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Vol.4 No.2 - May/June 2010
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Sep 2007 — Vol. 1, Iss. 1

Tips on Shaping and Finishing Composite Restorations

Howard E. Strassler, DMD:
When placing a direct composite resin veneer or restoring traumatically fractured incisal edges with composite resin, all aspects of the technique are important for the esthetics and durability of the restoration. To me, the "crowning touch" for achieving a final esthetic result that the patient can truly appreciate is the shaping of the incisal edges.

For the majority of composite resin placements and finishing of these restorations—especially for the incisors and canines—I seat the patient in a supine position, and I am typically sitting behind the patient.

During the initial finishing of the veneer or for incisal edge repair, I establish a preliminary incisal length. After completing almost all of the facial and lingual contouring, I sit the patient to an almost upright position (Figure 1 View Figure). Then I stand in front of the patient, hand the patient a mirror, and then I complete the shaping, establishing the length and embrasures of the incisal edge. I accomplish this task using both coarse and medium grit disks (Soft-Lex, 3M ESPE, St. Paul, MN) or diamond disks (Gateway diamonds, Brasseler® USA, Savannah, GA).

By examining the tooth shape from in front of the patient, I am viewing the restoration from the same perspective as the patient, as well as how others view the smile. I can see the interpupillary line, midline, and other soft tissue landmarks in their true visual position. Incisal edges have a chisel-shaped appearance when viewed from a profile view, not a flat, square appearance.

Therefore, when shaping these aspects of the restoration and tooth, it is important to orient the disks you are using with a lingual tilt (Figure 2 View Figure). Also, these thin finishing disks can be used to shape the incisal embrasure.

Larry R. Holt, DDS:
The most valuable instrument in my armamentarium for final contouring and finishing is my camera (Canon EOS 20D, Canon USA, Inc, Lake Success, NY). Close-up photography, full-face shots, and my dual-monitor computer setup (Figure 3 View Figure) are invaluable when evaluating direct composite placement and finishing.

Direct bonding procedures are typically intense, one-on-one appointments. Direct composite veneers or multiple diastema closures can take 2 or more hours to complete. By the end of an appointment, everyone in the operatory is tired or downright worn out. Achieving a critical evaluation can be an overly optimistic goal at that immediate moment (Figure 4 View Figure, Figure 5 View Figure, Figure 6 View Figure, Figure 7 View Figure).

Therefore, I suggest finishing only as much as possible at that initial appointment. Then, use the camera and take multiple digital photographs from various perspectives (ie, retracted frontal, retracted left and right lateral, close-up frontal, close-up left and right lateral, full-smile frontal, full-smile left and right lateral, full-smile headshot). Check the quality of the photographic images on your computer.

Dismiss the patient. Make a follow-up appointment for a week or so later, but do not study the photographs until you are rested and ready to critically evaluate your results.

Obviously photographic analysis can be performed the day the procedure is completed. However, in my opinion, the follow-up appointment provides you with another opportunity to refine the case with "new vision."

Viewing images on a 23-inch monitor is invaluable. Central incisors that are 6 inches tall reveal every potential flaw in the treatment. Viewing restorative work in this manner provides an opportunity to deliver treatment at an entirely new level. The follow-up images for the case illustrated here (Figure 8 View Figure and Figure 9 View Figure) demonstrate the improvements made possible from critical photographic evaluation.

Figure 1 After completing almost all of the facial and lingual contouring with the patient in a supine position, elevate them to an almost upright position. Figure 2 When shaping the incisal edges of teeth and/or composite resin restorations, orient your disks with a lingual tilt
   


Figure 3 View of full-facial shots as seen on a dual-monitor computer setup. Figure 4
   
 
Figure 5 Preoperative full-facial view of the patient.  
   
Figure 6 Immediate postoperative right lateral view of the patient after a 2-hour bonding appointment. Figure 7 Immediate postoperative left lateral view of the patient after composite bonding.
Figure 8 and Figure 9 View of the composite restorations after the second appointment for finishing and refining.

About the Authors
Howard E. Strassler, DMD, is professor and director of operative dentistry in the Department of Endodontics, Prosthodontics, and Operative Dentistry at the University of Maryland Dental School in Baltimore, MD. He may be reached at: hstrassler@umaryland.edu.
Larry R. Holt, DDS, is an adjunct associate professor in the Department of Operative Dentistry at the University of North Carolina School of Dentistry in Chapel Hill, NC. He may be reached at: drdk@mac.com.