resin restorative materials . J Prosthet Dent. 2008;99(6):435-443.
5. Hervás-García A, Martínez-Lozano MA, Cabanes-Vila J. Composite resins. A review of the materials and clinical indications . Med Oral Patol Oral Cir Bucal. 2006;11(2):E215-220.
About the Author
Kevin Brown, DDS
Private Practice
Bellevue, Washington
