Van_Putten_Composite_Surface_Slideshow_8.2017A Cost-Effective Repair of a Mesial Incisal Fracture By Clifford Van Putten, DDS
Key Words: gloss, polish, fluorosis, nanocomposite,
AACD Accreditation Case Type IV
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About the patient:
INTRODUCTION
Preoperative smile showing a fractured right central incisor.
This slideshow underlines the importance of manipulating the final surface gloss in a restoration the same way a clinician controls other factors such as materials, layering, surface texture, anatomic form, translucency, and color.
Enamel and dentin were both lost. Surface scarring due to orthodontic etched attachment removal was noted. The decision was made to recreate anatomical features similar to the adjacent central incisor in the new composite restoration rather than to polish off the surface morphology.
Diagnosis and Treatment Plan
The fracture of the mesial incisal included approximately 20% of the vital right central incisor.
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A sample selection of composite dentin and enamel shades and modifiers was applied to the central incisor and cured to develop a plan for material selection, position, and thicknesses.
Treatment
Color map of the planned three-dimensional composite placement. (Illustration by Stephanie Milanowski, Grand Rapids, MI)
A nanohybrid composite was used because the universal enamels are achromatic and vary only in value. Optical properties of dental composites have been improved by using nanoparticles in the space previously occupied only by resin.
Optical improvements have sacrificed neither mechanical strength nor wear resistance. Because individual nanoparticles are smaller than the wavelength of visible light, nano- composites made from these particles exhibit extremely high translucency.
Composite Selection
Diamond-polished Filtek Supreme XT (3M ESPE; St. Paul, MN) at 3000x magnification; note the surface scratches and sheared-off filler and nanoparticles. (Image reprinted with permission of Dr. Tatsuo Endo; Sendai, Japan)
Success of the final restoration depended upon these elements:
• Depth and the intensity of chroma • 3D position of the white decalcification spots • Degree of transparency • Overall value
Subsequent layers were built up, coated with a glycerin gel and then cured. Coating eliminates the oxygen-inhibited layer and produces maximum surface hardness.
Preparation and Layering
Tooth #8 was prepared and etched, and adhesive was applied and light- cured. The first layer of composite was very thin and extended to the incisal edge.
The lingual surface was contoured and shaped. Interproximal contouring and final polishing were completed. The incisal edge and embrasures were adjusted for protrusive and excursive movements.
Contouring and Polishing
The patient was instructed in home care and scheduled to return for final finishing and polishing.
Mimicking the surface texture proved to be a challenge that necessitated multiple trials in vitro. A duplicate tooth was fabricated in the laboratory, utilizing the same materials and shades used on the patient.
Trial runs were conducted to create the highest surface polish based upon the parameter of gloss while maintaining secondary anatomy (gloss is the property that indicates how well a surface reflects light in a specular [i.e., mirror-like] direction).
Discussion
A high level of gloss was achieved with diamond paste in the laboratory’s practice tooth with secondary anatomy.
…sculpting artificial materials to mimic the absorption and the glossy reflection of light
from natural teeth is an art. ” “
In the trial run, a high gloss surface texture was achieved to a roughness of approximately .2 µ. Tertiary anatomy needed to be developed by cutting shallow furrows on highlights and deeper furrows on concavities. Polishing paste was reapplied at a slow speed until surface polish was developed.
Tertiary anatomy added with coarse diamond and polished.
The same sequence was repeated with the patient, pausing frequently to evaluate the amount of surface texture and gloss.
The preoperative fracture, 1:1 view. The postoperative restoration with polished secondary anatomy.
The final restoration with tertiary anatomy added.
Developing and maintaining gloss (i.e., specular highlights) is possible with the reduction of interstitial spacing by the addition of nanoparticles. Nanoparticles in dental composites allow for more surface gloss and enamel translucency than is needed for some clinical situations.
Summary
Preoperative and postoperative 1:2 retracted views.
Rather than always polishing the restoration to be as shiny as possible, less gloss may be desired, as it was for this case. Decisions regarding these variables add to the deliberative nature of esthetic composite placement.
Preoperative and postoperative full-face views.
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Dr. Van Putten maintains a private practice in Hudsonville, Michigan. He is an inventor and dental patent holder.
Disclosure: The author did not report any disclosures.
This slideshow is an excerpt from the original article published in the Journal of Cosmetic Dentistry (jCD) titled, Controlling Composite Surface Texture: Cost-Effective Repair of a Mesial Incisal Fracture. The jCD is an exclusive member benefit of the American Academy of Cosmetic Dentistry.
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