It can be challenging to create a visually-pleasing anterior composite restoration. The anterior teeth are, essentially, the ones you see when you smile. For obvious reasons, people want perfectly-crafted replacements. To be successful, the clinician needs to understand proper shade selection and must be able to accurately replicate the natural luster of a tooth and the correct tooth shape. This understanding is particularly important when restoring a single front tooth, which are seen more than back teeth. The very latest direct composite systems can be particularly effective, enabling a skilled dentist to create a restoration that will blend in with the patient’s natural teeth. The basic principle behind creating an anterior composite restoration is to replace dentin, the hard material that makes up most of the tooth, with dentin-like materials. They must also replace enamel with enamel-like materials. Often adding a few extra steps to your technique will help produce a far superior result, meeting a patient’s expectations.
Choosing the Correct Materials
Currently, there is a comprehensive choice of composite materials available, and most have a range of color and visual options to choose from. Materials to replace dentin are generally made with a higher filler particle size, providing additional strength, less shrinkage, and a firmer consistency. These materials also closely mimic the color and opacity of dentin. Materials to replicate enamel are generally less opaque and are made from fine filler particles, providing good wear characteristics and a more natural luster once polished. These materials are not as strong as those used to replace dentin and often shrink faster.
Preparing the Tooth
The tooth must be thoroughly cleaned to ensure it is free from stains, exterior film, or any plaque. Cleaning between the teeth should be completed using an “interproximal” strip, not floss. Floss would not be sufficient to guarantee a good bond. Once the tooth is cleaned, the appropriate shade can be chosen. This should be done before the tooth dries out because a dryer tooth will appear lighter than its real shade. Once the dentin shade is chosen, a complimentary enamel shade should be selected. Your choice of dentin and enamel can be verified by placing a tiny portion of each material onto the surface and light-curing it. It is important to examine the adjacent teeth to assess their translucency. Make a mental note of the tooth’s contours, its texture, and outward-facing surface. A dentist can also make notes on a photograph or drawing, as this will help when fabricating the contours of the restoration.
Generally, it’s recommended that a long bevel is created from the fractured area to the intact enamel surface because this exposes the enamel rods and improves bonding. Creating a knife-edged bevel makes it easier to achieve a good color transition zone between the tooth and the restoration. Another key factor is good tissue management, as it is essential to make sure the tooth surface isn’t stained by any fluids or bleeding. If staining is a possibility then a retraction cord should be used and must remain in place during the procedure; it should only be removed before the restoration is finally polished. It may also be useful to use a rubber dam to protect the restoration from fluids, blood, and saliva. Once the tooth has been prepared it can be acid-etched and dried. Usually, a bonding agent is applied to the exposed dentin to help increase the strength of the bond.
Using the “Inside-Out” Technique
With this particular technique, the clinician first creates a sub-layer of dentin followed by a layer of enamel. Building a thin lingual shelf helps create a good edge on which to create the dentinal lobes, which can then be used to accurately place the appropriate amount of translucency in between the lobes. Once this is in place, the outward-facing enamel shade can be applied. The shape of the restoration is adjusted to ensure the forms are closely duplicated before being polished.
When completed properly, a patient is left with a bright, vibrant, untarnished smile!
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