Develop a Restoration That Blends With Tooth Structure

In this article, I'd like to discuss a layering technique to help you develop a restoration that blends in with the surrounding tooth structure. Now that you have your lingual and interproximal walls developed, it is now like doing a facial resin, which is a lot easier to manage clinically. First, to help clarify things, some resin systems have labeled their different resins using dentin, opaque and enamel to help the clinician with the various opacities of their materials.

So for the purpose of this article, I'll describe the thought process and different opacities used to help develop the final restoration. This should allow you to use your current resin system, no matter what the labels are. Some systems also use tints and opaquers as well that serve to help alter the final restoration.

To begin with, I usually add my dentin shade or a denser, opaque color right along the area of the 45-degree bevel and bring this down into the area of what I have already created (Fig.1). The purpose of this is to help "hide" the seam in your restoration and break up the light. Often, when you can see your finish line of your restoration, it is because this area of the restoration has not been "disguised" well enough in the beginning. Ideally, when this layer is completed, you should not be able to see the original fracture line or area where your restoration meets the tooth.

I will then add a dentin shade or one that is of medium opacity. Remember, dentin is usually darker and more opaque and enamel tends to be lighter and less opaque and almost clear in some cases (Fig. 2, 3). I will use this shade to help develop the "body" of the restoration. The basis of how much and how thick, dentin lobe development, incisal edge opacity development and characterization is very individualized. It is important to look closely at the contralateral tooth to help develop this layer, as some teeth have a lot of incisal translucency and some don't; some also have dentin lobes shining through.

Right before the final enamel layer is placed, I will add incisal halo effects and white spots to help mimic any characteristics present. It's also important to look at the restoration using a mirror from the incisal edge from time to time to help you develop each layer as well as the final layer to keep you from creating a layer that is too thick and will alter your final restoration when you complete your polishing. The final layer is an enamel shade to allow the underlying layers that you have developed shine through.

Personally I will often use a microfill enamel shade due to its ability to be polished to an enamel-like shine and studies show that it will be retained for years. I will take the enamel shade and cover the entire restoration and drag it up onto the natural tooth and pat it into place until I have created a uniform layer. I will take an anterior composite instrument to develop some of the gross surface textures and I will take a brush using unfilled resin to smooth out the surface.

Then I remove excess and polish the restoration (Fig. 4). You can also use the same technique to add to insical edges that are being added to or restored (Fig. 5, 6).

Jeff Lineberry DDS, Visiting Faculty, Spear Education [ www.jefflineberrydds.com ]