Indirect and Direct Restorative Protocols - Caulk

› PRINCIPLES & PRACTICES
Direct Resin Procedures
for Aesthetics in
Anterior Restorations
› Abstract:
The aesthetic expectations of
today’s dental patients require
the practitioner to have an
innate understanding and
the clinical skills necessary
to perform smile repair or
enhancement. Composite
resins such as Esthet•X ®
Micro Matrix Restorative
(DENTSPLY Caulk, Milford,
DE) possess physical and
aesthetic properties that
facilitate the clinician’s ability
to provide direct treatment
with success and predictability.
This presentation reviews
guidelines that influence
composite material selection
as well as placement protocols
used in their direct application.
The increasing aesthetic expectations
of dental patients
dictate the use of state-of-theart,
imperceptible anterior
restorations for smile repair
or enhancement. When treating a fractured
tooth or repairing an existing restoration
(Figure 1), it is necessary to mimic the aesthetics
of the surrounding dentition and
to build up the resin restoration in a manner
that matches the contours, length, and
width of the adjacent teeth. In selecting an
appropriate shade, it is important to do so
prior to the placement of a rubber dam to
prevent improper shade matching due to
dehydration or the tooth reflecting the color
of the dam. For a Class IV fracture or repair
of a porcelain veneer, a chamfer preparation
is placed around the entire margin to increase
the adhesive surface area, and a scalloped
bevel should be used to break up the
chamfer line. Once the preparation is complete,
the tooth may be etched and a dental
adhesive may be applied.
The dentin layer may then be built up
with a composite resin material using slow,
steady pressure. For anterior procedures, a
material that provides high strength and
polishability (eg, Esthet•X® Micro Matrix
Restorative, DENTSPLY Caulk, Milford,
DE) should be selected. The range of shades
available in Esthet•X® ensures a successful
treatment outcome, whether performed in
a single-shade approach or an advanced
technique involving multiple shades and
opacities. It has also demonstrated high
fracture toughness in areas (eg, margins,
incisal regions) that must withstand considerable
intraoral forces.
First, a thin layer of opaque dentin is applied
(Figure 2). The regular body layer is
then built up over the opacious layer (Figures
3 and 4), followed by a translucent
enamel layer to mimic the natural dentition
(Figure 5). Care is taken to leave space
for the successive increments of composite
resin that will render the final appearance
of the restoration. The contour and shape
are adapted using the appropriate instruments,
and then light cured. For the aesthetic
blending of shades, additional body
and enamel layers may be individually
Figure 1. A Class IV anterior fracture, porcelain repair, or diastema
closure present similar aesthetic challenges.
Figure 2. Following preparation and surface conditioning, a thin layer of
Esthet•X ® is placed against the lingual matrix to form the palatal shelf.
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