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Fig 3: Composite button technique Fig 4: Value assessment in monochromatic image

Fig 5: Chroma assessment in oversaturated image Fig 6: Isolation

Fig 7: Shade is a match but shape and texture need improvement Fig 8: Better shape achieved and texture improved by using slow speed
diamond burs, carbide burs, silicone points and final lustre achieved
using Lucida paste (Style italiano)

FLOW OF APPOiNTMENTS varying the thickness of every layer will significantly alter the overall
1st APPOINTMENT: The patient did not reside in my city and had appearance of the restoration. In my experience, bulk of a tooth should
come through another dentist’s referral so I did not have sufficient time be built in body/universal and lesser thickness should be reserved for
to send the scans or impressions for a digital mock up or wax up. So, I dentin and enamel otherwise the restoration may appear too opaque
did a quick mock-up using composite on the stone cast and copied the or grayish respectively.
anatomy on a putty index facilitating accurate transfer of the palatal Blending ability of composites is a popular concept in recent times
anatomy since the restorative space was restrictive and the mandibular and it has been noted that some products blend in with the surrounding
incisor had supraerupted occupying the vertical space. It was decided tooth structures better than others. This is due to the size, refractive
(with the patient’s consent) to selectively contour the mandibular index and type of filler particles used in composite and their resin
incisor to prevent premature contacts during protrusive movement matrix. Smaller, more homogenous filler particles lead to a smoother
and chewing movements. surface finish and better integration of the restoration with the tooth
The putty index was created using polyvinyl siloxane in a colour structure. Clinician skills and application techniques are also crucial
that can contrast beautifully with composites. This will help identify for achieving a natural looking, vital, well - integrated restoration.
the margins and extensions predictably, eliminating palatal excesses
that can prevent complete seating of the index. I do not recommend 2nd APPOINTMENT:
using a condensation silicone and always choose a material that Isolation: A medium sheet (M care) was used for isolation and the
when mixed and made into a ball can bounce well. This material will sheet – frame assembly was stabilized using #138 and #139 wingless
reproduce surface details perfectly and also be stiff enough for us to clamps on the premolars (Harger – Werken).
carry out the restorations comfortably. Preliminary shade selection Tooth preparation: Placing appropriate bevels can significantly
using the composite button technique and pre-operative photographs improve the blending of composite restorations. In this case a 2 mm,
were taken at this appointment. It is important that the teeth are not 45-degree bevel was placed at the fractured margins that were later
dehydrated when selecting shade and the same can be verified using converted into infinity bevels using a 3M coarse disc. Bevels should be
a Custom shade guide created from composite shades in varying placed appropriately in the enamel to a depth of 0.5 to 1mm depending
thicknesses of opaque/dentin, universal/body and enamel shades. on the size of the defect. This disguises the demarcation line and offers
Managing opacity: While the composite button technique can give better mechanics. The tooth structure was air abraded using 30-50
us the clear recipe for every restoration, it is important to note that microns Aluminium trihydrate. The teeth were etched using the total

Dental Practice i March-April 2024 i Vol 20 No 2 23