Anterior composite restorations are a form of art. Drs. Ian Shuman and David Rice share their favorite resin composites for anterior restorations, opinions about polishing, and more in our latest Ask the Experts feature.
Ian Shuman, DDS
1. Which composites are you using in the anterior?
Direct anterior resin is an art, and all good resin artists usually have a box or drawer filled with all kinds of different composites. However, not all composites are the same. All of us have experienced those cases when we select a composite that we think will be a great match, only to be disappointed with the final cured result. Or perhaps the final polish isn’t as glossy as what you’ve seen in the magazines. The reasons? While different composites may appear to be similar, they have vast differences microscopically.
If you were to compare your different resins under an SEM, you’d find lots of silica, quartz, or glass particles of various sizes, shapes, and amounts. Knowing that anterior resin composites have so much variation, I prefer a reliable single composite system. But that system has to have just the right balance in its particles-to-resin matrix, and the particles should be smooth, even, and of similar size. I believe that Estelite Omega from Tokuyama meets those requirements. I’m very familiar with it and have been using it for my anterior cases since it launched in 2012.
This system offers those biomimetic properties we seek and matches the majority of natural tooth shades and variations. What makes this composite really special is particle size and shape. Using same-sized, spherically shaped nanoparticles, this composite is unique among the crowd.
2. Do you have any special preparation or restorative techniques that help you get maximum esthetics?
No matter the preparation shape after caries removal, I prefer to create a bevel at the cavosurface line angle. Beveling creates the area that allows a smooth, imperceptible blend from composite to enamel. More importantly, beveling also provides an improved barrier to microleakage when compared to the butt-joint design. Nearly 20 years ago, this benefit was demonstrated by Hoelscher, Gregory, Linger, and Pink in the American Journal of Dentistry.1 This was further studied by Swanson, Feigal, Tantbirojn, and Hodges, who showed that beveled margins minimized microleakage on both adult and primary teeth. This leads me to the next important item: etching.2
When you restore a butt-joint margin, as in a class V or class III cavity preparation, the composite is bonded primarily to dentin. A beveled margin involves bonding to enamel, and those bond strengths are supremely enhanced after the beveled enamel is acid etched. There is proof of this in early direct composite anterior veneer cases with acid-etch and resin bonding to enamel only. These cases have been shown to last far longer than others because enamel-resin bonds are very strong.
3. Give us your take on polishing.
Polishing usually takes the longest, because it does involve a number of steps. Much of my final shaping and margin trimming is done with Q-Finishers burs from Komet and carbide polishers from SS White. My go-to shapes are football and flame. These cover the majority of my needs. I use plenty of water spray on composite because a dry bur running against dry composite can actually remove the microscopic particles from the resin matrix, a phenomenon known as “plucking.” This leads to a dull finish and a greater susceptibility to marginal breakdown and leakage.
The next step is further refinement with Brasseler ET composite shaping and polishing discs. I go through all four grits, and I finish with Jazz polishers from SS White. For cases involving the restoration of proximal contacts, polishing strips are a must. Finally, always check your case with floss prior to dismissing the patient. I have encountered resistance to flossing even after a Class V due to curing some of the resin accidentally in the interproximal.
David Rice, DDS
1. Which composites are you using in the anterior?
IPS Empress Direct from Ivoclar Vivadent for what the manufacturer calls “Efficient Esthetics.” It has easy dentin and enamel shades, as well as incisal shades to add translucency.
2. Do you have any special preparation or restorative techniques that help you get maximum esthetics?
Large facial bevels for color blending, Bioclear matrices for diastema closure, and Teflon tape to maximize contour and contact to adjacent teeth.
3. Give us your take on polishing.
Invest the extra few minutes and use a system that steps you through coarse, medium, and fine. The one-step polishers are fine in the posterior, but I prefer the real deal in the anterior.
References
1. Hoelscher DC, Gregory WA, Linger JB, Pink FE. Effect of light source position and bevel placement on facial margin adaptation of resin-based composite restorations. Am J Dent. 2000;13(4):171-175.
2. Swanson TK, Feigal RJ, Tantbirojn D, Hodges JS. Effect of adhesive systems and bevel on enamel margin integrity in primary and permanent teeth. Pediatr Dent. 2008;30(2):134-140.
