1. The document discusses different types of composite materials used for direct composite restorations including microfills, microhybrids, and nanofills.
2. Microfill composites most closely simulate the appearance and properties of enamel but have lower strength, microhybrids have higher strength making them more suitable for dentin replacement, and nanofills exhibit good strength and esthetics making them a universal material.
3. Opaquers, tints, and proper technique are important to achieve esthetic results when using composites for direct restorations.
Overview: Dental restoration has taken up dental composites as it is handier and gives a more esthetic look. However, taking care of what percentage of composites and with what thickness it has makes it more convenient to use. One has to know the problems associated with composite usage.
This paper aims to submit the report the aesthetic correction in a disharmonious smile and unsatisfactory composite restorations in anterior teeth who were treated with direct aesthetic restorative procedure. The results show the use of this technique to allows an immediate aesthetic quality, directly and inexpensively restoring the natural features of the smile.
Key words: Composite Resin,Class IV, Aesthetic.
Aesthetic Anterior Composite - A Simple TechniqueCHAULONG NGUYEN
Aesthetic Anterior Composite: A Simple Technique - Prepared & Presented by Dr. ChauLong T. Nguyen, DDS, MAGD, AF AAID at the AGD Annual Meeting on June 7, 2018
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
Overview: Dental restoration has taken up dental composites as it is handier and gives a more esthetic look. However, taking care of what percentage of composites and with what thickness it has makes it more convenient to use. One has to know the problems associated with composite usage.
This paper aims to submit the report the aesthetic correction in a disharmonious smile and unsatisfactory composite restorations in anterior teeth who were treated with direct aesthetic restorative procedure. The results show the use of this technique to allows an immediate aesthetic quality, directly and inexpensively restoring the natural features of the smile.
Key words: Composite Resin,Class IV, Aesthetic.
Aesthetic Anterior Composite - A Simple TechniqueCHAULONG NGUYEN
Aesthetic Anterior Composite: A Simple Technique - Prepared & Presented by Dr. ChauLong T. Nguyen, DDS, MAGD, AF AAID at the AGD Annual Meeting on June 7, 2018
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
Techniques of direct composite restorationMrinaliniDr
Techniques of the direct composite restoration. Includes different instruments, matrix system, wedges, bevel, etching, bonding, and placement of composite along with finishing and polishing and clinical management
Microtomography of Deciduous Teeth EnamelIJERA Editor
Purpose: To develop an in vitro model of de- and re-mineralization with an etching gel (i-Gel) and with a
mineralization varnish - Clinpro ™ White Varnish with TCP (3M).
Methods: The material used is from 20 temporary intact teeth. They are first applied throughe preparation of the
smooth temporary enamel surfaces with a 30 second demineralization with 37% phosphoric acid (i - gel -
etching gel). Then the samples are washed and dried with water and airflow. Demineralized surfaces of the
temporary teeth go through a remineralization with application of varnish - Clinpro ™ White Varnish with TCP.
The measurement was done with a desktop X-ray microtomography scanner SkyScan 1272 produced by the
company Bruker.
Results: Representative images of the observed tooth sample are shown in Figure 3. Figure 1 shows the outer
surface of the tooth on which there are visible specific roughness. Clearly differed are two areas; a lighter one,
i. e. denser, which is on the outside – the tooth enamel, and a darker one – from the inner side of the tooth –
dentin. These two areas are visible on all transverse (software) sections. Such a section is shown in Figure 1.
The enamel thickness of a test sample varies between 300 and 500 μm.
There are noticeable defects on the tooth enamel, which represent dark areas, i.e. areas of reduced density. Such
areas in the depth of the enamel are presented in Figure 3 and 5 and Figure 4, clearly shows their volumetric
nature.Monitoring of the area with "damage" of dental caries, i.e. darker areas of enamel in Figure 4 show that
the larger of the two, which is located closer to the tooth surface in fact does not go out of it. It is covered by a
layer with a thickness between 10 and 14 μm, whose density is very close, and perhaps a bit higher than that of
tooth enamel.
Conclusions:
1. CT has observations that result in such a direction that the tooth surface is uneven as there are areas with
varying degrees of unevenness. In the uneven areas, their height, potentially that of the crystals from
remineralizing coverage, is between 6 and 14 μm, with a horizontal size 14-40 μm.
2. In the tooth enamel monitor an area is observed that is "sealed" with a layer of a density close to that of
healthy dental enamel and a thickness of 10-14 μm. In cutting of a sample such layer has also emerged on its
surface. This leads to the hypothesis of the presence of the enamel coating layer whose density is very similar to
that of the enamel.
This paper aims to submit the report the aesthetic correction in a disharmonious smile and unsatisfactory composite restorations in anterior teeth who were treated with direct aesthetic restorative procedure. The results show the use of this technique to allows an immediate aesthetic quality, directly and inexpensively restoring the natural features of the smile.
Key Words: Composite Resin,Class IV, Aesthetic.
Dentin bonding agents/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Mastering Composite Artistry to Create Anterior Masterpieces: Step-by-Step Approaches for Anterior Direct Restorative Challenges, with Newton Fahl, Jr., DDS
Techniques of direct composite restorationMrinaliniDr
Techniques of the direct composite restoration. Includes different instruments, matrix system, wedges, bevel, etching, bonding, and placement of composite along with finishing and polishing and clinical management
Microtomography of Deciduous Teeth EnamelIJERA Editor
Purpose: To develop an in vitro model of de- and re-mineralization with an etching gel (i-Gel) and with a
mineralization varnish - Clinpro ™ White Varnish with TCP (3M).
Methods: The material used is from 20 temporary intact teeth. They are first applied throughe preparation of the
smooth temporary enamel surfaces with a 30 second demineralization with 37% phosphoric acid (i - gel -
etching gel). Then the samples are washed and dried with water and airflow. Demineralized surfaces of the
temporary teeth go through a remineralization with application of varnish - Clinpro ™ White Varnish with TCP.
The measurement was done with a desktop X-ray microtomography scanner SkyScan 1272 produced by the
company Bruker.
Results: Representative images of the observed tooth sample are shown in Figure 3. Figure 1 shows the outer
surface of the tooth on which there are visible specific roughness. Clearly differed are two areas; a lighter one,
i. e. denser, which is on the outside – the tooth enamel, and a darker one – from the inner side of the tooth –
dentin. These two areas are visible on all transverse (software) sections. Such a section is shown in Figure 1.
The enamel thickness of a test sample varies between 300 and 500 μm.
There are noticeable defects on the tooth enamel, which represent dark areas, i.e. areas of reduced density. Such
areas in the depth of the enamel are presented in Figure 3 and 5 and Figure 4, clearly shows their volumetric
nature.Monitoring of the area with "damage" of dental caries, i.e. darker areas of enamel in Figure 4 show that
the larger of the two, which is located closer to the tooth surface in fact does not go out of it. It is covered by a
layer with a thickness between 10 and 14 μm, whose density is very close, and perhaps a bit higher than that of
tooth enamel.
Conclusions:
1. CT has observations that result in such a direction that the tooth surface is uneven as there are areas with
varying degrees of unevenness. In the uneven areas, their height, potentially that of the crystals from
remineralizing coverage, is between 6 and 14 μm, with a horizontal size 14-40 μm.
2. In the tooth enamel monitor an area is observed that is "sealed" with a layer of a density close to that of
healthy dental enamel and a thickness of 10-14 μm. In cutting of a sample such layer has also emerged on its
surface. This leads to the hypothesis of the presence of the enamel coating layer whose density is very similar to
that of the enamel.
This paper aims to submit the report the aesthetic correction in a disharmonious smile and unsatisfactory composite restorations in anterior teeth who were treated with direct aesthetic restorative procedure. The results show the use of this technique to allows an immediate aesthetic quality, directly and inexpensively restoring the natural features of the smile.
Key Words: Composite Resin,Class IV, Aesthetic.
Dentin bonding agents/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Mastering Composite Artistry to Create Anterior Masterpieces: Step-by-Step Approaches for Anterior Direct Restorative Challenges, with Newton Fahl, Jr., DDS
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
In the last decades the development of the porcelain materials, the reliable bonding strength to enamel and dentin, and the bonding of resin cement to the porcelain through the silane, Porcelain laminates become trusted type of treatment in the daily practice.
It is an aesthetic treatment that concerns mainly the labial face of the anterior teeth, its thickness is about 0.3 mm in the cervical area to 0.4 -7 at the incisal third, in certain cases it can be done without any prep or just little touch of the enamel (lumineer), but in most prep is indicated to improve the adaptation in the cervical area also to remove the aprismatic enamel layer which which has low bonding strength with the resin cement, however prep should be in the enamel limits, 3 different type of prep are practiced, however, they are the same on the labial surface but the but the difference concerns the incisal edge.
In this lecture, indications and contraindications are exposed. All the materials in use and their indications as well as the clinical procedures are detailed.
Veneers /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Mercury from restorations constitutes the largest non occupational source of mercury in the general population, being greater than all environmental sources combined
The pulp is the formative organ of the tooth.
The pulp has been described as highly resistant organ and as organ with little resistance or recuperating ability.
Its resistance depends on cellular activity, nutritional supply, age and other metabolic and physiologic parame
1 effect of different bleaching materials on color of stained resinAmeer Al-Ameedee
In this work, ZnO, and TiO
2
(Hombikat UV 100) and TiO2 doped with 0.5 % of Pt, and Pd metals, that
prepared by photo deposition method. The bare TiO
2
and prepared samples were characterized by powder
X-ray diffraction (XRD), UV–vis diffuse reflectance spectra (UV–vis DRS), nitrogen adsorption BET, and
atomic force microscopy (AFM) were evaluate the effect of photochemical activation by kinds of
semiconductors (ZnO, TiO2, Pt/TiO2, and Pd/TiO2) in bleaching gels with UV-light type A, with the
purpose of accelerating the process of pigmented component oxidation on Filtek Z350XT resin composite
(3M ESPE).The bare catalysts and metal doped prepared where testing by taken twenty-five disc-shaped of
the Filtek Z350XT resin composite specimens (3M ESPE) were used in this study, then immersion in tea
staining solutions, after that they were randomly divided into five groups specimens (each group n = 10)
according to the type of whitening chemical materials treatment applied(ZnO, Pt/TiO
2
, TiO
2
, Pd/TiO2 and
TiO2/UV 100). The color measurements were taken: at baseline, after immersion and after chemical
treatment procedures by using a stereomicroscope (vita easy shade device). The results recorded,
tabulated and statwastically analyses.The results showed the highest mean color difference ∆E values
were: group two Pt/TiO2, group three TiO2, group five TiO2 / UV 100, Pd/TiO2 and group one ZnO
respectively. However, there was no statistically significant difference in-group three TiO
2.
In addition, a
whitening effect was demonstrated with group two Pt/TiO
2
and group five TiO
2
/ UV 100 showed
statistically significant lowest in a* color space compared to others groups. In addition, results show
immersion tea staining solutions had a positive influence on the color changes of resin composite.
Effect of aqueous suspensions of titanium dioxide in photoreactor withAmeer Al-Ameedee
The study performed to assess the effect of titanium dioxide using (Photoreactor) with the source of radiation on the color change of the
three contemporary dental fillings by composite resin material. The resins were divided into three groups head of considering the type of
charge and each group of which is composed of five discs and each disc thickness of 2 mm and diameter of 5 mm and manufactured by
the mold of Teflon material and then been refined and soften the disc surface and stored in distilled water for one week at 37 °C in order
to complete the polymerization. After the completion of the first week is staining the surface of disks and putting it in a solution of iodine
mouth wash (AVALON pharma
®
) at 37 °C for a period of just one week after the completion of this week has been directed drive and put
it in aqueous suspension consisting of titanium dioxide in Photoreactor Radiation with 355 NM periods of time 0, 5, 10, 15 and 30
seconds. Colorimetric readings were taken of the tablets based on, before staining substance iodine solution, after staining discs textured
iodine solution and after treatment disks Palmalq water for titanium dioxide. In addition, the absorbance was measured after each period
of time and put the disks. Palmalq watery results were analyzed statistically. There were significant effects on pay chromatography and the
palace of color where are different for each group from the other and come the second group of the most influential change chromatography
and minors chromatography and then finished second the third set. Finally, comes the first group, as well as influenced by absorbance
time in extrusive and different for each group of the three groups of disk attributed to their chemical composition
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Chapter 3 - Islamic Banking Products and Services.pptx
Lect.3
1. 1
Lect. 3 operative Dr. Ameer AL-Ameedee
Direct composite restorations from Esthetic view:
Modern resin materials have opened a huge door of opportunity for both dentists and patients by offering an
esthetic and minimally invasive alternative for restoring the dentition that can be accomplished in just one office visit.
Direct composite restorations make it possible to restore defects, repair tooth structure invisibly (Figures 1 to 3), and
change tooth shape and alignment (Figures 4 and 5) without the use of a dental laboratory.
2. 2
For esthetic results to be achieved, proper technique and the choice of materials are of paramount
importance. Physical and handling properties, opacity, translucency, color stability, and polishability greatly affect the
esthetic outcome of the restoration.
When proper technique and the proper choice of materials are combined, the result will leave the dentist and
patient more than satisfied, composite procedures are actually less stressful for dentists because tooth preparation is
kept to a minimum, no impressions are necessary, no temporization is required, the results are instantaneous, and
there is no lag time because the laboratory is eliminated. Dentists can also use composite to quickly mock up the final
results for their patients. Having patients see what their dentist can do for them.
Over time, many different bonding agents have been developed with varying adhesive qualities. This is
important because bonding agents allowed the dentist to have complete control in placing, shaping, and sculpting
composite material. The new adhesive qualities permitted higher bond strengths to enamel and dentin and yielded a
better bond to metal, porcelain, and other materials.
1- Macrofill materials were the first composites used in direct anterior dentistry. Macrofill composites were
highly filled, large-particle-sized materials exhibiting great strength and low esthetic properties. In 1978 the
first microfill material was developed and has since been the premier material for simulating the enamel
surface.
2- Microfill composites are the best material for simulating the enamel surface both esthetically and
biologically. Owing to their small-sized, uniform, spherical particles, microfills exhibit the greatest long-term
polish and the best wear resistance; they are the most plaque resistant and exhibit a refractive and reflective
index closest to that of the enamel surface. Microfills also most closely simulate the enamel surface in color
density, polishability, light refraction, and reflection, in both the short and long terms, and give the natural
vitality of a finished enamel surface. Microfills have a translucence that most closely resembles enamel, thus
allowing tints to shine through. When microfill composites are used, fracture toughness must be addressed.
The single contraindication for a microfill is use in high-stress areas because of its lowered fracture toughness.
3- The Microhybrids composite materials were first developed to compete with microfill materials owing to
their higher strength properties. Although microhybrids are not as polishable or as compatible with the tissues
as microfill composites, their strength and opacity are extremely helpful in simulating the strength and support
characteristics of the dentin. These composites work well for posterior restorations and, because of their
increased opacity, for masking of dark or discolored areas. Their esthetic properties are not as good as those of
a microfill or a nanofill composite; however, their physical properties include strength and fracture toughness.
The mean particle size range of microhybrids is 0.4 to 0.7 micron. The larger particles are agglomerated up to
35 microns to give the material workability and strength. Because of their larger particle size, microhybrids are
not as polishable. The esthetic qualities of microhybrid composites do not compare with those of a microfill in
any way.
4- The Nanofills composite materials are considered today’s universal material, exhibiting qualities of immediate
polishability and great surface smoothness. In addition, nanofill materials are strong, demonstrate low
shrinkage, and offer good opaquing qualities. They are recommended for use on their own or underneath a
microfill, except in areas where extreme color changes are needed. Their translucent quality allows the
vitality of the tooth to be apparent when the light reflects through them. When used as a universal anterior
material, nanofills exhibit excellent surface smoothness and ease of handling and good color. However, when
compared with microfills, they will not maintain their polish long term and do not have the same translucent
qualities of enamel. Although not yet proven clinically, nanofill composites are unlikely to be as biologically
compatible with the gingival tissues over time as their microfill counterparts.
To summarize:
1- microhybrids exhibit great strength and opacity; therefore they are great for dentin replacement.
2- Nanohybrids exhibit good strength and better esthetics then microhybrids and thus are more suited for a
universal material.
3- Microfill composites are the most esthetic of the three composite types and are the only materials that closely
simulate the enamel surface. (Microhybrids and nanofills simulate dentin in strength and opacity, whereas
microfill simulates enamel.)
4- When there is enamel involvement, especially in anterior sites, microfill is still the most appropriate choice.
5- If the dentin’s physical properties are an issue, either nanofill or microhybrids are more appropriate.
3. 3
Opaquers help dentists achieve complete invisibility of the restoration with composite by blocking unwanted
color and raising the value of the final restoration. Opaquers are primarily used to block out the unwanted shine-
though from a dark under-color, to block metal, to cover a tetracycline stain, or to eliminate unesthetic translucent
shine-through. The best example for the value of a reliable opaquing system is when repairing a fractured incisor. Often
clinicians try to replicate the dentin color and then overlay this layer with a compensating shade of enamel to achieve
the right surface color.
For example, if a fractured tooth is A1, then an A1 hybrid or nanofill can be added to recreate the incisal dentin
portion of the tooth to help achieve opacity and strength. To eliminate translucent shine-through, an A1 opaquer can
be placed over the top of the nanofill or microhybrid (Figure 6) to block and blend. Once the shine-through has been
eliminated, there should be no difference between the tooth surface and the restoration. The addition of A1 microfill
will create a perfect match of material to tooth structure and completely simulate the entire enamel surface once
finished and polished. In this type of system, the colors of the opaquers, microhybrids, nanofills, and microfills should
match one another and the corresponding shade guide exactly; only their values are different.
Tints are yet another underutilized material that if used properly can greatly enhance the esthetics of anterior
composite restorations. Tints are used to enhance incisal translucency as well as gingival hue and chroma. A good tint
must be transparent to allow the light to shine through and carry the color into the overlying composite layer.
Because of its translucency, microfill is the only composite material that truly allows this phenomenon of color shine-
through to take place, creating the color realism from within (Figure 7). This is yet another reason for using microfill as
the prime enamel layer.
4. 4
Clinical consideration
Composite Indications:
1-Composite materials are indicated for almost all types of anterior restorations, from surface and incisal defects to
routine restorations such as class III (Figure 8), class IV (Figure 9), and class V (Figure 10).
2-They are ideally suited for other situations such as diastema closures, anterior veneering for color change, tooth
reshaping, and tooth realignment to obtain a desired smile design (Figure 11).
3-Composites can be used for any type of treatment; such as full-bonded crowns (Figure 12), short-span anterior
bridges, and porcelain repairs (Figure 13) which can all be constructed with direct composite resin.
4-The indications for the use of anterior composite materials depend on how skilled the operator is, how comfortable
the procedure feels, and how well the operator can develop the desired restoration. (Figure 14)
5. 5
Consider these important advantages of composites:
1. These types of restorations require minimal or no preparation.
2. Patient comfort is increased (often no anesthesia is required).
3. No temporization is necessary.
4. Dentists have complete control over the final result because a laboratory technician is not involved.
5. If something does break, it is easily repairable.
6. 6
For restorative procedures it is important to properly estimate the value of the procedure and reflect that value in how
much is charged, technique can be used to save a person’s tooth and restore it beautifully.
Contraindications:
Anterior direct composite restorations should not be done by a dentist who does not feel sufficiently skilled. Patients
who have areas of extremely high stress, such as severe bruxers or clenchers who refuse to wear nighttime
appliances, in overly aggressive eaters (e.g., those who chew hard candy), and in fingernail biters. In cases with long-
span spaces to be restored, these restorations are generally not successful.
Treatment planning:
Treatment planning is driven by the characteristics of each individual case. For patients who have no problems with
their centric occlusion, centric relation or vertical dimension, treatment planning can be done in segments. Anterior
restorations can be accomplished without restoring the posterior, always remember to look at tooth size, inclination,
rotation, or position and then visualize what needs to be done to create the illusion of perfection. For patients whose
teeth are over-closed and those with decreased vertical dimension, it is necessary to treat the posterior occlusion first
before addressing the anterior problems. Once the correct vertical dimension and centric occlusion have been
established, then the proper anterior length and incisal guidance can be achieved with ease (Figure 15).
Sequence of Treatment
When planning a case, dentists must first look at the patient’s occlusion and all of the excursive and protrusive
movements. If a person has either lateral or protrusive interferences, these must be addressed before tooth
lengthening. For example, establishing proper canine rise with the use of composite is an excellent way to allow dentists
the space necessary for tooth lengthening and proper disclusion (Figure16). In wear cases, the patient’s mouth is
treated according to the lip line. Often it is necessary to restore the cusp tips of the bicuspids and at least the first
molar to achieve the ideal look and the uniform curve of Spee.
Treatment Considerations:
The treatment considerations depend on what the patient wants. It is important to get the patient’s input on the
proposed treatment, particularly when creating a complete color change. During a patient consultation, let the patient
do the talking, then offer him or her advice and discuss the options available. Often the patient does not see exactly
what all the problems are. Doing just half the case will never make a patient happy. In treatment considerations, a thor-
ough functional and esthetic diagnosis is essential to get the best result. After treatment, patient input is also welcome.
The first treatment choice would be a layered technique, which would simulate both the enamel and the dentin layers.
In the procedure, a material that simulates the dentin—a hybrid or nanofill—is used first, followed by a material that
simulates the enamel—typically a microfill placed on the outermost surface. Knowledge of opaquing and tinting
principles helps in achieving invisibility and overall consistency in the final restoration.
7. 7
Clinical conservation concepts:
The object of minimally invasive dentistry with the use of direct resin bonding is the preservation of tooth
structure. In preparation, dentists should consider how conservative the approach can be, what the plan is,
and how minimally invasively the results can be achieved. The hard tissues should be preserved whenever
possible because excessive destruction of these tissues can cause many long-term problems. The amount of
preparation depends on the procedure to be done. For example, if a tooth is in labial version, the preparation
may extend into the dentin, whereas if the tooth is in lingual version, no preparation may be necessary. It is
desirable in any preparation to maintain as much enamel as possible for the best adhesion of the composite.
Morphology:
It is often difficult for dentists to shape anterior teeth properly. To establish proper morphology:
1-The dentist must recognize the relationship of tooth size and form to the facial structure and understand
the relationship of lip line to tooth size.
2- A completed smile should follow the curvature of the lip line.
3-The art form of creating correct morphology is sculpting, in order for the dentist to achieve proper sculpting
of the tooth form and to be able to manipulate the material beneath the gingiva, the dentist must have
8. 8
proper instrumentation, such as Cosmedent’s anterior instruments. These titanium-coated instruments
make it easier to apply and refine morphological aspects of tooth formation (Figure 17).
Smile relation:
After observation of the occlusion in relationship to the lip line and an exploration of the patient’s needs
and wants, the occlusal relationship and the relationship in phonetics must be considered. It is important
that the patient be able to pronounce the sounds needed for communication. The relationship of one tooth
to another is explored because not all teeth are the same length. The central incisors are more prominent,
the laterals are less prominent and perhaps a millimeter shorter, and the canines are longer, about the same
length as the central incisors. It is desirable to have a nice smile line and a good curve of Spee, plus well-
defined contact areas with good proximal contact, although sometimes some spacing may be desirable. The
dental arches should conform to the relationship of the buccal mucosa over the dentition so that no
negative space and no narrowing of the arch form are present. The smile line should follow the lip line, giving
a good curve of Spee and avoiding a negative smile (Figure 18).
9. 9
The importance of color:
There are many techniques for color management. Shade taking has always been a problematic area for
dentists. Some materials do, in fact, match existing porcelain shades guides exactly (Figure 19). Some
manufacturers make shade guides from polymerized and polished materials to work with their system.
There are three different aspects of color in the tooth structure (hue, chroma, and value):
1-Hue is the actual color of the tooth; the color one can see.
2-Chroma is the density of that color. This correlates to the depth of intensity or how much color is present.
3-Value is the relative lightness and darkness of the tooth.
In trying to take a shade, overall hue is seen in the center of the tooth or the center of the shade guide.
Looking at the tooth from the front will help determine the density of the gingival color and whether there
is a deeper chroma or more color at the gingival margin or the tooth has a straight flat color gingival to incisal.
The incisal edge will show the amount and color of translucency. This may be, on the blue side, violet side, or
gray side. Taking all Electronic or computerized instruments are now available to help match shade.
Taking a shade should always be done in a moist environment. Drying the area dehydrate the tooth, and it
loses its color. Shade reading is best taken under fluorescent light; the whiter the better. Shades can be
taken in colored light, but not in sunlight because sunlight contains all shades, which will influence the
appearance of the tooth.
Translucency is different for every patient and every tooth. Dentists tend to consider translucency as uniform,
but some patients have no translucency in their teeth. The translucency is very important because in a vital
tooth there is subtlety of transfer. People like subtle translucency; it is something they can see. Generally
people do not like hyper-translucent incisal edges. Teeth that are so thin that they can be seen through are
not esthetically pleasing.
Beveling:
In preparing the facial aspect of a class III or IV or the buccal aspect of a class V restoration, beveling is
important for making the margin of the restoration disappear into the tooth structure. The preferred
method is a feather-edged bevel blended into the enamel surface (Figure 9-20). Neither butt joints nor
chamfers are desirable. Once composite material is placed past the bevel, it should be finished and polished
into the enamel surface, following its contours past the long bevel. One should never polish to the beveled
margin because this will create an area of visible demarcation between the restoration and the tooth surface.
10. 10
Contouring, finishing, and polishing anterior composites:
A common mistake made by most practitioners is trying to polish without properly contouring the
restoration first. Proper contouring can be accomplished only if one sculpts the material to correct
morphological shape before polymerization (Figure 21). Precontouring is accomplished through the use of
reliable instruments such as fine diamonds, esthetic trimming carbides, or coarse disks (Figure 22). Once the
proper contour has been achieved with these instruments, then the finishing and polishing process can be
started. It is extremely doubtful that this will ever happen. It takes a series of different systems to obtain the
best finish and polish. Composite materials cannot be marginated with the use of silicone or rubber-
impregnated material alone. The only way to properly marginate composite material is with the use of a
series of different aluminum oxide disks with various grits ranging from coarse to superfine (Figure 23).
A aluminum oxide– or diamond-impregnated instruments will characterize composite restorations very nicely
(Figure 24). Diamond-impregnated rubber instruments are also extremely helpful in polishing hybrids and
nanofills, but they will not polish a microfill as well as the aluminum oxide cups and points. Given all the
finishing and polishing instruments that are available, it is a matter of finding the ones that work best for each
material. The final step of polishing should include the use of an aluminum oxide polishing paste on microfill
and the use of a fine diamond polishing paste followed by an aluminum oxide polishing paste on a
microhybrid or a nanohybrid. Using these pastes under pressure, with a felt wheel, point, or felt disk will
highly enhance the final polish (Figure 25).