Aside from the necessary theoretical knowledge, working with composites also requires patience and manual skill. This especially applies to the anterior region. Here in particular, it is important to place the respective appropriate amount at the correct place and to apply the layers with particular care, to achieve the ideal clinical result. In work that requires an alteration, reconstruction or transformation, it is generally important to keep the desired target shape, design or image in mind. So the first step should involve a wax-up, an analysis of the smile from different perspectives, as well as consideration of the type of tooth to be formed. Naturally, the patient's concerns should also be taken into consideration when planning treatment.
Clinical case
In the case presented here, the patient expressed a desire for his teeth to be visible when speaking. It bothered him immensely that, in a resting position or half open, his lips totally covered his upper teeth. Furthermore, the patient refused any preparation of his teeth using grinding burs. This meant that possible treatment with ceramic veneers was out of the question. An additive wax-up and an occlusal analysis were carried out to check if it was possible to lengthen the anterior teeth with composites, as well as to create incisal edges with an opalescent effect and absorption materials for youthful-appearing teeth. To achieve such a youthful effect with composites, attention should be paid to the exact three-dimensional shape of the tooth. It should not be forgotten that a tooth characterised as youthful is more translucent and absorbs light in the blue or grey areas between the dentinal mamelons. Conversely, these mamelons reflect light especially in the incisal area. A smaller degree of light absorption effects can also occur in the approximal areas. In order to form these absorbent areas, we can use pigments or translucent composites. But it is most important to apply the dentine material, in a controlled fashion, from the cervical to the incisal areas, and to leave free spaces for translucent effects between the mamelons.
For this, it is important to select a composite that reflects light, without being too opaque. This is why Amaris (Voco) was used, a highly aesthetic light-curing restorative material, the system design of which (with opaque base or dentine shades, translucent enamel shades and individual or effect shades) enables natural dental aesthetics in an easy to use layering technique. Amaris is versatile and extremely aesthetic, very easy to use and enables intuitive shade selection. The Amaris system consists of five base or dentine shades, three translucent enamel shades and two individual or effect shades (the latter as liquid composites):
- Base or dentine shades: O1 (Amaris Opaque 1), O2 (Amaris Opaque 2), O3 (Amaris Opaque 3), O4 (Amaris Opaque 4), O5 (Amaris Opaque 5).
- Enamel shades: TL (Amaris Translucent Light), TN (Amaris Translucent Neutral), TD (Amaris Translucent Dark)
- Individual or effect shades: HT (Amaris Flow High Translucent), HO (Amaris Flow High Opaque).
- With this concept, Amaris takes a pioneering role in active shade management through dentists, whereby even less experienced users are able to select the correct shade far more easily.
Intuitive methods for visual assessment
The following describes the sequence of intuitive shade management with the Amaris system, which facilitates the correction of the shade during the restoration. The same procedural method also applies for a prior restoration mock-up:
1. Initially, the dentine is layered after the selection of one of the system's opaque base shades.
2. Checking the colour:
λ If it approximately corresponds to the desired colour, continue layering with Translucent Neutral TN, in order to maintain the shade appearance and create depth.
λ If it is too pale, continue layering with Translucent Dark TD, because this shade reduces the brightness and colour intensity of the restoration and provides depth.
λ If it is too dark, continue layering with Translucent Light TL, because this shade increases the brightness and colour intensity, while maintaining the required depth and translucency.
3. In the third step, the restoration can be finished with the selected translucent shade or effects can be applied using the individual shades. For example: provide more colour intensity cervically, increase the brightness in the middle third, and so on.
In the illustrated clinical case the teeth were not prepared in any way, the enamel was merely etched, which is indicated here and ensures a pure enamel bond as well as a reliable outcome. Light-activated dental whitening using a UV lamp (Zoom 2!, Discus Dental) was carried out in advance and the expected result was achieved in two sessions. Layering is facilitated on a light surface.
There is a documentation of the individual treatment steps with each fig.