Direct composite restoration of anterior teeth is a popular and minimally invasive procedure that is gaining traction in the dental field. Dentists often turn to social media for information on techniques and materials used in these restorations. However, there are challenges in understanding which composites to use, how to layer them, and how to achieve optimal results in terms of blending and masking.
One common application of direct composite restoration is repairing Class IV fractures and adding incisal length to anterior teeth. A major mistake that dentists make is having a show-through of the incisal edge against the more translucent composite. This occurs when a single-shade composite system is used, as it lacks color and cannot mask a hard line by itself. To address this issue, a supplementary composite must be used in conjunction with the single-shade composite.
There are two key principles to consider when creating a direct composite restoration that blends and masks properly. First, the tooth preparation should include an inciso-facial bevel to allow for feathering of the composite onto the facial surface. Second, the single-shade composite system should be applied in conjunction with a supplementary composite that has more opacity. The single-shade composite functions as the enamel with translucency, while the supplementary composite functions as the dentin with opacity.
In a case report, examples are provided to illustrate common errors and the proper use of composites in direct anterior composite restorations. It is important to avoid placing too much of the single-shade composite, as it can result in show-through and an unsatisfactory result. On the other hand, if the supplementary composite is applied too thickly, the restoration will appear opaque and reflective.
Proper layering of the composites is crucial. The supplementary composite should be placed as a palatal shelf, keeping it back against the palatal aspect of the incisal edge and avoiding overlap onto the facial surface. The thickness of the shelf should be kept to 0.5 mm or less. Once the shelf is properly layered, the single-shade composite can be placed and sculpted to the final contour.
In a clinical case, a modified layering technique was used to achieve maximum aesthetics with a single-shade composite system. The old restorations on teeth Nos. 8 and 9 were replaced using a 45° infinity bevel and air abrasion. The palatal shelf was created with a thin layer of the single-shade composite, followed by sculpting of the supplementary composite to replicate the dentin layer. The final layer of the single-shade composite was placed using a Mylar strip to shape the facial embrasures. The restorations were shaped and polished to achieve a seamless blend with the surrounding dentition.
Overall, direct composite restoration of anterior teeth requires careful consideration of the layering technique and the use of appropriate composites. When done correctly, these restorations can achieve excellent aesthetic results.