Being Brilliant at the Basics: Blocking Out the Ugly From Your Restorations

Being a Spear dentist means taking pride in your dentistry - the front teeth AND the back ones. It means ensuring that you’re taking great impressions, providing the highest level of care to your patients and that your restorations don’t look ugly.

You replace an old leaky amalgam and your final restoration looks hazy. Or you close the access to a PFM after endo and now there is a terrible grey area in the middle of their crown. Or you close the access to a screw retained implant and now there’s a beastly spot in the middle of the patient's $4,000 implant. 

I’m not suggesting that you spend hours layering your posterior composites with dentin and enamel shades. I’m merely suggesting that you take 45 extra seconds to make sure your restoration doesn’t look ugly. Read on if you’re ready to block out the ugly like a boss and make your posterior restorations exceptional.

The basics of restorations

Most of the composite that we use for posterior restorations is a little bit translucent. This is great, because it means the light can travel through the material and the restoration will be cured more thoroughly. A bulk-fill composite will be even more translucent than a body shade, because the curing light has to travel even further. Since your composite is translucent, it’s allowing the underlying color to show through. This is great if there’s beautiful dentin under there, but when you’re trying to hide stain and metal, it looks grey.

Covering an amalgam stain like a boss

You remove an amalgam and you're left with a dark stain.

1. Etch, prime and bond as usual.
2. Instead of going straight to your composite, place a thin layer of opaque over the stain and light cure. I love Estelite Omega’s Light Chroma Opaque.
3. Place your composite like normal. Voila!

Closing an endo access like a boss 

Whether you are working with a PFM or an all-porcelain crown, you’ll typically get a grey tint to your restoration. With a PFM, you’re seeing the metal show through. With an all porcelain crown, you’re seeing the depth of the big black hole.

1. Once you’ve cleaned out the access, micro-etch and etch the porcelain.
2. Silanate, etch and bond as usual.
3. Place a dual cure build-up material (I like fuji II LC) up until the last 2 mm.
4. Use a dentin-shaded composite to fill the final 2mm of the restoration. I usually use Filtek Supreme's A2 Dentin because it blends with most porcelain and is the most opaque dentin shade on the market.

FAQ

“Why wouldn’t you just use the dentin shaded composite for the whole thing?”

If you put composite all the way down there, you can’t be sure that the light was able to reach that deep. The dual cure material for the depth of the restoration ensures that the whole restoration is cured. 

“Why wouldn't you use the opaquer to block out the walls like with an amalgam stain?”

The opaquer is very flowable and I find it difficult to handle when blocking out that many walls.

Covering a screw-retained implant access like a boss

1. Seat and torque your implant restoration. The porcelain around the access should already be treated by your laboratory so you don’t need to micro-etch.
2. Place Teflon (i.e. Plumber’s Tape) over the implant screw head. The Teflon should be packed in tightly but leave 2mm for your final composite layer. 
3. Bond the porcelain and place your dentin composite. Teflon is easy to handle and doesn’t leave behind the fibers like cotton does. It’s also very white and opaque so it doubles as somewhat of an opaque layer.

Your patient will probably not see these restorations, so why should you care? Because you’re a Spear dentist and you take pride in your work, that’s why. When you see your restoration every six months, you and your team will be proud. And if you can rock a posterior composite, then you’re one step closer to rocking an anterior. 

Dawn Wehking, D.D.S., M.A.G.D., Spear Visiting Faculty and Contributing Author

www.DentistLafayette.com