cosmetic dentistry_ beauty & science

I 25 case report _ direct restorative procedures I cosmeticdentistry 2_2013 to the incisal and from the palatal to the vestibular area. In order to achieve this, a 3-D layering tech- nique is applied, using materials with different levels of saturation. In our case, a material with asaturationonedegreehigherthanthedesiredfinal tooth shade was applied. Therefore, dentine mate- rial in shade A3 was used in the area of the cervical margin. The layer was applied to the palatal wall using a flat spatula suitable for composite resins (Fig. 8). Subsequently,alayerconsistingofdentinematerial with a lower saturation was applied (shade A2). A pointed silicone instrument was used to design a slightly wavy margin covering half of the chamfer up to 1 mm below the incisal edge (Fig. 9). (If this techniqueisapplied,thetranslucencyoftheenamel material becomes visible in the area of the incisal edge and the transition from tooth structure to composite material is masked.) Each layer was polymerised with the bluephase curing light for ten seconds. _Designing the enamel portion The opalescence effect was enhanced by apply- ing a thin layer of Trans Opal material in the area of the incisal edge. Since the visible effect of this material is very intense, only a small amount could be used. An enamel layer (shade A2) was applied in several steps to the vestibular area, then contoured withbrushesandcuredfortenseconds.Thisenamel material covered the entire restoration (Fig. 10). _Finishing and polishing The patient’s teeth exhibited a very pronounced macro-andmicrotexture(verticalpitsandhorizon- tal streaks, respectively). Imitating these features to achieve a lifelike reflection on the restorative surfaces was a challenging task. Thisstepwassimilarlyimportanttodetermining the appropriate shade. We imitated the surface texturewithfine-graindiamond-coatedburs,using flame- and lens-shaped instruments (first with the red and then with the yellow colour code). The burs were used in the red handpiece without water irrigation. Another important step was the finishing of the transition lines and the interproximal areas. It is advisable to use abrasive strips for this purpose because rotary instruments may produce flat areas that cause inappropriate reflections. OptraPol Next Generation polishers (Ivoclar Vivadent) with water irrigation were used for the polishing process. We always take great care to polish restorations perfectlywhilstavoidinganydamagetothesurface texture we design. The polishing was greatly faci- litated as a result of the extraordinary polishability of this composite material (Figs. 11 & 12). _Conclusion Owing to high-performance materials such as IPS Empress Direct, which are consistently improv- ing, and a clearly defined approach, we may use direct restorations for more indications than ever before, thus constantly extending the boundaries of feasibility. The advantage of direct restoration procedures is that they are time saving and con- servative. Nevertheless, it may happen that directly restoredteethshowdiscolourationagaininspiteof the perfect aesthetic outcome. In this case, another treatment is inevitable._ Figs. 11 & 12_The restored tooth #11 exhibits a harmonious appearance, achieved with a minimal loss of tooth structure. Dr Gauthier Weisrock is a dental surgeon from Marseille in France. He can be contacted at gauthier.weisrock@gmail.com. _about the author cosmeticdentistry Fig. 11 Fig. 12