콤포지트 레진을 이용하여 성공적인 심미수복을 얻기 위한 기본 원칙은 두가지다: 자연치아의 시각적인 요소와 사용하는 수복시스템을 이해할 것.
우리가 이런 요소들을 잘 이해하고 활용한다면, 수복할 치아를 보다 자연스러운 심미성을 부여할 수 있는 층간 두께 등의 사항에 적용할 수 있을 것이다.
심미성을 갖춘 수복물을 제작하는 것은 단순히 정확하게 색조만 재현하는 것에 국한되지는 않는다. 투명도와 불투명도간의 적절한 균형을 잘 맞추어야 하는 것이 매우 중요하다.
이번 임상은 파절된 상악 중절치 2개를 Amaris system(Voco)을 이용하여 단계별로 수복해가는 과정을 보여준다. 이번 임상에서는 콤포지트 레진의 층간 축성에 대한 컨셉과 폴리싱을 통해 자연스러운 심미성을 만드는 과정에 중점을 두었다.
Keywords: Composite. Stratification. Aesthetic finishing
The colour of natural teeth is determined by the dentine1. The enamel acts as a filter and modulates the dentine shade, thereby enhancing the aesthetics of the tooth in most cases. The colour of natural teeth is therefore developed from within the tooth2. With restorations with composites, however, the dentist normally uses coloured composite enamel materials. The colour effect of the tooth is determined to a very large extent by these coloured enamel materials, with the colour being developed from the outside to the inside of the tooth which is the exact opposite to how colour is developed naturally3. The traditional layering technique used in composite restorations adopts this approach. The composite enamel materials may be divided into coloured, modulating and translucent material for incisal edges. The coloured enamel materials form the final layer which ultimately determines the shade of the restoration. Modulating enamel materials, which do not however change the shade, are then applied to the coloured enamel material to enhance the final depth and translucency of the restoration. In an alternative layering technique the colouring is developed outwards from within as with natural teeth. In this case, dentine composites with saturated shades can be used because they are covered and modified by an additional layer of modulating enamel material which enhances the aesthetic value of the restoration in the same way as with natural teeth. With both techniques it must be ensured that these modulating enamel materials are applied in thin layers. As a final procedure, which is mainly carried out on young patients 4, the translucent incisal edge materials are applied to reproduce the opalescent incisal edge.
A clinical case is described below involving Class IV restorations on teeth 11 and 21 using the Amaris System (VOCO). This system is based on the concept of modulating enamel materials. It comprises five dentine materials of different colour saturation and three translucent modulating enamel materials. The system is easy to use and delivers predictable results. The enamel materials TN, TL or TD serve, respectively, to maintain the shade of the selected dentine, to slightly lighten it or to slightly darken it. The procedure, which is extremely simple to carry out, entails selecting the dentine composite whose shade most closely matches the desired final result and using the neutral modulating enamel material TN. This thin enamel layer over the dentine gives the restoration more depth and “life”. Another possibility is to select a dentine material that is a shade darker than the tooth and then to lighten this with the enamel material TL. In the author’s view this approach more accurately reproduces the transition between enamel and dentine found in natural teeth. The Amaris System (VOCO) also includes two flowable effect composites: HO, which is highly opaque in order to prevent discoloured dental hard tissue from showing through and to create effects and characterisations, and HT, which is extremely translucent.
Sanzio Marques has a Master’s degree in conservative dentistry at the Dental Faculty of the Federal University Minas Gerais (Brazil) and a specialist in dental prosthetics at the Dental Faculty of Ribeir?o Preto of the University of S?o Paulo (Brazil). He is the author of the book Est?tica com resinas compostas em dentes anteriores: percep??o, arte e naturalidade (Aesthetics with composites on anterior teeth. Perception, skill and natural appearance) and director of the “Excellence in Aesthetic Dentistry” and “Mastering Composite Restoration Techniques" courses run by the Institute for Dental Studies (IEO) Belo Horizonte (Brazil).
Address for correspondence:
Dr Sanzio Marques
Rua Lavras, 605
CEP: 37.902-314 ? Passos/MG
1. Chinche G, Pinaut A. Comunica??o com o laborat?rio dental: provas e sele??o de cor. In: Chinche G, Pinaut A. Est?tica em pr?teses fixas anteriores. S?o Paulo: Quintessence; 1996. cap. 6, p. 115-142.
2. Vanini L. Light and color in anterior composite restorations. Pract Proced Aesthet Dent. 1996 Aug;8(7):673-82.
3. Marques S. Sele??o de cores e das resinas restauradoras. In: Marques S. Est?tica com resinas compostas em dentes anteriores: percep??o, arte e naturalidade. S?o Paulo: Ed. Santos; 2005. cap. 4, p. 55-91.
4. Baratieri LN, Ara?jo EM Jr, Monteiro S Jr. Basic fundamentals and restorative protocol for the use of composite resins in anterior teeth. In: Baratieri LN, Ara?jo EM Jr, Monteiro S Jr. Composite restorations in anterior teeth: fundamentals and possibilities. S?o Paulo: Quintessence; 2005. cap. 1, p. 3-82.
Fig. 1: Fractured teeth 11 and 21.
Fig. 2A and 2B: Intraoral simulation (mock-up) without conditioning of the dental hard tissue with restoration of the length and contour of the teeth in order to assess aesthetics and phonetics.
Fig. 3A and 3B: Impression of the mock-up with kneadable silicone and fabrication of a silicone impression.
Fig. 4A and 4B: The Amaris System (VOCO) selected to carry out the restorations.
Fig. 5: Bevelling of enamel with the diamond bur 4138 (KG Sorensen).
Fig. 6: Note the dimensions of the bevel under the rubber dam.
Fig. 7A, 7B and 7C: Complete etching, application of the two-stage adhesive Solobond M (VOCO) and light polymerisation for 15 seconds per tooth.
Fig. 8: Application of an increment of enamel material Amaris TN to the silicone impression.
Fig. 9: Positioning the silicone impression coated with Amaris TN and light polymerisation of this increment which restores the palatal and incisal enamel.
Fig. 10: Application of dentine material Amaris O1 and contouring the mamelons. This increment should overlap the fracture line and mask it by extending to roughly half of the bevel.
Fig. 11: Selective application of Amaris Flow HO to the tips of the dentinal mamelons in order to accentuate them.
Fig. 12A and 12B: Amaris Flow HT is applied incisally in the area of the mamelon in order to achieve a translucent and opalescent halo effect.
Fig. 13A and 13B: The approximal edges are modelled with the enamel material, Amaris TL.
Fig. 14: Yellow pigment Kolor + Plus (Kerr) is applied lightly by brush to the mamelons to reproduce an effect of counter-opalescence.
Fig. 15A, 15B and 15C: Modelling of the final enamel layer of the teeth with the help of a spatula and smoothing with an Artist Line brush (Hot Spot Design).
Fig. 16: Application of a water-soluble gel to prevent the ingress of oxygen and final light polymerisation of the restorations for 60 seconds vestibularly and 60 seconds palatally.
Fig. 17: Removal of the excess with the diamond bur 2134 (KG Sorensen) in the contra angle handpiece T2 Revo (Sirona).
Fig. 18A, 18B and 18C: Basic shaping of the teeth with flat area and vestibular slopes using the abrasive disc Sof-Lex Pop On (3M Espe).
Fig. 19: Start of surface polishing with the rubber polisher Astropol (Ivoclar Vivadent).
Fig. 20A, 20B and 20C: Grinding of the vertical micromorphology (longitudinal recesses in the vestibular surface) using the diamond burs 2134 and 1015 (KG Sorensen) and the contra angle handpiece T2 Revo (Sirona).
Fig. 21: Smoothing the vertical recesses with the abrasive disc Sof-Lex Pop On (3M Espe).
polisher Astropol (Ivoclar Vivadent), diamond paste Diamond Excel (FGM) and goat's hair brush as well as Enamelize paste (Cosmedent) and Flexi Buff (Cosmedent) felt polishing wheel.
Fig. 22A, 22B, 22C and 22D: The final surface gloss is produced by using the green and pink-coloured rubber
Fig. 23A and 23B: Approximal polishing with Epitex polishing strips (GC), Enamelize paste and Super-Floss (Oral-B).
Fig. 24A, 24B and 24C: The final result of the aesthetic restoration: the patient now has natural-looking, perfectly proportioned and aesthetic teeth, as well as a perfect, radiant smile.
Fig. 25: The final aesthetic result.
Fig. 26A and 26B: The optical properties of Amaris reproduce the interaction of light with the natural dental hard tissue.