March 2007, Volume , Issue
Published by AEGIS Communications
Tips on Shaping & Finishing Composite Restorations
Larry Holt, DDS and 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 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). 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 disksa or diamond disks.b
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). 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.c Close-up photography, full-face shots, and my dual-monitor computer set-up (Figure 3) 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 two 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, Figure 5, Figure 6, Figure 7).
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 (i.e. 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 head shot). 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 don't 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 "new vision."
Viewing images on a 23" monitor is invaluable. Central incisors that are 6" 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 and Figure 9) demonstrate the improvements made possible from critical photographic evaluation.
a Sof-Lex™, 3M™ ESPE™, St. Paul, MN
b Gateway diamonds, Brasseler® USA, Savannah, GA
c Canon EOS 20D, Canon USA, Inc., Lake Success, NY
About the Authors
Larry R. Holt, DDS
Adjunct Faculty, Department of Operative Dentistry
University of North Carolina School of Dentistry
Chapel Hill, North Carolina
Charlotte, North Carolina
Howard E. Strassler, DMD
Director of Operative Dentistry, Department of Endodontics, Prosthodontics, and Operative Dentistry
University of Maryland Dental School