Aesthetic anterior composite restorations: a guide to direct placement

The color-matching ability of single-shade universal composites in extracted human teeth

OBJECTIVES

To evaluate the color-match with extracted natural teeth of three single-shade universal composites, a group-shade universal composite, and a highly translucent-shade conventional composite.

METHODS

Twenty extracted human teeth were divided into light- and dark-shade groups (n = 10, LSG and DSG). A preparation was restored with the 3 single-shade universal composites, OMNICHROMA (OMC), Admira Fusion x-tra U (AFU), and Essentia U (ESU); a highly translucent-shade conventional composite, Tetric EvoCeram T (TEC-T); and two shades of a group-shade universal composite-Filtek Universal Restorative (FUR A1 and A4). Composites were photopolymerized, polished, and stored in water for 24 h. The ΔE00 value between the unprepared and restored surfaces was obtained using a spectrophotometer. Composite placement and measurements were repeated three times per tooth. Color differences were statistically analyzed with the within-between-subjects t-test and repeated-measures analysis of variance (ANOVA), followed by post hoc pairwise comparisons with a Bonferroni adjustment (α = 0.05).

RESULTS

There were no statistically significant differences between OMC and FUR (A1 and A4). AFU and ESU showed significantly higher ΔE00 values than OMC and TEC-T (p < 0.05). Single-shade composites exhibited significantly higher ΔE00 values in the DSG than in the LSG except ESU (p < 0.05). None of the composites satisfied the criteria for an acceptable match (ΔE00 >1.8).

CONCLUSION

OMC showed the same color matching ability as a group-shade universal composite. A highly translucent-shade conventional composite and OMC exhibited better color matching ability than other single-shade composites. Overall, single-shade universal composites performed better in lighter-shaded teeth.

CLINICAL SIGNIFICANCE

Single-shade universal composites have the potential to reduce chair time by eliminating shade selection in cavities with lighter-shade teeth. Highly translucent incisal conventional composites also may be used if the appropriate shade of composite is not available.

The Effect of Usage of Antiasthmatic Inhalers on Color Stability and Surface Roughness of Dental Restorative Materials: An In Vitro Study

OBJECTIVES

 Increased demand for esthetics by parents and children has resulted in the use of tooth-colored restorative materials. Children with chronic respiratory conditions like asthma use inhalers which have shown to affect the surface of restorative materials. Hence, the aim of the present study was to evaluate the effect of antiasthmatic inhalers on color stability and surface roughness of three restorative materials.

MATERIALS AND METHODS

 Forty samples each of three dental restorative materials: group A: glass ionomer cement (GIC), group B: alkasite restorative material, and group C: composite resins were prepared. Each group was further divided into two subgroups of 20 samples each according to the inhaler used. All the specimens were polished using polishing discs and stored in artificial saliva in order to simulate the oral environment. The baseline color value and surface roughness of all the samples were measured using a spectrophotometer and a profilometer, respectively. Group 1 and group 2 were exposed to 0.31 mg of salbutamol sulfate and 20 mg formoterol fumarate in combination with budesonide, respectively, for every 12 hours, for a period of 15 days following which the samples were evaluated for color changes and surface roughness.

STATISTICAL ANALYSIS

 The data obtained was subjected to statistical analysis and level of significance was set at p < 0.05.

RESULTS

 Exposure to both the inhalers caused a change in color and surface roughness in all three restorative materials. There was a significant change in the color of GIC and composite resin (ΔE > 3.3), following exposure to both the inhalers (p < 0.05). The change in color of alkasite restorative material was not significant. A significant increase in the surface roughness of composite resin from 0.56 ± 0.14 to 0.67 ± 0.19 was seen following 15 days' exposure to formoterol in combination with budesonide inhaler (p < 0.05).

CONCLUSION

 Following exposure, both the inhalers had an equal effect on color and surface roughness of all three restorative materials. Alkasite restorative material showed greater resistance to change in color and surface roughness when exposed to antiasthmatic inhalers, compared to GIC and composite resin. Thus, children who use inhalers and nebulizers should be advised to implement more precautionary oral hygiene measures and periodic dental visits.

Anterior Matrix Systems for Composite Restorations: A Review

In the field of restorative dentistry, composite resins have emerged as the most utilized materials. They revolutionized the cosmetic approach to anterior tooth treatment since their introduction to dental practice. In cases where one or more of the tooth's walls are absent, matrices are employed to assist in the creation of the proper anatomic contour and proximal contacts without the occurrence of gingival overhangs. Matrices come in a variety of designs suitable for various therapeutic conditions. Depending on the level of tooth destruction, they might range from a simple metal or plastic strip to a circumferential ring of metal surrounding the entire crown. Although the handling characteristics of modern composites have significantly improved, dentists still encounter challenges with the development of good interproximal contact and proper anatomical contour. The utilization of an anterior matrix system can be paramount in achieving these objectives.

The Effect of Various Polishing Systems on the Surface Roughness of Two Resin Composites—An In Vitro Study

The long-term success of a composite restoration largely depends on its smoothness, which can be achieved by the appropriate polishing tools and material selection. The purpose of this study was to evaluate the surface roughness of two composite materials after the application of selected polishing systems. Filtek Ultimate (FU) and Filtek Z250 (FZ) were tested. Forty specimens of each material were prepared. After polymerization under a Mylar strip, the surface roughness of five samples from each group was measured. Subsequently, all specimens were ground by 600 grit sandpaper. The surface roughness of five samples per group was tested again. The samples from each group were randomly assigned to eight subgroups, and polished by Sof-Lex, Sof-Lex Diamond Polishing System, Super Snap, One Gloss, Astrobrush, Stainbuster, Enamel Shiny, and Jiffy Polishing System. The collected data were analyzed using the Shapiro–Wilk and Kruskal–Wallis tests. The lowest Ra coefficient after polishing is found in the Super Snap groups (FU—0.077 μm, FZ—0.085 μm). The lowest Rlr coefficient is measured in the Enamel Shiny group for FU (1.000), and for Sof-Lex, Sof-Lex Diamond Polishing System, and Jiffy Polishing Kit for FZ (1.001), and only slightly higher for Super Snap (FU—1.001, FZ—1.002). The roughest-measured surface is in the One Gloss group for FU (Ra—0.657 µm, Rlr—1.009), and Astrobrush group for FZ (Ra—0.525 μm, Rlr—0.011). Additionally, it was not confirmed that the nanoparticle material (FU) demonstrates better results than the microhybrid one (FZ). Different polishing systems produce varying surface roughness. The most effective polishing system is Super Snap. The structure of composites does not significantly affect their surface roughness after polishing.

Comparative evaluation of compressive strength and flexural strength of GC Gold Hybrid, GIC conventional and resin-modified glass-ionomer cement

Purpose:

The aim of the study was to emphasize the compressive strength and flexural strength of glass-ionomer cement (GIC)–gold hybrid, conventional GIC, and resin-modified GIC (RMGIC).

Methodology:

Three GIC materials were used in the study: group A: GC–gold hybrid (Gold Label hybrid Universal Restorative), group B: type II conventional GIC, and group C: RMGIC. A total of 120 cylindrical test specimens of dimensions 4 mm diameter × 6 mm height were prepared from a custom-made Teflon mold according to respective study groups. The specimens prepared were then stored in 20 mL of deionized water at 37°C for 3 h daily for 30 days, and the solutions were changed every week, after which they were tested for compressive strength and flexural strength by using a universal force testing machine. All the results were analyzed by SPSS software and were subjected to statistical analysis using ANOVA followed by the Bonferroni post-hoc test.

Results:

The mean compressive strength was the highest for group A and lowest for group B. Similarly, the mean flexural strength was the highest for group A and lowest for group B.

Conclusion:

The conclusions can be drawn from this in-vitro study that the compressive strength and flexural strength of GC–gold hybrid were greater than those of RMGIC and conventional GIC.

Esthetic Dentistry on Twitter: Benefits and Dangers

Objectives

The demand for esthetic dentistry is growing, and social media constitute the main driving force behind this revolution. Twitter is a leading social media platform; however, there is a lack of research on the pattern of communications and the impact of Twitter on esthetic dentistry. The purpose of this study was to analyze the content of tweets related to esthetic dentistry and to investigate how Twitter has affected the perception of, and demand for, esthetic dentistry. Moreover, it aimed to assess the potential benefits and risks of esthetic dentistry advertising strategies on Twitter as a potential social media platform.

Materials and Methods

Using a specialized web scrapping tool made available by the Python programming language, a total of 54,000 public tweets were downloaded from Twitter at real-time by matching specific keywords. The downloaded tweets were manually filtered, and 13,787 tweets were included and categorized into four tweet sets by content.

Results

The main categories were tweets regarding specific cosmetic procedure, totaling 56.53% (43.2% for veneers, 13.3% for whitening), advertisements (36.72%), information (5.53%), and general cosmetic dentistry (1.22%). Negative opinions towards veneers and whitening were the most common themes (68.03% and 43.44%). For veneers, illegal use for kids was the most common negative theme (59.7%) and being destructive for whitening (86.3%). Positive opinions counted 6.26% of veneers and 4.3% of whitening tweets. Advertising for whitening products was the second most common between all tweets (16.6%), and advertising for dental practices was the third (14.7%). Presenting facilities/services was the most common marketing strategy for dental practices (49.7%). Twitter was weakly used to circulate educational content (5.5%) and to post reviews (0.75%).

Conclusion

Twitter was extensively used to share experiences/opinions towards dental cosmetic interventions. Advertising is another vital use of this platform. However, circulating information was the least common use of this social media. Additionally, tweeters were rarely to post online reviews and specific advices and recommendations regarding esthetic dentistry. Moreover, females tended to participate and tweet more significantly in cosmetic-related topics than males. This platform should be tailored efficiently to target users' priorities and to improve health literacy and self-care. Twitter was weakly used to circulate educational content according to this study and rarely used to share online reviews.

Color Match of Composite Resin and Remaining Tooth Structure over a Period of 28 Days Using Spectrophotometer-A Randomized Clinical Trial

OBJECTIVES

The tooth and the composite restoration can undergo a change in color after the restorative procedure over time. The purpose of this randomized clinical trial was to evaluate the color difference (ΔE) of two types of composite resins and remaining tooth structure over a period of 28 days.

METHODS AND MATERIALS

A total of 40 teeth in 30 patients with Class IV caries or EllisClass II fracture in maxillary incisors were randomized into two groups based on the type of composite resin used for restoration: IPS Empress (n=20 teeth) and Filtek Z250 (n=20 teeth). Shade selection was done using a spectrophotometer. Restorations were performed using an anatomical layering technique, and finishing and polishing was done after 48 hours. Baseline spectrophotometer color values for the remaining tooth structure were measured before isolation and for composite restorations, 10 minutes after light cure. Further color evaluations using a spectrophotometer for the remaining tooth structure and composite restorations were done at 48 hours (both before and immediately after finishing and polishing), 7days, 14 days, and 28 days, and color difference (ΔE) from baseline values for remaining tooth structure and restorations and ΔE between remaining tooth structure and restorations were calculated. Descriptive statistics including mean, standard deviation, and frequencies were computed. Mann-Whitney U test was done to compare spectrophotometer values.

RESULTS

There was a significant reduction in mean color difference (ΔE) from baseline values for both tooth (p<0.05) and composite restoration (p<0.05) at all evaluation periods in both groups. Filtek Z250 showed significantly lower mean ΔE between the tooth and the composite resin restoration than IPS Empress at 48 hours (before and after finishing and polishing), 7 days and 14 days (p<0.05). At the 28 day recall, mean ΔE value of IPS Empress restorations to tooth structure was 3.5, while the mean ΔE value of Filtek Z250 restorations to tooth structure was 3.6, which was not statistically different (p>0.05).

CONCLUSION

The remaining tooth structure as well as the composite restorations showed color changes at all evaluation periods, compared to baseline values in both the composite resin groups. Filtek Z250 exhibited less ΔE with remaining tooth structure at 48 hours, 7 days, and 14 days, when compared to IPS Empress. The composite restorations of both the groups reached clinically acceptable color match (mean ΔE<3.7) with the remaining tooth structure 28 days after the procedure.

Influence of different thermopolymerization methods on composite resin microhardness

Background

Additional heat polymerization in composite resins allows greater effective­ness of microhardness, flexural strength, fracture tough­ness, wear resistance, and increased color stability.

Material and Methods

150 composite resin specimens were made using a 4 mm diameter and 2 mm thick bipartite steel matrix. Five resins composed of different compositions were tested (Brilliant Everglow/Coltene, Filtek One BulkFill/3M, Filtek P60/3M, Filtek Z350XT/3M, Filtek Z250XT/3M), and for each of them three types of polymerization were tested: light curing only (n=50); photopolymerization + autoclave thermopolymerization (n=50) and photopolymerization + microwave thermopolymerization (n=50). Each specimen was submitted to three indentations by means of the Vickers microhardness test, applying a load of 300gf, associated with the time of 15s. Data were analyzed descriptively by means of statistics, standard deviation and coefficient of variation and inferentially by the F test (ANOVA) in the comparison between groups. The margin of error used in statistical test decisions was 5%.

Results

The highest vicker microhardness averages were from the Control group (light curing only) on P60 (82.16) and Z250 XT (79.61) resins. The lowest averages were all verified on Brilliant Everglow resin in all polymerization methods studied: Photopolymerization (37.32), with microwave (43.80) and autoclave (45.12), followed by Bulk Fill 3M resin, ranged from 52.23 to 59.15.

Conclusions

Both autoclave and microwave thermopolymerization methods showed similar behavior on the microhardness of the composites studied. Considering the resin type, there was a varied behavior compared to thermopolymerization, which increased the microhardness values for Brilliant Everglow resins (Coltene) and Filtek One Bulkfill (3M) and decreased for Filtek P60, Filtek Z350XT and Filtek Z250XT resins.

Key words:Dentistry, composite resins, polymerization.

CAD/CAM: Applications for transitional bonding to restore occlusal vertical dimension

OBJECTIVE

Explore the best technique for achieving stable and comfortable occlusion. This is critical for long-term oral health and the foundation of durable esthetic, restorative, periodontal, and prosthodontic treatments.

CLINICAL CONSIDERATIONS

Various techniques and therapies have been proposed for establishing, determining, and restoring ideal centric relation (CR) and vertical dimension of occlusion (VDO) in patients who require restorations and/or full-mouth rehabilitation. An interim prosthesis phase can help establish and stabilize an enhanced esthetics and/or functional outcome for a limited period of time before the definitive dental restorations are placed. Transitional direct composite bonding and its additive nature have provided clinicians and patients with advantages when establishing a physiologic CR and VDO in interim restorations. However, it is time consuming, tedious, and challenging chairside. The author has been using additive CAD/CAM designed and milled restorations for over 10 years to make transitional bonding more efficient, manageable, and predictable.

CONCLUSION

Transitional bonded prostheses are significantly important to providing patients with an interim therapy to determine if the proposed esthetic outcome and occlusal scheme will function as expected, or if adjustments are needed prior to the delivery of the definitive long-term restorations. CR and VDO are essential for establishing a functional and healthy occlusion, ideal restoration proportions and smile design, and treatment planning esthetic and prosthodontic restorations for long-term durability.

CLINICAL SIGNIFICANCE

This article reviews CR, VDO, and the characteristics of a CAD/CAM transitional bonding technique in reversing the signs and symptoms of a compromised dentition and reestablishing an ideal esthetic and functional occlusal outcome. Transitional bonded prostheses are significantly important to providing patients with an interim therapy to determine if the proposed esthetic outcome and occlusal scheme will function as expected, or if adjustments are needed prior to the delivery of the definitive long term restorations.

Clinical applications of polytetrafluoroethylene (PTFE) tape in restorative dentistry

Restorative dental procedures are ever developing; one reason for this can be attributed to newer materials with better handling properties and our ability to manipulate them more effectively. As a result various techniques have been described to aid clinicians in obtaining predictable results in restorative dental procedures. This article aims to review the use of plumber's tape to assist in adhesive, endodontic and implant related dental procedures, when compared to other available materials.

Flexural Strength of Glass Carbomer Cement and Conventional Glass Ionomer Cement Stored in Different Storage Media over Time

OBJECTIVES

Glass ionomer cement (GIC) is routinely placed as a restorative material in dentistry. However, due to its poor physical properties, its use is limited to cases where the level of stress on restoration is minimal. Improved formulations of GIC have been developed to overcome these drawbacks. The purpose of this study was to evaluate flexural strength of a conventional GIC (Fuji IX) against a newly developed glass carbomer cement (GCP).

MATERIALS AND METHODS

For Fuji IX and GCP, a total of 80 blocks were prepared and divided into 16 groups (n = 5). These groups were further categorized according to the storage medium (artificial saliva and Vaseline) and time intervals (24 h and 1, 2, and 4 weeks). A 3-point bending test was carried out, and statistical analysis was done using ANOVA and Tukey post hoc tests.

RESULTS

Fuji IX showed a mean flexural strength of 25.14 ± 13.02 versus 24.27 ± 12.57 MPa for GCP. There was no significant statistical difference between both materials when compared under storage media. Both materials showed the highest value for flexural strength at 2 weeks of storage and lowest at 4 weeks.

CONCLUSION

The storage media do not affect the flexural strength of the specimens with reference to time. Time is the unique factor with relative influence on mean resistance to fracture. Further testing is required to evaluate the true potential of the newly developed GCP.

Evaluation of the surface hardness, roughness, gloss and color of composites after different finishing/polishing treatments and thermocycling using a multitechnique approach

The objectives of this study were to evaluate the mechanical and physical properties of resin composites. The materials evaluated were the Clearfil Majesty Posterior, Filtek Z550 and G-aenial Posterior composites. A total of 189 specimens were fabricated for microhardness, roughness, gloss and color tests. The specimens were divided into three finishing and polishing systems: Enhance, OneGloss and Sof-Lex Spiral. Microhardness, roughness, gloss and color were measured after 24 h and after 10,000 thermocycles. Two samples from each group were evaluated using SEM and AFM. G-aenial Posterior exhibited the lowest microhardness values. The mean roughness ranged from 0.37 to 0.61 µm. The smoothest surfaces were obtained with Sof-Lex Spiral for each material. G-aenial Posterior with Enhance was determined to be the glossiest surfaces. All of the materials exhibited similar ΔE values ranging between 1.69 and 2.75. Sof-Lex Spiral discs could be used successfully to polish composites.

Modified putty index matrix technique with mylar strip and a new classification for selecting the type of matrix in anterior proximal/incisal composite restorations

Matrix technique described in this article combines the advantages of both flexible and rigid matrix in anterior composite restorations. Using mylar strip provide advantages, of one utilizing the mylar strip for contouring the labial aspect of restoration thereby, and overcomes the problem in adapting the teflon tape around the tooth.

Direct composite resin layering techniques for creating lifelike CAD/CAM-fabricated composite resin veneers and crowns

Direct composite resin layering techniques preserve sound tooth structure and improve function and esthetics. However, intraoral placement techniques present challenges involving isolation, contamination, individual patient characteristics, and the predictability of restorative outcomes. Computer-aided design and computer-aided manufacturing (CAD/CAM) restorations enable dentists to better handle these variables and provide durable restorations in an efficient and timely manner; however, milled restorations may appear monochromatic and lack proper esthetic characteristics. For these reasons, an uncomplicated composite resin layering restoration technique can be used to combine the benefits of minimally invasive direct restorations and the ease and precision of indirect CAD/CAM restorations. Because most dentists are familiar with and skilled at composite resin layering, the use of such a technique can provide predictable and highly esthetic results. This article describes the layered composite resin restoration technique.

The management of anterior tooth wear using gold palatal veneers in canine guidance

Localised anterior tooth wear can be managed using minimally invasive techniques with conservation of tooth structure and preservation of pulp vitality. This article describes and illustrates with two clinical cases, the management of localised tooth wear, with the restoration of canine guidance by a combination of gold palatal veneers and direct composite restorations.

Aesthetic composite veneers for an adult patient with amelogenesis imperfecta: a case report

This case has been presented as part of the continual assessment requirement for the MSc in Aesthetic Dentistry, King's College Dental Institute. Amelogenesis imperfecta (AI) is a hereditary disorder of enamel formation, affecting both the permanent and deciduous dentitions. It can be classified into hypoplastic, hypomaturation and hypocalcified types and presents with different hereditary patterns. The aim of this article is to provide an overview of amelogenesis imperfecta, including a detailed case report for an aesthetically concerned adult patient presenting in general practice with a Witkop's Type IA defect managed with the placement of direct, layered resin composite veneers.

CLINICAL RELEVANCE

Amelogenesis imperfecta patients are susceptible to the restorative cycle of replacement restorations like any other patient, but start with a distinct disadvantage.This case report demonstrates a minimally invasive, relatively simple and cost-effective option for the aesthetic correction of a case of hypoplastic amelogenesis imperfecta with layered composite veneers. Dent Update 2011; 38:594-603

Morphologic texture characterization allied to cigarette smoke increase pigmentation in composite resin restorations

STATEMENT OF THE PROBLEM

The staining effect of tobacco smoke on resin color is clinically observed. However, there is no evidence determining whether this staining is increased on texturized surfaces or if the color change is superficial and can be removed by repolishing procedures.

OBJECTIVE

To evaluate the effect of tobacco smoke on the color of a composite with smooth or texturized surfaces, before and after repolishing.

MATERIALS AND METHODS

Forty composite specimens were allocated into four groups (N = 10): Smooth surface not exposed (G1) and exposed to tobacco smoke (G2), texturized surface not exposed (G3), and exposed to tobacco smoke (G4). During 21 days, G2 and G4 were daily exposed to the smoke from 20 cigarettes. Color measurements were carried out at baseline, after 21 days, and after repolishing. Variables L* (luminosity), b* (blue-yellow), and DeltaE (total color change) were statistically analyzed (repeated measures analysis of variance/Tukey).

RESULTS

Texturized and smooth specimens presented similar luminosity at baseline. Tobacco smoke significantly reduced L* in G2 and G4, and increased b* in G4. After repolishing, L* increased and b* reduced in stained groups, but values continued to be different from baseline ones. Repolishing significantly reduced DeltaE, but values from stained groups were still greater than that from unstained groups.

CONCLUSION

Tobacco smoke changes the color of composite, and surface texture can increase the staining. Repolishing reduces superficial staining, but this procedure may not return the composite to baseline color.

CLINICAL RELEVANCE

Smokers that will receive anterior composite restorations should be warned about the negative cosmetic effect of the smoking habit on the color of restorations.