Composite resin is a very tricky restoration that needs a lot of practice and expertise. It's a continuous learning process. Today I'll share a few procedures I have learnt while restoring anterior teeth. Yes, it a small drop of a huge ocean and there's a lot more learning and practice for me to do..... let this be the first milestone of a really long way to go!!
STEP 1: Preoperative evaluation.
We often undermine the importance of working models and preoperative record. An impromptu treatment is often a recipe for disaster. Understanding the tooth angulation, emergence profile and tooth shade often help us to determine the type of restoration required and the armamentarium needed.
STEP 2: Isolation
longevity of any restoration depends mainly on how well we maintain the isolation. Rubber dam isolation might be frustrating. But, it's a lot better than your patient returning back with a failed restoration.
STEP 3: Tooth preparation
The tooth preparation should be done to roughen the surface to enhance adhesion. And the second purpose is to have a good transition from tooth to the restorative surface without making it evident. A wavy bevel gives good optical properties. The amount of roughened surface should be almost equal to the amount of surface to be restored.
STEP 4: Transfer of details from the mock up.
use of a putty index helps to transfer the details. if the mock up was not done layering the palatal shelf by layering with finger support and mylar strip can help to have a good base to start layering.
STEP 5: Layering
the dentin is more opaque and has different optical properties. Using a dentin shade helps to replicate the tooth shade. the bulk of dentin is slightly more than the actual dentin. this helps to mask the interface of tooth and restoration. We can also replicate the variations in the insical edge by creating mameleon like effect. Translucent shade adjacent to the mamelons help to exaggerate their appearance. Later a thin layer of enamel shade gives uniformity to the tooth.
STEP 6: Finishing
it starts with removing the excess restoration and tracing the line angles. this gives a good morphology of the tooth. We can further improve the appearance with secondary and tertiary anatomic features.
STEP 7: Polishing
polishing the restoration not only helps to improve the appearance but also reduces plaque retention. The use of polishing paste helps to enhance the lustre of the tooth.
Postoperative care is equally important to enhance the longevity of a restoration. It is important to educate the patient regarding postoperative care.
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