3 - anterior composite restorations

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What do anterior composite restoration materials need to create?

Esthetic anatomy
Characterization
Hue
Value
Chroma
Position
Form
Function
Direction
Texture

What is used to classify composite resins?

Filler size

What are the filler size classification of composite resins?

Microfilled
Hybrids
Nanofilled

What do the fillers in composite resins determine?

The mechanical properties

What do the fillers in composite resins allow for?

Reduction of the amount of resin matrix and, consequently, the polymerization shrinkage

What happens when filler loading in composite resins is increased?

Optimizes translucency and opalescence while simultaneously enhancing the esthetic and handling properties

What do filler arrangement and distribution within the resin matrix affect?

Light scattering and gloss retention

What is the relationship with filler size of composite resin and optical scattering?

Indirect - smaller filler size translates to more efficient optical scattering

What particles are in nanofilled composite resins?

100nm or below particles of silica, zirconia and other organic fillers

Which composite resin class is used at SBU SDM due to its superior polishing ability and gloss retention?

Nanofilled = Filtek Supreme in enamel, body, and dentin shades

What promotes characterization and allows us to mimic optical properties in anterior composite restorations?

Composite staining kits to help correct fluorosis, incisal edge blue for youthful appearance, incisal edge gray for more mature look, incisal edge lavender or purple-ish for elderly, increase saturation dark brown for pits/fissures and craze lines, white

What color appearance comes along with reflected light?

Blueish

What color appearance comes along with transmitted light?

Reddish-orange

What is a disadvantage to the typical composite spatula?

Too thick, so cannot get into embrasures well enough for esthetic restorations

What are the gold, blue, and green instruments used for with respect to anterior composite restorations?

Gold = incisal area
Blue = carving
Gingival area (class v lesions benefit from this instrument = green

What needs to be addressed before esthetics?

Disease
Function

If incisal wear is localized, what is the probable cause?

Parafunctional habit like nail biting since patient is probably targeting that specific area repeatedly over time

Why is it important to evaluate the patient's habits and normal function?

This will reveal occlusal problems such as abrasion, nutritional problems, erosion, or bruxism

Once wear is evaluated and the cause is identified, what is the next step?

Treatment possibilities AND precautions are planned
PATIENT EDUCATION IS KEY

How can patients avoid wear in the future or at least minimize the threat of repetition?

Provider needs to evaluate what has happened to the individual's teeth, and to the opposing dentition, to ensure that a better profile, shape, and position can be created for those teeth

What are the indications for anterior composite restorations?

Correcting diastema
Masking discolored or stained teeth (i.e. fluorosis, white spots)
Correcting maligned or malformed teeth (i.e. peg laterals)
Trauma - chipped or fractured teeth
Tooth wear (i.e. attrition, abrasion, erosion)

What are the contraindications for anterior composite restorations?

Limited incisal clearance
Gross loss of tooth structure where composite would not be strong enough

What are the advantages of direct composite veneers vs. porcelain veneers?

Conservative/Noninvasive
Temporary/Reversible
Immediate results
No lab expense
Cost - less expensive

What are the disadvantages of direct composite veneers vs. porcelain veneers?

Can stain, chip, and lose luster
Technique sensitive (need to use rubber dam!)
Rely on dentist
More maintenance

What should the provider keep in mind when treatment planning anterior composite restorations?

Are you confident free-handing? If not, consider veneer
How high are the patient's esthetic demands? If unrealistic, consider veneer
Are you planning a full mouth rehabilitation? If yes, consider veneer

What characteristics need to be thoughtfully analyzed to achieve a a natural esthetic outcome?

Translucency
Value
Chroma

What needs to be considered to mimic natural tooth appearance?

4 main variations of translucency
Chromaticity and brightness among enamel and dentin

What are the steps in the anterior composite layering technique? (Examples in slideshow where this applies include fracture on central incisor and diastema closure)

Layering technique
First of all, make a diagnostic waxup on a cast use that to form a putty starting on the lingual and extending to the buccal surface. If the putty is too thin, it will be flimsy. If the putty is too thick, it may not fit in the patient'

What are the steps to finish and polish anterior composite restorations?

Remove the rubber dam and check the occlusion by having the patient tap their teeth together and go through protrusive and lateral movements. Finish the lingual surface with fine burs. Finish the proximal surface with strips going in an S shape starting w