As clinicians, we are forever in the pursuit of clinical excellence and long-term success with our restorations. We continually seek new trends, different innovations, and cutting-edge materials that not only simplify procedures but also elevate esthetic outcomes. Inspired by the concept of a “quantum leap,” a significant step forward, BISCO’s Quantium Universal Composite system aims to deliver exceptional performance in strength, esthetics, and handling for a wide range of clinical cases. It reflects BISCO’s dedication to innovation and true clinical excellence. Formulated with a unique nano-micro filler blend, the composite pushes the limits of both performance and esthetic excellence. It offers a versatile solution that performs flawlessly in both anterior and posterior restorations.
Anterior esthetic restorations present clinical challenges that make material selection, technique, and attention to detail essential for long-term success.
One of the most common mistakes is incorrect shade matching. The final shade of the restoration is not only influenced by the composite itself, but also by the thickness of layers and surrounding tooth structure. It is imperative to select the shade before tooth dehydration occurs.1 Teeth dry out quickly, becoming lighter and misleading the final selection. The shade should be matched under natural daylight, with a color-corrected dental light, or cross-polarized dental photography. Layering different shades mimics natural translucency and depth.
The preparation design is the key for overall esthetics and longevity. Over-preparation can lead to unnecessary tooth structure loss, while under-preparation may result in weak adhesion and visible margins. Follow minimally invasive principles and retain as much enamel as possible for optimal bonding using a bevel on enamel margins.2 This creates a gradual transition between the composite and tooth structure, minimizing the visible line at the composite-tooth junction and masking the restorative interface.
An adhesive protocol is crucial for the longevity of the restoration. Errors in etching, priming, or curing can lead to debonding, marginal leakage, and postoperative sensitivity. The appropriate adhesive system should be selected based on the clinical case (total-etch, self-etch, or selective-etch).3 Overetching dentin tends to cause excessive demineralization, which compromises bonding. Adhesive should be applied in a thin layer, with complete evaporation of the solvent and adequate polymerization using appropriate, calibrated curing times and intensity.
Excessive or insufficient material application can affect esthetics and function. Over-bulking can create unnatural contours, while under-bulking can lead to weak restorations. Restoring in increments of no more than 2 mm ensures complete light penetration while avoiding polymerization shrinkage.4 Sculpt each layer carefully, using anatomical guides to mimic the natural tooth morphology. Evaluate your work from multiple angles and use a silicone index when necessary to guide layering. Patience is crucial to making your results stand out.
Restorations that lack correct overall shape, proper line angles, and symmetry appear artificial and fail to blend seamlessly with surrounding natural dentition. Study the anatomy of adjacent teeth and use them as a reference. Shape primary and secondary contours before polymerization to reduce excessive finishing work. Utilize hand instruments, brushes, and composite sculpting instruments to create natural definition.
Poorly finished restorations are more prone to plaque accumulation, staining, and surface roughness, which compromise both longevity and esthetics. Use of a multi-step polishing protocol with different grits and polish pastes results in a high-gloss finish achieved without excessive heat generation.
Lastly, failure to check and adjust occlusion can lead to excessive wear, fractures, and discomfort. Verify occlusion in both centric and excursive movements to ensure there are no interreferences. Recommend night guards for patients with bruxism to prevent fracture and wear.
Case Report
A 60-year-old male patient presented with concerns regarding chipping of his two front teeth along with discoloration and canting of a filling on tooth No. 9 that had been placed several years earlier to repair a fracture (Figure 1). A few different options were discussed in light of the patient’s history of excellent oral care and minimal previous dental treatment. Thus, a conservative esthetic approach was presented to the patient that involved replacing the existing restoration and smoothing the edges of the other anterior teeth. The patient agreed to proceed with this treatment.
For the appointment, the patient was pleased that no anesthetic would be required. Cotton roll isolation was used to retract the lip and give adequate visibility. A No. 330 pear-shaped carbide bur was used to remove the existing restoration on tooth No. 9-DIFL. A medium diamond flame-shaped bur was used to place a facial bevel on the preparation. The resulting rough surface increases the total surface area and maximizes bond strength and retention while allowing the composite to blend seamlessly with the natural tooth structure and mask the cavosurface margin (Figure 2).
A selective-etch technique using BISCO’s Select HV Etch with Benzalkonium Chloride (BAC) was applied (Figure 3). This product’s high viscosity offers precise placement, making it ideal for the selective-etch technique. BISCO’s All-Bond Universal, a single-bottle, light-cured dental adhesive designed to combine etching, priming, and bonding for both direct and indirect restorations, was applied twice with a disposable applicator brush (Figure 4). High-volume suction was used to facilitate solvent evaporation before light curing.
A Mylar strip was placed between teeth Nos. 9 and 10. The composite was warmed using a composite warmer. Preheating composite can reduce viscosity, facilitate adaptation to cavity walls, increase the degree of conversion, and decrease polymerization shrinkage.5 Quantium shade A2-Body was placed incrementally, followed by a thin layer of A1-Enamel (Figure 5). The warmed composite instruments were used to shape and sculpt the material without sticking. Once completed, the restoration was light cured from both the buccal and lingual aspects. A sequence of abrasive polishing discs was then used to finish, contour, and polish the composite material to maintain proper line angles and a natural esthetic appearance (Figure 6).
The bite was verified with articulating paper and adjusted as needed in centric and excursive movements. The original cant of the distal incisal edge of tooth No. 9 remained slightly evident because of the patient’s occlusion. A Brasseler Diacomp Fine cup polisher was used for final polishing (Figure 7). The patient expressed satisfaction with the final result (Figure 8).
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BISCO
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References
1. Burki Z, Watkins S, Wilson R, Fenlon M. A randomised controlled trial to investigate the effects of dehydration on tooth colour. J Dent. 2013;41(3):250-257.
2. Baratieri LN, Ritter AV. Critical appraisal. To bevel or not in anterior composites. J Esthet Restor Dent. 2005;17(4):264-269.
3. Ma KS, Wang LT, Blatz MB. Efficacy of adhesive strategies for restorative dentistry: a systematic review and network meta-analysis of double-blind randomized controlled trials over 12 months of follow-up. J Prosthodont Res. 2023;67(1):35-44.
4. Romero MF, Haddock FJ, Freites AG, Brackett WW, Brackett MG. Restorative technique selection in Class IV direct composite restorations: a simplified method. Oper Dent. 2016;41(3):243-248.
5. Lopes LCP, Terada RSS, Tsuzuki FM, et al. Heating and preheating of dental restorative materials—a systematic review. Clin Oral Investig. 2020;24:4225-4235.
Figures and Images
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John K. Zalesky, DMD, MBS
