Alter the Esthetic Appearance of Incisal Thirds in 6 Steps

Solving Esthetic Dilemmas for Provisional Restorations: Part 2

Patients will accept provisional restorations that appear slightly too bright, but rarely will they accept one too low in value or which appears gray. If the provisional is too low in value or too translucent, surface colorants will not be effective in increasing the brightness.

Assume you can never stain (characterize) a low value restoration to make it higher in value. Applying white stain is the only option, but on the surface, the outcome is generally unacceptable.

Follow these steps to increase the value or decrease the translucency in the incisal third.

1. Hollow grind the incisal third from the lingual surface. Use carbide burs (my suggestion is Brasseler H390E 016 and H139EF 023).

2. Air abrade the surface with 50-micron aluminum oxide at 20-40 PSI at a distance of 1.0 cm.

3. Clean the surface with an air-water spray or in an ultrasonic using water.

4. Apply two coats for dental adhesive, light curing only the first application. I use 3M Single Bond Plus or Ivoclar-Vivadent Adhese Universal.

5. Place an opaque high-value composite resin into the depression that has been created. In this case, Tokuyama Estelite Omega Bleach 1 was used. Light cure.

6. Polish the surface with the pink rubber polisher (Brasseler RW PPP) or similar.

Following this protocol can significantly alter the esthetic appearance in the incisal third of provisional restorations, whether they are pontics or abutments.

If you choose a composite that has color as well as being opacified, you can shift the shade of the provisional as well.

(Click this link to read more dentistry articles by Dr. Bob Winter.)

Bob Winter, D.D.S., Spear Faculty and Contributing Author