Sep 2007 —
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
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 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: email@example.com.
|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: firstname.lastname@example.org.