Advances in diastema closure and tooth shape change using direct composite restorations: the Front Wing Technique.

Closing a diastema with a direct composite restoration still represents a real challenge for clinicians, mainly due to the need to create a correct contact point and emergence profile at the cervical level. The present article describes a novel anterior direct composite restoration technique for closing diastemata and changing tooth shape. The proposed technique, called the Front Wing Technique (FWT), does away with the use of the traditional wax-up and silicone index-based procedures. To date, there has been no effective way to transfer the anatomy modeled in the wax to the interproximal cervical area of anterior restorations every time these areas need to be corrected or restored. Therefore, the FWT provides a new approach to freehand model the emergence profile without gap formation. The cases in this article demonstrate the closure of maxillary and mandibular incisal diastemata, with the rationale behind each clinical step of the FWT described. This technique should be considered an alternative approach for the direct composite restoration of anterior teeth, saving chair time and cost.

Essential Lines: a simplified filling and modeling technique for direct posterior composite restorations.

There is a continuing increase in demand for the direct restoration of posterior teeth with resin-based composites. However, the execution of these restorations, especially the reproduction of the anatomical details of the tooth, still presents difficulties for most clinicians. Nowadays, resin-based composite restorations have become increasingly popular due to the development of new materials and filling techniques. Direct composite restorations are usually performed using the time-consuming incremental filling technique, which minimizes polymerization shrinkage. With this technique, the composite is built up in individually cured increments. Due to the superior physical and chemical properties of the newer bulk-fill composites, it is possible to replace this incremental filling technique with a more time-efficient bulk-fill technique, whereby the composite is placed and modeled in a single layer up to the occlusal surface. This article presents this novel technique for direct posterior composite restorations. The technique, called Essential Lines, is simple, esthetic, and time saving. It combines the advantages of the bulk-fill technique with a modeling technique that utilizes minimal so-called diagram lines to restore the tooth anatomy. This procedure can be used by beginners and expert practitioners alike in various clinical situations to produce direct posterior composite restorations with optimal function and esthetics.

Composite shade guides and color matching.

Finding reliable systems that can help the clinician match the color of direct composite restorations is often an issue. After reviewing several composite shade guides available on the market and outlining their main characteristics and limits (unrealistic specimen thickness, not made with the same material the clinician will use, only a few allow to overlap enamel tabs on dentin ones), the authors evaluated the reliability of a system designed to produce self-made standardized "tooth-shaped" shade guide specimens. Small changes in composite enamel thickness may determine huge differences in esthetic outcomes. In conclusion, the results showed that all the specimens demonstrated comparable enamel thickness in all the examined areas (cervical, middle, incisal).

Achieving a precise color chart with common computer software for excellence in anterior composite restorations.

Achieving similar features to those on natural teeth is a common problem with esthetic restorations. Color matching is a fundamental procedure required to perform a predictable composite resin restoration. It is no longer enough to measure these criteria with conventional shade guides, which provide the hue and chroma, but do not take into account other dimensions of the tooth such as value, intensives, opalescence and characterizations. The present article presents a simple and effective technique for color selection using a digital photograph of the tooth and an image-editing program such as Adobe Photoshop or Picture Project. The digital editing of the photograph with two simple steps described in this paper reveals the internal structures of the tooth easily. The modified photographs highlight the opalescence, white spots, shape of the internal mammelons and other features that are not visible at first glance. This procedure provides an accurate color chart with which the clinician can begin an esthetic restoration process.

Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.

In daily practice, composites are the materials most commonly used for restorative dentistry. They are used for preventive seals, microinvasive restorations, build-ups and complex direct and indirect restorations in posterior sections. Indeed, it is in the anterior sections that composites have traditionally been used to the greatest effect, enabling clinicians to carry out complex restorations using direct techniques with notable esthetic and clinical results. Recent product developments combined with clinical research on stratification make it now possible to utilize new composites that have excellent opalescence and fluorescence characteristics and provide an excellent color range to choose from. It is however, a common complaint among clinicians that the layering techniques are rather complex and it is difficult to make the right color choice. Paradoxically, they say that the appearance on the market of sophisticated materials, designed to give ever better results in the medium and long term, only makes it more difficult to make the correct decision. Indeed, many of these colleagues, after the first buzz of enthusiasm, give up on the layering technique and opt for materials which they say are more simple or "mimetic." In the present article, the authors will discuss these topics and make suggestions on how to achieve high quality results every day, both from an esthetic and clinical point of view. However, predictability of the results is more important, as predictability provides advantages in terms of the quality of work and economy for clinicians and patients.