Page 18 - NYSAGD GP Fall 2018

“Composite Button Try:” A Novel Technique for Shade Matching

By Arthur R. Volker, DDS, MSEd, FAGD
Serhat Kokens, DDS, PhD Candidate (University of Siena)

The robustness of modern comprehensive photographs should be judiciously studied. ways. First, it was converted to grayscale
direct composite resin systems allows the If possible, a large screen should be utilized as a means to evaluate the value or enamel
clinician to create life-like restorations that for easier assessment. shade (Figure 4). Also, a cross-polarized
can seamlessly mimic nature. The ability to
do so lies in the dentist’s ability to properly Essentially, the technique uses 0.5mm in-
combine color, shape, and translucency / crements of composite “balls” placed on an
opacity. Often, while the shape of the res- adjacent tooth and cured (Figure 1), then
toration may be accurate, a discrepancy in photographed and analyzed. Typically,
color can lead to dissatisfaction for both the dentin shades are placed along the cervical,
dentist and patient. and enamel shades towards the incisal. It is
imperative that the balls are placed quick-
There are numerous methods with which
to evaluate the proper color and translu- Figure 4. Greyscale view of Figure 3 to
cencies / opacities of the composite resto- help assess value and composite selection.
ration. While there are value-based guides
and digital shade matching modalities photo was taken for further assessment 8
available, traditional chroma-based shade (Figure 5).
tabs are often employed to shade match.
These guides are often fabricated from Figure 1. Oblique view of composite buttons
acrylic, not resin. Matching the optical placed on tooth for shade assessment.
properties of dissimilar materials can be ly, and the teeth are kept hydrated. If not,
challenging, and it has been shown that the the tooth will dehydrate, and the color will
shades of composite do not always match change, often becoming lighter and chalk-
those found on classic shade guides. 1 ier in appearance. This can negatively im-
pact shade selection. 7
In an effort to remedy this situation, custom
shade tabs have been suggested. To ac- Case Report
2
complish this, uniform composite masses The patient, a 40-year-old male in good Figure 5. Photo taken with a cross-polarized
of composite resin are cured and polished, general health, presented with a fractured filter to further assess composite selection.
then affixed to a tab. While this is an ef- incisal edge of tooth #8 due to trauma (Fig- Once the appropriate shades were deter-
fective method, the technique can be dif- ure 2). To best determine the needed com- mined, an intra-oral mock-up was per-
ficult to manage if multiple manufactures formed with composite to determine the
or composite classifications (ie microfilled, morphology and occlusion of the incisal
nanohybrid) are found in a clinic or prac- edge, then the edge was indexed using
tice. A more simple and direct, but no less PVS. The teeth were isolated via rubber
effective method, can be to employ the dam and the index was tried in in to assure
“Composite Button Try” technique. accuracy (Figure 6). Using a football di-

To understand how to best implement this
technique, an understanding of the optical Figure 2. Pre-op frontal view. Patient fractured
properties of enamel and dentin need to be the incisal edge of #8.
explored. Dentin tends to be more opaque
and saturated in color compared to enamel. posite masses, composite balls of varying
Enamel tends to be more translucent and shades were placed on the adjacent cen-
gray compared to dentin. Properly combin- tral, and a photograph was taken (Figure Figure 6. PVS stent with mock-up and
ing the best properties of both will result in 3). To best assess the needed composite rubber dam in place.
the desired outcome. 3,4,5,6 shades, the photograph was processed two
amond, #8 was prepared via a long facial
To mimic nature, we should first observe bevel (Figure 7). The mock-up was subse-
the existing tooth structures. The neigh-
boring tooth should be photographically
examined and the incisal third, in partic-
ular, should be analyzed, as it is the most
variable in terms of translucency / opacity
due, in part to the interplay of light between
the layers of dentin and enamel. As such,
Figure 3. Placement of composite Figure 7. Preparation of long facial bevel
www.nysagd.org l Fall 2018 l GP 18 buttons on tooth. to help mask composite tooth interface.