Kevin M. Brown, DDS; and Greg Gillespie, DDS
A 75-year-old patient presented with worn incisal edges of teeth Nos. 8 and 9 (Figure 1). The restoration was performed using OMNICHROMA resin-based one-shade universal composite in conjunction with OMNICHROMA BLOCKER (Tokuyama Dental America). OMNICHROMA BLOCKER, a supplementary material that can be used as a lingual layer to prevent shade-matching interferences, was indicated in this case because a few millimeters of unsupported composite were being added to restore the teeth to the proper length. Generally, the incisal one-third of anterior teeth are translucent, so use of the BLOCKER helps mask color interference from surrounding structures.1
The teeth were lightly prepared with a facial bevel and air abrasion (MicroEtcher™ II; Zest Dental Solutions, zestdent.com) for increased retention and color blending.2 The BLOCKER was used to create a palatal shelf with the aid of a prefabricated silicone putty index (Figure 2). The thickness of this shelf with the BLOCKER should be no more than 0.5 mm. If the shelf is too thick, the final restoration will look opaque; if it is too thin, however, it may not work as intended, and the final restoration may appear too translucent.
Because this older patient had internal craze lines, the OMNICHROMA was placed in two layers. An initial layer was placed to just short of the final facial contour to allow space for internal characterization with white resin stain to replicate faint craze lines (Figure 3). A second thin layer of OMNICHROMA was then placed to the desired contour, finished, and polished (Figure 4). Due to the high chromatic dentin at the incisal edge of tooth No. 9, the restoration on this tooth was slightly visible in the high magnification photograph. This result could have been avoided with the use of a deeper bevel in the tooth preparation to remove the high chromatic area of dentin.
In this case, OMNICHROMA was used to restore a large diastema between maxillary central incisors without the need for OMNICHROMA BLOCKER (Figure 5). The supplementary blocker material was unnecessary because OMNICHROMA achieves its final color from the tooth to which it is bonded, and even in the case of a large diastema, the composite is fully bonded to the natural enamel, unlike with the incisal edge repair in Case 1.
Retraction cord was placed and tooth preparation was performed with air abrasion (MicroEtcher II). Then, a silicone putty index was used to aid in establishing the midline and proper contouring (Figure 6).3 Finishing and polishing were then achieved with a series of Sof-Lex™ discs (3M Oral Care, 3m.com), diamond and carbide burs (Komet USA, kometusa.com), a silicone PDQ™ brush (Kerr, kerrdental.com), and a diamond polishing paste and felt disc (Cosmedent, cosmedent.com) (Figure 7).4 The palatal view shows the seamless contour and imperceptible color blending (Figure 8).
The final case shows a typical class II composite restoration of tooth No. 19, shade A3.5, using OMNICHROMA. After rubber dam isolation (OptraDam®, Ivoclar Vivadent, ivoclarvivadent.com), the decay was removed and the cavosurface margin was lightly beveled to aid in achieving seamless margins and retention (Figure 9).2 A sectional matrix and ring system (Composi-Tight® 3D Fusion™, Garrison Dental Solutions, garrisondental.com) was used to establish the distal contact and then removed for the remainder of the layering (Figure 10).
Four additional layers of OMNI-CHROMA were incrementally placed and light-cured (Bluephase® wand, Ivoclar Vivadent) up to the final contour to reduce shrinkage stress (Figure 11).5 Occlusion and anatomy were achieved with diamond and carbide burs (Komet USA) (Figure 12).
Kevin M. Brown, DDS
Private Practice, Bellevue, Washington; Accredited, American Academy of Cosmetic Dentistry
Greg Gillespie, DDS
Private Practice, Vancouver, Washington
References
1. Omnichroma® Technical Report. Tokuyama. p.4. https://omnichroma.com/us/wp-content/uploads/sites/4/2019/01/OMNI-Tech-Report-Color-Final.pdf. Accessed September 18, 2019.
2. LeSage B, Milnar F, Wohlberg J. Achieving the epitome of composite art: creating natural tooth esthetics, texture, and anatomy using appropriate preparation and layering techniques. Journal of Cosmetic Dentistry. 2008;24(3):132-141.
3. Vargas M. A step-by-step approach to a diastema closure. Journal of Cosmetic Dentistry. 2010;26(3):40-45.
4. Brown KM. Transitional bonding for the severely eroded dentition. Journal of Cosmetic Dentistry. 2017;33(1):28-40.
5. Burke FJ, Palin WM, James A, et al. The current status of materials for posterior composite restorations: the advent of low shrink. Dent Update. 2009;36(7):401-409.
Figures and Images
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