This document outlines a conservative and artistic approach to anterior composite restorations, detailing step-by-step procedures for challenges such as tooth preparation and creating seamless transitions to achieve natural aesthetics. It emphasizes the importance of utilizing color mock-ups, silicone matrices, and specific enamels to replicate the optical and textural qualities of natural teeth. Ultimately, the finished restorations are designed to be indistinguishable from surrounding dentition, showcasing advanced techniques in cosmetic dentistry.

1. Step-by-Step Approaches for Anterior Direct Restorative Challenges
Mastering Composite Artistry to
Create Anterior Masterpieces
Newton Fahl, Jr., DDS

2. This slide show presents a conservative, effective, and artistic
philosophy for performing esthetic direct anterior composite restorations
based on the principles of emulating the proper form, color, and function
of natural dentition. This particular article outlines step-by-step
procedural approaches to solving day-to-day anterior direct restorative
challenges, including tooth preparation, artistic application, and how to
create seamless transitions from tooth substance to the synthetic
composite restoratives using correct finishing and polishing techniques.
Adapted from the full article, which originally appeared in the AACD’s
Journal of Cosmetic Dentistry, Winter 2011 issue.
For more information, visit www.AACD.com.
© 2011-2013 American Academy of Cosmetic Dentistry, All Rights Reserved

3. Color mock-ups were
created for each tooth
according to the achromatic
and chromatic enamel
techniques to verify the
accuracy of the layering
techniques.
A properly trimmed silicone
matrix made on a waxed-up
model is key for
establishing a three-
dimensional blueprint for
layering composite
increments.

5. The lingual shelf must be an
achromatic enamel no thicker than
0.3 mm.
Once cured, the lingual shelves of
both centrals denote amber-whitish
nuances that replicate the
opalescence present in natural
enamel.

6. A fine-tipped dental instrument was used to gently create
the dentin mamelons.

7. If correctly selected and
applied, artificial dentins of different
brands should provide nature-
mimicking color and opacity.
Translucent effect enamels
were used on both teeth to
create natural opalescence
and deep translucency
around and in between the
mamelons.

8. A Vita-based chromatic enamel was applied beyond the bevel line and contoured to
create a seamless transition between the tooth structure and composite.

9. The chromatic enamel was faded-out An achromatic enamel was placed
toward the incisal third and cut back over the lobes to promote higher
along the incisal and proximal areas opacity and color value.
to allow room for value effect
enamels.

10. After refinement and curing, the To render the proximal lobes, a
higher value achromatic enamel microfill shade of the same optical
blended in, replicating optical characteristics as those of the
properties of natural enamel lobes. hybrid composite used on #8 was
placed on #9.

11. A non-VITA, more translucent achromatic hybrid composite enamel was chosen
for the middle lobes of both central incisors to allow more dentin show-through.
After application and light-curing of chromatic and achromatic enamels, both
centrals depict similar optical characteristics. [Right] To establish natural facial
planes, the transitional line angles were evaluated and the facial planes worked
with finishing discs to establish the primary anatomy.

12. The transitional line angles
were worked and the
embrasures opened until
symmetry was achieved.
Anatomy mapping was penciled in
on the centrals to aid in attaining
proper tooth morphology during
finishing.

13. Secondary anatomy was achieved Tertiary anatomy was completed with
with a flame-shaped, fine diamond a diamond bur at slow speed to create
bur to reduce volume and arch-like horizontal lines.
emphasize the proximal lobes.

14. [Left] Worn blunt rubber rotaries were used to eliminate undesired texture and to
impart a smoother appearance. [Right] Specialized chamois and cotton wheels
were used in the polishing steps to produce an enamel-like gloss.
Felt disc and aluminum
oxide paste finalized the
polishing, bringing the
restorations to a smooth
and glossy surface.

15. The finished restorations presented identical color and optical characteristics and
were indistinguishable from the surrounding dentition.

16. The optical properties of the dentin and enamel composites selected for the
buildups replicate the lifelike qualities of natural tooth structures.

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