Page 34 - DP Vol 19 No 2 HR_Neat

cosmetic section

COMPOSiTES TO LiGHT UP A SMiLE!

Sanah Sayed

“You are just one decision away from a
completely different life”

I have always believed that there is a strong connection between
Mental and Dental.
Stable Mental health and Sound Body Awareness are the main
reasons why patients exhibit a discipline in maintenance of oral
hygiene. Stress and diet are the major contributing factors why
most young patients report with high caries index and cracked/
fractured teeth these days.
Here my patient is a 24 year old young male who has been
bravely battling Cancer for most of his life and this year he is
finally Cancer – Free. As he begins his new journey, a brand new Fig 1: Smile makeover with composites
smile and confidence awaits and he has started taking baby steps
to live a normal life.
MATERiAL SCiENCE
Refractive index variation and Glass effect are the major reasons
why composites should be layered and in most anterior cases
(except Class III with an intact palatal wall) it is indicated to
layer different opacities and chromaticity to prevent a non-vital
looking restoration because currently no composite is able to
maintain translucency without losing value.
Teeth are unique and possess varying degrees of translucency
and poly chromia thus making understanding of opacities and Fig 2: Young male patient with multiple decays looking for a quick
value crucial for mimicking natural teeth for a dental professional. fix before he flies out
Our eyes are extremely sensitive to Value since rods outnumber
cones however the eyes cannot record color but can appreciate the
brightness or dullness of a restoration.
Enamel shades provide translucency essential to mimic enamel
but lose value when layered in the thickness equivalent to enamel.
Hence layering creates an underlying opaque or chromatic base
over which the enamel can create varying degrees of translucency.
Translucency is most appreciated in the Incisal third and Chroma
is appreciated in the middle one third area bringing us to the next
step of Shade selection.

SHAdE SELECTiON
It is important to select the shade in the beginning of the
appointment since teeth start dehydrating in just 3 minutes and are Fig 3: Occlusion needs to be addressed but he plans to work on it
most dehydrated at 45 minutes. This can give a false impression of once he’s back
a tooth that is “brighter” than actual. When the tooth rehydrates
back in 24-48 hours the restoration is not a perfect shade match
making the margin obvious and unsightly.
The technique to choose shade described here is the
Composite button technique. Though Composites are calibrated
to a Vita shade guide, it would be wrong to think that A2 from
two different companies would be identical. The discrepancy of
chroma (saturation) is pretty evident when working with different
commercially available products.
This technique involves placing small increments (buttons)
on the surface of the tooth without etching and bonding. The
increment is then cured and photographed to arrive at the closest Fig 4: Multiple areas of decay and demineralization
34 Dental Practice i March-April 2023 i Vol 19 No 2