Basics of anterior esthetic

restoration
Bartosz Wróbel

Stomatologia Zachowawcza z Endodoncją

Katedra i Zakład Stomatologii Zachowawczej i Endodoncji
Dual Shade Layering Technique
DSLT

• When using the dual-shade

procedure, missing tooth
structure is restored using two
distinct resin composite
colors.
• For novices who are not
familiar with the idea of
composite layering, it is
typically advised.
DSLT
• To replicate the lost dentin, a darker, more
opaque hue is used. The enamel is then
built up using a more translucent
composite shade.

• But the ability of the doctor to choose the

right composite shade to mimic the
natural tooth layers in form and color is
what makes this possible.
Vanini’s Stratification Technique
VST
VST
Five Dimensions of colour
Monochromatic technique
MT
• As the name suggests, it entails replacing the lost tooth
structure—whether it be dentin and/or enamel—using a single
composite shade.
• Because no single composite shade can accurately mimic the
complex color and optical characteristics seen in a real tooth,
using a monochromatic method frequently results in less than
ideal aesthetic outcomes.
• The patient is therefore very disappointed with the outcome of
the restorative procedure.
Natural
Layering
Concept
NLC

• Didier Dietschi's "natural layering" concept

restores the tooth anatomy by using two
distinct composite masses.
• The idea is predicated on using real teeth as
models and determining the optical
characteristics of authentic dentin and
enamel.
• With L* representing brightness or value, a*
representing hue over the green-red axis, and
b* representing hue over the blue-yellow axis,
it makes use of the "tristimulus L*a*b* color
measurements and contrast ratio."
 • Dietschi recommended using a composite material
with a single color, a single opacity, and a large chroma
(beyond the standard VITA system's four Chroma
levels) in order to mimic dentin.
• As young, mature, and old, he defined three distinct
forms of enamel.
• This description is based on how the contrast ratio and
value L* vary with tooth age, showing that as teeth age,
their enamel becomes less opalescent, more
NLC translucent, and yellower in color.
• lingual enamel is applied first, then the dentin is built
up using a high chromatic shade, and finally the
restoration is finished with a final layer of transparent
enamel.
• Certain tints or effect materials may be employed to
replicate the natural tooth in situations when unique
optical properties, such as regions of hypocalcification
or areas with strong opalescence, are observed in the
tooth.
NLC
Histological
Layering
Technique
 • The method is predicated on the idea of
using a composite material, which is similar
HLT to natural tissues in terms of both color and
opacity, to replace the missing tooth layers.
• A single enamel shade of composite is
chosen and applied if only the enamel layer
needs to be replaced.
• However, two distinct hues are employed for
dentin and enamel restoration, respectively,
with larger and deeper preparations.
• It has been suggested that HLT requires
"minimal artistic skills," meaning that even
novice physicians can provide beautiful
cosmetic effects in a matter of minutes.
 • The HLT principle of restoring only the
missing tissue layer encounters a minor
HLT deviation in the case of direct composite
veneers. Direct composite veneers typically
involve very little dental work or even no
tooth change at all.
• Therefore, it is not actually restoring any
tooth layer. But in this scenario, the dentist
has to construct the translucent enamel
layer with the imitation of the incisal edge's
natural halo effect, as well as the chromatic
dentin layer with the curves and mamelons.
• A lifelike restoration with the best possible
aesthetics would be the outcome.
Polychromatic Layering
Approach
 • It is a sophisticated clinical procedure that
builds up the missing or damaged tooth
substructure using several shades of
composite material.

PLA • By using this approach, the dentist can get

very pleasing and functional results by
having control over both the color and form
of the final restoration.
• The physician has to be well-versed in the
material properties and optical qualities of
both the native tooth and the available
materials in order to perfect this
stratification approach.
• The fact that our natural dentition is likewise
polychromatic—that is, the chroma and
translucency of dentin and enamel change
depending on the location of the tooth—
favors the polychromatic approach.
• Because of this, the procedure recommends
choosing a single dentine shade that is
ideally one shade lighter than the native
tooth in terms of chroma.
PLA
 • Fahl recommended using the following various shades of
composite for a direct composite veneer or a medium-
PLA sized class IV direct composite restoration:
• a shade of dentin having a high chroma and low value
• a body enamel color that is less chroma and more
valuable than dentin.
• An enamel effect shade that is translucent to provide
effects in the incisal third
• A high opacity shade of "milky white semi-translucent
effect enamel" to enhance features and create a halo
effect
• A shade of "value effect enamel" that serves as the
restoration's last exterior layer
• Opaquers are used in conjunction with dentin and
enamel tints to cover up severe discolorations of the
underlying teeth.
PLA
 • A fairly simple yet quite beautiful method known as Style
Italiano is a recent addition to the realm of restorative
and aesthetic dentistry.
• A collection of well-known Italian dentists known as
"style italiano" serve as the technique's promoters.
• The idea, which was really developed by Prof. Angelo
Putignano and Dr. Walter Devoto, attempts to give
medical professionals the know-how and abilities
needed to produce aesthetically pleasing composite
restorations that are "feasible, teachable, and
repeatable."
• The method uses just two masses of 3MTM ESPETM
FiltekTM Supreme XTE Universal Composites to create
multilayer restorations thanks to unique color
formulations.
• As a result, Style Italiano is really just a version of the
dual-shade layering method.
• It declares that just one shade should be used to rebuild
Style Italiano enamel and one to reproduce dentin.
• According to the Style Italiano philosophy, the
morphology and thickness of the composite layers have
just as much bearing on a restoration's aesthetics as
does the number of hues.
• For anterior restorations to have the best possible
aesthetics, an enamel layer thickness of 0.5 mm has
been shown to be desirable.
 Repair of Composite fillings
Bartosz Wróbel

Stomatologia Zachowawcza z Endodoncją

IV rok, kierunek lekarsko-dentystyczny
Katedra i Zakład Stomatologii Zachowawczej i Endodoncji
Benefits of repairing fillings
• Many advantages come from filling repair, including less loss of
healthy tissue, less chance of detrimental effects on the pulp
(such as overheating and oversensitivity linked to the residual
monomer), shorter treatment times and costs, longer lasting
original dental restorations, less pain (and hence less anesthetic
requirement), and a lower risk of iatrogenic damage to the
neighboring tooth.
Contra-indications for repair
Patient reluctance to accept a repair as
an alternative to restoration
replacement;

Irregular attenders;

High caries risk patients;

Presence of caries undermining the

restoration;

History of failure of a previous repair.

5R strategy – a minimally invasive concept
The monitoring of minor defects, where there would
Reviewing
be no clinical advantage to undertaking treatment
The treatment of small defects present in the
Refurbishment restoration which require intervention to prevent
further deterioration
The application of sealant into a non-carious,
Resealing
defective marginal gap
The placement of additional restorative material to
Repair
an existing restoration
The removal and replacement of an entire
Replacement
restoration
Criteria for
repair of
restorations
 • The presence of limited marginal defects does not
necessarily indicate the presence or likelihood of
secondary caries. Many marginal defects in direct
composite resin restorations can be simply
managed using refurbishing procedures, given that
the overcontouring associated with many direct
Localized marginal composites results in chipping and in marginal
overhangs. Such overhanging margins may be
defects and removed using a fine-grit diamond finishing bur. This
will also remove any superficial staining which may
marginal staining have accumulated in the angle of the overhang and
help harmonize the contour of the restoration and
the adjacent tooth surface. The composite resin
surface is subsequently polished using appropriate
composite finishing systems, possibly followed by
the application and photopolymerization of an
unfilled resin which may seal over any marginal
cracking of the composite and enamel and provide
a surface glaze
 Localized marginal defects.
• The best course of action is typically to monitor minor marginal defects on the occlusal surfaces
of posterior composite restorations that are imperceptible to the patient. Intervention should be
postponed until there is evidence of accumulation of plaque or food stagnation, along with the
accompanying discoloration that may lead to secondary caries.

• Because anterior composite restorations are more likely to absorb exogenous stain, particularly
from smokers and heavy users of, say, black coffee, marginal flaws in these restorations provide
a greater risk. Refinishing in conjunction with restoration refurbishment when needed is usually
the best way to deal with this kind of discoloration.
Bulk fracture
Bulk fracture
 • Secondary caries, or cavities that are next to the edge of a com
posite repair, need to be handled as a brand-
new primary lesion.
Preventive treatments should be started, as they should be for
all patients who present with a new lesion. When the lesion is
demonstrated to be active and moving into dentine, or when ca

Secondary
vitation has occurred, surgical intervention should be perform
ed.
Minimal intervention is recommended during operation, along

caries
with partial replacement of the affected composite restoration
component that is compromised by caries or obstructs access
for removing caries and properly placing a repair. If there is no
radiographic or clinical indications of failure, the section of the
composite restoration that is still in situ should be kept there,
unless there is a strong clinical indication that the entire
restoration should be replaced with all of the associated risks.
 • Complete replacement should be
done if there is cause to believe
that leakage has happened along
the tooth/restoration interface of
the restoration portion that is not
Secondary impacted by the secondary caries
lesion. Similarly, total
caries replacement may be
recommended if it is predicted to
be challenging to obtain a good
marginal seal to a repair, which
would prevent the growth of any
residual caries.
Superficial colour
correction
• Sometimes a wrong shade was chosen for a
composite restoration that had already been
installed. Resurfacing the restoration using a
different shade of composite material can help
control a minor shade discrepancy. The same
restorative material should be used as the composite
substrate whenever possible. However, this may not
be feasible if a different dentist placed the
restoration, if the patient's notes do not include
information about the material used, or if the
material that was previously placed is no longer
readily available on the market.
• Before opting to undergo a complete restoration
replacement treatment, it is often possible to try a
color correction.
 • Careful assessment is necessary because
passive eruption, or the tilting of neighboring and
opposing teeth, may have coincided with the
deterioration of composite resin restorations.
Resurfacing the restoration may be the solution if
the restoration's wear is restricted, such as
shallow faceting that is restricted to a portion of
Wear of the the occlusal surface, and there is room to do a
repair. This is usually feasible in cases when the
restoration wear has resulted from a three-body abrasion
that happened during chewing, as opposed to,
say, a parafunctional attrition. If the wear is on a
proximal surface and there isn't enough room to
restore anatomic form, another restorative
strategy would be necessary.
 • Fracture of tooth tissue adjacent to a
composite resin restoration may occur for
various reasons, including:

Fracture of • Inappropriate location of loading;

• Bearing occlusal contacts;
adjacent • Insufficient or unsupported tooth tissue;

tooth tissue • Parafunctional activity;

• Trauma
• Subsequent to damaging polymerization
stresses at the time of restoration placement.
Oxygen inhibition layer

When a bonding or composite resin is polymerized in

air, an uncured layer known as the oxygen inhibition
layer (OIL) is always present. It is sticky and rich in
resin. Because oxygen reacts more strongly with
radicals than monomers do, oxygen in the air during
the light-curing process interferes with the
polymerization reaction. An OIL forms on the
composite's surface as a result of this. The OIL is
sometimes referred to as an unpolymerized (uncured)
layer of resin since its composition is comparable to
that of an uncured resin with consumed or decreased
levels of photoinitiator.
 Clinical process for
repairing composite
restorations
Sandblasting using
silica-coated
particles for
composite repair
 • To maintain moisture isolation, this approach
Composite should be carried out under a rubber dam or
repair based with the careful application of cotton wool
rollers, salivary ejectors, and other tools. The
on following are the clinical steps:
conventional
• After 15 to 30 seconds of acid etching the
adhesive composite resin substrate and the
bonding surrounding tooth tissue preparation
margins, carefully wash and dry the area with
systems a three-in-one syringe. Acid etching not only
creates a good substrate surface for bonding,
but it also has a good cleaning effect.
• As directed by the manufacturer, an adhesive bonding system should be applied to the
preparation margins, neighboring tooth tissues, and the acid-etched composite substrate.
An alternative is to employ a commercially available composite repair system, which comes
with its own adhesive compound that has been specially designed.
• To repair the flaw, an incremental procedure is used to apply a composite resin restorative
material that is compatible with the adhesive bonding system. Each increment is fully photo-
polymerized. Once more, if the practitioner is aware of this information, the same kind and
brand of composite material need to be utilized as the composite substrate.
• After that, the repair is meticulously shaped and completed utilizing modern composite
finishing techniques, enabling the repair to blend seamlessly into the restored tooth unit.
• After that, the occlusion is examined to make sure that the restored restoration won't
experience unfavorable occlusal loading.
Bonding methods
between new and
old tooth filling.
Macromechanical
retention
Micromechanical retention
Another technique that
enhances filling
microretention is
hydrofluoric (HF) or 37%
phosphoric (H3PO4) acid
etching. H3PO4 alone has a
negligible impact on
microretention;
nevertheless, it eliminates
any remaining
contaminants from the
material surface following
sandblasting or roughening.
Moreover, H3PO4 is most
likely to blame for the higher
reactivity between filler
molecules and silane.
But it's important to
Additionally, HF
remember that HF
administered at different
contamination of dentine
doses (3%–9.6%) and action
lowers the resistance
periods (20–120 sec.)
against forces slantwise.
demonstrated efficacy in
Contamination of tooth
the creation of
tissues is generally
microretention. The primary
unavoidable because filling
filler in composite
repairs are typically made
materials, SiO2, is affected
on the tooth/filling
by the acid by rupturing its
boundary. Application of HF
Si-O bonds.
is therefore not advised.
 • The use of silanes in the composite filling
repair procedure is currently considered
controversial. Due to the relatively low
proportion of inorganic molecules on the
surface of the prepared filling, no
Silane significant improvement in adhesion is
achieved. Some authors do not
recommend its use due to the risk of
contamination of the dentin surface,
which will reduce the adhesion.
Chemical bonding
• Self-etching bonding agents have been shown to be
effective for composite repairs.Six Tensile strength from
these repairs, when carried out on samples, is
equivalent to that of the homogenous material block
without repairs.23
• The self-etching bonding systems' chemical contact
with the healed composite is linked to acidic
monomers, which combine with non-organic composite
components to generate a homogenous structure
between the bonding agent and the repaired composite.
Time matters
• The amount of unsaturated double bonds decreases with the age
of the composite, reducing the adhesive potential of the organic
matrix of that composite even if after polymerization there is a free
monomer in the composite (required to initiate bonding with the
new material).
• When the repair is done quickly after the initial damage (and on
"fresh" composite) , it works better.