evolution of conservative odontology

Color & Enamel PreservationAugust Bruguera, TPD

Jon Gurrea, DDS Sidney Kina, DDS, MS

Mr. Bruguera is an instructor at the Acadèmia de Ciències Mediques de Catalunya, in Barcelona, Spain. He owns a dental laboratory in Barcelona.

Dr. Gurrea lectures internationally. He maintains a private practice with special emphasis on esthetics and comprehensive care in Bilbao, Spain. Dr. Kina lectures internationally on esthetic dentistry. He maintains a private practice in Maringá, Brazil. Disclosures: The authors did not report any disclosures.

All images in this slideshow are copyright protected and belong to the authors. Copyright © 2017. All rights reserved. No part of this slideshow may be reproduced, distributed, or transmitted in any form or by any means, including copying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher.

CASE I: A Fracture of a Single Central

The goal in this type of restoration is to get the non-supported part to have a chromatic continuity with no changes in the color in respect to the substrate. Cross-polarized light helps us see the color, value, and structure of the natural tooth dentin.

For the clinician to transmit the color to the technician, it is necessary to obtain photographs with the most similar ceramic dentin shade tab. A light-emitting diode lamp is helpful in obtaining such information.

Before the final restoration is placed, the clinician should provide the patient with a temporary restoration. If the clinician cannot find an identical color match to the patient’s dentin, they should give instructions to the laboratory technician to find the perfect matching color for the temporary.

Preparing the tooth to align it with the other central incisor and preserving as much natural enamel as possible.

The ceramic thickness is limited, forming a 0.2- to 0.3-mm layer at most in the area where we have the substrate.

The ceramic layering will always be based upon the color of the substrate. It reveals how the translucence affects the color from the substrate and how it is transmitted to the surface.

In a restoration with such a transparent layer, the cement will also be a variable in the color.

We can appreciate how the color of the dentin of the substrate is perfectly transmitted by the ceramic.     In this case, the most difficult color characteristic to reproduce was the high value of the dentin in the incisal edge area, where the dentin disappears and there is only enamel left.  

Document your results after bonding and observe the color results with the polar_eyes filter. See how the color, and especially the value, of the dentin are perfectly matched in the final outcome.

Itisimportantthatimpressionshavecleansurfaceswithnoimperfec4ons.Fromtheocclusalplane,wecanseehowtheinterproximalshaveafavorableinser4onaxis.

CASE II: Diastemas with favorable color, vestibular insertion axis without stops.

The wash bake is essential to isolate the ceramic from the refractory material. This layer’s color depends upon the substrate’s color, but with contact lens veneers, this layer will always be transparent, with the goal of improving the substrate color transmission.

The dentin will be placed only in areas where there is no substrate, to provide opacity and equalize the surface dentin with the substrate dentin. Before the first bake the free edge was finished by contrasting nontranslucent masses with translucent ones to form the mamelons.

This first bake must take up as little vestibular space as possible because it completes the areas where there is no substrate.

The last layer is made with translucent material. It is important that while we build it up we do not miss the occlusal plane, because it provides information about how much space we have used.

After baking, perceive the investment. From the occlusal plane, prevent over-contouring of the restorations so that after bonding they will transmit the color of the dentin and ensure that the volume is correct and perfectly matches the substrate.

Veneers with no preparation must be placed perfectly, because any premature interference could promote a fracture due to the veneer’s extreme fragility before being bonded.

The occlusal view shows how little ceramic has been added.

See how the moment the cement contacts the substrate surface, the veneer immediately takes its color as if it were a contact lens.

Preoperative and postoperative images.

Minimum or non-invasive odontology, along with the possibility of restoring teeth in both esthetic and functional ways occupies our daily work. No preparation and usually with no need for anesthetic is now a reality.

_________________________________ The AACD would like to thank the authors of this slideshow for their work and dedication to the education in esthetic dentistry. _________________________________

This slideshow was an excerpt from the original article published in the Journal of Cosmetic Dentistry titled,

Evolution of Conservative Odontology: Color & Enamel Preservation by August Bruguera, TPD, Jon Gurrea, DDS, and Sidney Kina, DDS, MS.

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