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Composite resin layering: An esthetic technique for restoring fractured anterior teeth
fractured M. Zalkind, The Hebrew
ite resin layering: anterior teeth
An esthetic
DiVID,a and I. Heling, DMD, MSb University-Hadassah School of Dental
Medicine,
Basic tooth color depends on the color of the dentin and the amount of light reflected, absorbed, and transmitted by the enamel.1,2 Attempts to restore the natural anterior teeth with composites, therefore, are based on morphologic, optic, and biologic tooth properties.3 Composite resin materials offer a wide range of possibilities of shade and technique for tooth restoration.* Several shades of composites should be used for restoring fractured anterior teeth and those with extensive caries in the dentin and enamel. This report suggests a simple method of layering composites for restoring extensive loss of dentin and enamel in anterior teeth.
technique
Jerusalem,
for
restoring
Israel
7. Apply a bonding of the enamel and dentin. 8. Create a composite core simulating the original anatomy of the dentin, matching its shade, and including the indentations at the incisal edge. The composite is light-cured at this stage (See Fig. 2, B). 9. Apply a second layer of composite that matches the enamel in shade over the first layer and shape and light-cure it (Fig. 2, C). The number of layers depends on the amount of tooth structure to be restored and the degree of esthetic similarity to the adjacent teeth. 10. Finish the built-up tooth and polish it using conventional methods.
PROCEDURE A composite core, matching the dentin in color, is secured to the exposed surface to implicate the dentin. Another composite matching the color of the tooth enamel is layered onto the core (Fig. 1). The steps of the procedure are as follows: 1. Clean the tooth to be restored (Fig. 2, A) with fluoridefree pumice. 2. Select shades of composites to match the dentin and enamel. 3. Bevel the enamel. d_. Use cavity liners for teeth with fractures or caries close to the pulp. 5. Prepare the dentin for retention. 6. Etch the enamel. %enior bLecturer,
Lecturer, Department Department
of Prosthodontics.
of Endodontics.
10/4/36282
Fig. 1. Schematic illustration of the composite resin layering technique. B, Bevel; D, core of composite simulating dentin; E, composite simulating enamel.
204
Fig. 2. a, Coronal fracture of maxillary central incisors in a lo-year-old girl before treatment. b, Beveled etched enamel with core of composite simulating the dentin. c, Restored maxillary central incisors.
JULY
1992
VOLUME
68
NUMBER
1
TIPS
FROM
OUR
READERS
DISCUSSION
REFERENCES
This method of layering composite resin follows the stages used in fusing a porcelain crown. In conventional methods, composite resins matching the fractured tooth in shade are placed in the fracture site. Layering the composite resins, as described, gives esthetically superior results. Although layering is not technically more complicated, it is time consuming. This technique also allows different shades to be used in the cervical regions and in the incisal portions of the tooth. In a well-layered restoration, it is difficult to distinguish between teeth restored by this method and adjacent natural teeth. SUMMARY A method of layering composites for restoring a fractured anterior tooth, or one with extensive caries, outlining the step-by-step procedure, is described.
Bound
volumes
available
1. Muia PJ. The four dimensional tooth color system.Chicago; Quintessence,1982, 11-30. 2. McLean JW. The scienceand art of dental ceramics.~011. The nature of dental ceramics and their clinical use. Chicago: Quintessence, 1979, 122-7. 3. Goldstein RE. Esthetic in dentistry. Philadelphia: JB Lippincott, 19’76, 54-61. 4.
Lutz F, Setcos JC, Phillips RW, et al. Dental restorative resins. Dent Clin North Am 1983;4:697-712.
Reprint
DR. M.
requests to: ZALKIND
THE HEBREW UNIVERSITY HADASSAH SCHOOL OF DENTAL P.O.B. 1172 JERUSALEM 91010 ISRAEL
MEDICINE
to subscribers
Bound volumes of THE JOURNAL OF PROSTHETIC DENTISTRY are available to subscribers (only) for the 1992 issues from the publisher at a cost of $55.00 ($68.00 international) for Vol. 67 (January-June) and Vol. 68 (July-December). Shipping charges are included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 65 and 66 are also available. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USA, phone (800) 325-4177, ext. 4351, or (314)453-4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
205
ite resin layering: anterior teeth
An esthetic
DiVID,a and I. Heling, DMD, MSb University-Hadassah School of Dental
Medicine,
Basic tooth color depends on the color of the dentin and the amount of light reflected, absorbed, and transmitted by the enamel.1,2 Attempts to restore the natural anterior teeth with composites, therefore, are based on morphologic, optic, and biologic tooth properties.3 Composite resin materials offer a wide range of possibilities of shade and technique for tooth restoration.* Several shades of composites should be used for restoring fractured anterior teeth and those with extensive caries in the dentin and enamel. This report suggests a simple method of layering composites for restoring extensive loss of dentin and enamel in anterior teeth.
technique
Jerusalem,
for
restoring
Israel
7. Apply a bonding of the enamel and dentin. 8. Create a composite core simulating the original anatomy of the dentin, matching its shade, and including the indentations at the incisal edge. The composite is light-cured at this stage (See Fig. 2, B). 9. Apply a second layer of composite that matches the enamel in shade over the first layer and shape and light-cure it (Fig. 2, C). The number of layers depends on the amount of tooth structure to be restored and the degree of esthetic similarity to the adjacent teeth. 10. Finish the built-up tooth and polish it using conventional methods.
PROCEDURE A composite core, matching the dentin in color, is secured to the exposed surface to implicate the dentin. Another composite matching the color of the tooth enamel is layered onto the core (Fig. 1). The steps of the procedure are as follows: 1. Clean the tooth to be restored (Fig. 2, A) with fluoridefree pumice. 2. Select shades of composites to match the dentin and enamel. 3. Bevel the enamel. d_. Use cavity liners for teeth with fractures or caries close to the pulp. 5. Prepare the dentin for retention. 6. Etch the enamel. %enior bLecturer,
Lecturer, Department Department
of Prosthodontics.
of Endodontics.
10/4/36282
Fig. 1. Schematic illustration of the composite resin layering technique. B, Bevel; D, core of composite simulating dentin; E, composite simulating enamel.
204
Fig. 2. a, Coronal fracture of maxillary central incisors in a lo-year-old girl before treatment. b, Beveled etched enamel with core of composite simulating the dentin. c, Restored maxillary central incisors.
JULY
1992
VOLUME
68
NUMBER
1
TIPS
FROM
OUR
READERS
DISCUSSION
REFERENCES
This method of layering composite resin follows the stages used in fusing a porcelain crown. In conventional methods, composite resins matching the fractured tooth in shade are placed in the fracture site. Layering the composite resins, as described, gives esthetically superior results. Although layering is not technically more complicated, it is time consuming. This technique also allows different shades to be used in the cervical regions and in the incisal portions of the tooth. In a well-layered restoration, it is difficult to distinguish between teeth restored by this method and adjacent natural teeth. SUMMARY A method of layering composites for restoring a fractured anterior tooth, or one with extensive caries, outlining the step-by-step procedure, is described.
Bound
volumes
available
1. Muia PJ. The four dimensional tooth color system.Chicago; Quintessence,1982, 11-30. 2. McLean JW. The scienceand art of dental ceramics.~011. The nature of dental ceramics and their clinical use. Chicago: Quintessence, 1979, 122-7. 3. Goldstein RE. Esthetic in dentistry. Philadelphia: JB Lippincott, 19’76, 54-61. 4.
Lutz F, Setcos JC, Phillips RW, et al. Dental restorative resins. Dent Clin North Am 1983;4:697-712.
Reprint
DR. M.
requests to: ZALKIND
THE HEBREW UNIVERSITY HADASSAH SCHOOL OF DENTAL P.O.B. 1172 JERUSALEM 91010 ISRAEL
MEDICINE
to subscribers
Bound volumes of THE JOURNAL OF PROSTHETIC DENTISTRY are available to subscribers (only) for the 1992 issues from the publisher at a cost of $55.00 ($68.00 international) for Vol. 67 (January-June) and Vol. 68 (July-December). Shipping charges are included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 65 and 66 are also available. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USA, phone (800) 325-4177, ext. 4351, or (314)453-4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
205