Using opaquers under direct composite resin veneers: an illustrated review of the technique

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.

Masking Ability of the Combined Application of Opaquers and Resin Composite on Discolored Backgrounds

The aim of this study was to evaluate the masking ability of a combined application of opaquers and resin composite over discolored backgrounds: A3, A3.5, C2, C3, and C4. The groups were divided according to the opaquer brand, the number of opaquer coats (one or two), and the thickness of the resin composite layer (0.5 or 1.0 mm). The color measurements were made by a reflectance spectrophotometer (SP60, EX-Rite). The color difference between the opaquer + resin composite + background and a reference background was calculated using the CIEDE2000 formula. ANOVA and Tukey's post hoc test (α=0.05) were used to analyze the ΔE00 mean values. A bivariate analysis was used to determine the association between dependent and independent variables. The masking ability was rated by the ΔE00 visual thresholds of acceptability and perceptibility (Excellent Match: ΔE00 ≤ 0.8; Acceptable Match: 0.8 < ΔE00 ≤1.8; Moderately Unacceptable Mismatch: 1.8 < ΔE00 ≤ 3.6; Clearly Unacceptable Mismatch: 3.6 < ΔE00 ≤ 5.4; Extremely Unacceptable Mismatch: ΔE00 > 5.4). The mean ΔE00 values ranged from 0.5 to 5.52. Masking ability was affected by the opaquer brand, thickness of the resin composite layer, and background shades. Most of the combinations that achieved either excellent or acceptable masking ability were obtained with combinations composed of one or two coats of opaquer and a 1.0-mm-thick resin composite layer for all backgrounds except C4. Acceptable results were also obtained for combinations with 0.5-mm-thick resin composite over C2, A3, and A3.5 backgrounds.

Direct Composite Resin Veneers in Nonvital Teeth: A Still Viable Alternative to Mask Dark Substrates

Direct composite resin veneers are a practical esthetic restorative treatment for reestablishing the shape and color of affected anterior teeth. The present clinical case reports aim to describe restorative treatment techniques for nonvital anterior teeth presenting color alteration. The direct composite resin layering technique has proven to be an efficient method for recovering the esthetics of darkened teeth. The direct vs indirect restorative treatments are debated as well. Clinical follow-ups of the presented case reports demonstrate that direct composite resin restorations are not affected by the darkened tooth substrate over time.

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.

Management of the single discoloured tooth. Part 2: Restorative options

This is the second article of a two part series covering the aetiology, prevention and broad range of management options for the single discoloured tooth. The article covers situations where masking and simulation techniques with direct composite are required. Direct composite, indirect composite and ceramic veneers are then considered, as well as full coverage crowns. The option of extraction of the affected tooth and its prosthodontic replacement will also be considered. Clinical cases are used to illustrate various scenarios.

CLINICAL RELEVANCE

The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and it is recommended that general dental practitioners consider adopting minimally invasive techniques in the first instance before moving on to more invasive therapies.

Direct esthetic restorations based on translucency and opacity of composite resins

Light dynamics is a relevant phenomenon with respect to esthetic restorations, as incorrect analysis of the optical behavior of natural dentition may lead to potential clinical failures. The nature of incident light plays a major role in determining the amount of light transmission or reflection, and how an object is perceived depends on the nature of the light source. Natural teeth demonstrate translucency, opalescence, and fluorescence, all of which must be replicated by restorative materials in order to achieve clinical success. Translucency is the intermediary between complete opacity and complete transparency, making its analysis highly subjective. In nature, the translucency of dental enamel varies from tooth to tooth, and from individual to individual. Therefore, four important factors must be considered when appraising translucency. Presence or absence of color, thickness of the enamel, degree of translucency, and surface texture are essential components when determining translucency. State-of-the-art resin composites provide varying shades and opacities that deliver a more faithful reproduction of the chromaticity and translucency/opacity of enamel and dentin. This enables the attainment of individualized and customized composite restorations. The objective of this article is to provide a review of the phenomena of translucency and opacity in the natural dentition and composite resins, under the scope of optics, and to describe how to implement these concepts in the clinical setting.

CLINICAL SIGNIFICANCE

Choosing composite resins, based on optical properties alone, in order to mimic the properties of natural tooth structures, does not necessarily provide a satisfactory esthetic outcome. In many instances, failure ensues from incorrect analysis of the optical behaviors of the natural dentition as well as the improper use of restorative materials. Therefore, it is necessary to implement a technique that enables a restorative material to be utilized to its full potential to correctly replicate the natural teeth.

Clinical strategies for success in proximoincisal composite restorations. Part II: Composite application technique

Reproducing the form, function, and optical characteristics of natural dental structures with direct composites in large and moderately large proximoincisal (Class IV) restorations represents a great challenge for clinicians in general. Understanding color is fundamental to achieving success when restoring these defects, as was discussed in Part I of this two-part article (Volume, 16, Number 6). The proper restoration of the functional lingual contour is also a challenge that cannot be overcome without close attention to the restorative technique. In this second article, the composite application technique is discussed and presented in detail. Clinical photographs illustrate the proposed technique.

CLINICAL SIGNIFICANCE

The proposed clinical protocol, including a try-in of the shades in a mock-up restoration to more accurately define color and shape, and a silicone guide to transfer the lingual and proximoincisal contour of the mock-up to the final restoration, is of great help to successfully restore proximoincisal defects.

Clinical Strategies for Success in Proximoincisal Composite Restorations. Part I: Understanding Color and Composite Selection

The restoration of proximoincisal (Class IV) defects with direct resin-based composites requires attention to many technical and artistic details. This article is the first of a series of two articles that aim at presenting clinical strategies for optimal success when direct resin-based composites are used for the restoration of moderate or large proximoincisal defects. Concepts of natural anatomy, color as it relates to dental structures, and composite selection are discussed in this article and are illustrated with a preclinical exercise and two clinical cases in which these concepts are applied.