The Esthetic Anterior Restoration


Dental News Volume XIX, Number III, September, 2012

by Dr. Mayada Jemâa, Dr. Neila Zokkar, Dr. Amine Jenhani, Dr. Lotfi Bhouri, Dr. Sonia Zouiten, Dr. Nabiha Douki, Dr. MS Belkhir





Today, the demand for esthetic restorations is increasing. Thus, the use of composite resins is clearly growing. It is therefore our duty to perform high quality restorations that combine science, art and technology of high performance. [3]
 The increasing demands of patients in terms of aesthetics and the character of micro-invasive restorative materials placed directly restoration of anterior teeth at the heart of current concerns.
A thorough knowledge of color characteristics of natural teeth and restorative materials combined with a careful analysis of operative techniques and the sequence of stratification allow the clinician to obtain highly functional, aesthetic and predictable results. [8]
The composite resins have reached a high degree of excellence and are now utilized with predictable results in restoring the anterior dentition. (Fahl N Jr and al, 1995)
In our work, we are going to present 3 clinical cases of anterior stratification with composite resin Opallis® (FGM) that we have treated in our service of conservative dentistry.

Key Words:  Esthetic, stratification, composite, opallis ®


Introduction

Direct bonding is one of the most commonly used forms of restoration for the conservative esthetic improvement of anterior teeth. [6,8]
Recent developments in adhesive technologies, the design of composite resin materials,
and contemporary placement techniques have revolutionized the delivery of
minimally invasive direct restorations. Indeed, the aesthetic demands of patients for the restoration of the anterior teeth have prompted the doctors to see the tooth in a one complex: a smile and gingival and its components through the development of clinical procedures and techniques for restoration.
The stratification technique of composite resin shades is the most appropriate way to achieve a final restoration with a very natural appearance (Kose and Dourado Loguercio, 2009) 
Manufacturers have sought to improve more and more biomechanical and optical properties of composite resins. The evolution of composite resins is based on the dimensions of the charges. Turn, have appeared the macrofilled, the microfilled, hybrid and currently nanohybrids composite resins. [8]
Opallis is a microhybrid composite resin indicated for direct restoration of anterior and posterior teeth. It provides a complex and perfect balance between the masses of dentin and enamel as they have different levels of translucency and opacity (Sanzio Marques, 2009).
Two optical phenomena are indispensable: opalescence* and fluorescence**, the composite resin Opallis presents these features as well as many other advantages (Sanzio Marques, 2009).
The mechanical and physical-chemical properties of this composite guarantee stability and longevity for anterior and posterior restorations. Opallis restorations match the patients’ smiles gathering esthetic, functionality, longevity and patient’s satisfaction (Walter Dasch and al, 2009)
*Fluorescence: an optical property of a material capable of absorbing ultraviolet light ( non visible to the naked eye) and emitting light in a visible wavelength in response ( white and blue). Therefore, when irradiated by ultraviolet light, fluorescent bodies increase their brightness and opacity (Walters and al, 2009).
*Opalescence: a material property related to the capacity of an object to present a bluish color when observed under direct light and look reddish orange when observed under indirect light (Walters and al, 2009).


Objectives

- To present the stratification technique with composite resin Opallis ®

- Acknowledge the contribution of the composite resin in terms of better esthetic results, smoothing surface, saving time and easy manipulation.


Clinical case1

Age: 21 years
Reason for consultation: restoration of the 31 with an abnormal structure
Therapeutic decision: restoration of 31 by stratification technique with the resin composite Opallis ®



Fig1: Initial clinical view

Fig 2: Shade selection and elimination of the colored structure and the tooth was prepared for Placement of composite resin Opallis  

Fig3: Final aspect of the restoration after the stratification procedure 



Clinical case 2

Age: 17 years
Reason for consultation: restoration of the 11, 12 and 21 traumatized since 1 month
Therapeutic decision: restoration of the 11, 12 and 21 which are vital with stratification by composite resin: Opallis ®



Fig 4: Preoperative Facial view showing the fractured maxillary right and left central incisors and  the maxillary right lateral


Fig5: Palatal view


Fig6:  Plaster model and mock-up (after shade selection)


Fig7: Elaboration of silicone guide


Fig8: Adjustment of the silicone guide (verification of the adaptation and the retention) It helps in construction of the palatal enamel    


Fig9: Elaboration of the palatal enamel (A1 opallis®)



Then  elaboration of the incisal opaque halo with Opallis A1 enamel, the composite resin A2 dentin was employed to reconstruct the area corresponding to dentin, translucent enamel placed between dentinal mamelons and the layering of the restoration was finished with composite resin A1 enamel 


Fig10: Final aspect of the restoration after complete mimicry of the esthetic natural characteristics of the teeth    



Clinical case 3

Age: 23 years 
Reason for consultation: restoration of the 11 fractured
Therapeutic decision: restoration of 11 (vital) by stratification technique with the resin composite Opallis ®  



Fig 11: Initial aspect (the tooth is vital)

Fig12: The field was first isolated with a rubber dam after shade selection


Fig 13: A 0.5-mm scalloped bevel was placed with a long-tapered diamond
Fig 14: After the preparation of the surface 

Fig15: Acid etching with 37% phosphoric acid (30 seconds on enamel, 15 seconds on dentin)    


Fig 16: After (adhesive was applied to the cavity surfaces with an applicator tip and air dried, palatal enamel was constructed with composite resin Opallis  A1 , the incisal opaque halo with Opallis A2 dentin, Dentin reconstruction with increments of Opallis A1 Dentin,  enamel was placed( in marginal ridges and the last increment) with Opallis A1.


Fig17: Adjustment of the incisal edge morphology finishing procedure with abrasive disks to impart a high luster while maintaining the existing texture and surface anatomy

Fig18    


Fig19


Fig20 (18, 19): Superficial polishing with diamond past (Excel diamond ®) applied with felt disks


Fig 21: Occlusal adjustment of the restoration.


Fig22


Fig23 (22): Premature occlusal contacts should be removed


Fig 24: Postoperative appearance reflects the harmonious integration of composite resin with natural tooth structure.



Discussion

These cases presentations demonstrate restoration fractured incisors taking aesthetic consideration of the anatomic variations of the adjacent teeth to produce a direct composite resin in harmony with the surrounding dentition.
The major challenges is selecting the composite that have an adequate strength as well as provide lifelike optical properties that render the restoration functionally sound and esthetically pleasing. [6]
The results we have obtained in the three clinical cases, make us  reconsider this type of restoration with composite resin Opallis ®  quite satisfactory with an optimal esthetic  results (Surface, polishability, wear resistance..).
Therefore, we can integrate these restorations as aesthetic solutions to long term durability since opallis composite, under wet conditions, reached the highest fatigue limit values. [1]
Of course, provided they are carried out in good conditions and combined with regular annual clinical inspections.
To optimize the physical and optical characteristics of the natural tooth, Ardu S and al (2006) proposed the combination of microfilled composite with a microhybrid composite and the biomimetic composite restoration could be an interesting alternative to ceramics, minimizing invasiveness, chair time, and costs for patients.
To attend a functionally successful and esthetic natural appearing direct composite restoration, the clinician must have a comprehensive knowledge of adhesive dentistry, including the properties of composite resins, proper tooth preparation techniques, and an understanding of the primary and secondary optical properties of the natural tooth and their relationship to anatomical morphology. [8]


Conclusion

As contemporary modes of treatment continue to evolve, manufacturers and scientists are leading the way with new advances in restorative materials and adhesive technology. These techniques and concepts from clinicians, scientists, and technicians around the world are the spark that ignites the reaction. Nevertheless, it is the clinical experience and judgment that is the true catalyst of the reaction that creates form, function, aesthetics, longevity and more predictable options for direct treatment protocols.

The provision of high-quality restorative dentistry depends upon the dentist: ( Peter Jacobsen)

- Making an accurate diagnosis
- Devising a comprehensive and realistic treatment plan
- Executing the treatment plan to a high technical standard
- Providing subsequent continuing care  


References

1/ Walter Dasch, Ulrich Lohbauer, Andrea Wagner, Johannes Ebert,R.Frankenberger, Matthias Pelka, Lisa Scheuermeyer,Gudrun Amberger, Girit Stein, Martina Rödel, Herbert Brönner
Composite for anterior and posterior teeth. What expect from Opallis: Esthetic results, optimal balance of properties special shades, 4 degrees of translucency
Magazine FGM News- Edition 2- October 2009

2/ Carlos Kose, Alessadro Dourado Loguercio
Composite resin layering in anterior teeth- clinical case report
Magazine FGM News- Edition 2- October 2009

3/ Sanzio Marques
Mimicking the nature with opallis composite
Magazine FGM News- Edition 2- October 2009

4/ Peter Jacobsen
Restaurative dentistry: An integrated approach
Second Edition 2008

Protocol for predictable restoration of anterior teeth with composite resins.
Pract Periodontics Aesthet Dent. 1995 Oct;7(8):13-21; quiz 22.

6/ Fahl N Jr.

Achieving ultimate anterior esthetics with a new microhybrid composite.

Compend Contin Educ Dent Suppl. 2000;(26):4-13; quiz 26.


7/ Ardu S, Krejci I.

Biomimetic direct composite stratification technique for the restoration of anterior teeth.

Quintessence Int. 2006 Mar;37(3):167-74.


8/  Maud Conti

La stratification des résines composites sur dents antérieures

Thèse de doctorat en Médecine dentaire, 2010

Université Henri Poincare- Nancy1

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