Rotated teeth are straightened with composite restoration by adding to areas lingual to an ideal position and reducing tooth structure facial to an ideal position.  Correct tooth dimension should be maintained for esthetics, however, teeth can be altered to visually appear smaller or larger.  Restoration of rotated teeth is further complicated by crowding or diastemas.  Space analysis by visualization, diagnostic wax ups, or measuring teeth and space is required to assure proper esthetic results.

When minimal or no tooth reduction is done no anesthetic is required.  A diamond bur roughens the enamel surface for increased bond strength.  Acid is placed on enamel for 15 to 30 seconds.  Acidity is neutralized so only 10 microns of enamel is removed.  Inorganic structure dissolves quicker than organic structure and a porous, honeycomb surface is created.  Resin bonding agent flows into the honeycomb to create "micromechanical retention". Composite is placed and cured building the tooth incrementally.  When contacts to adjacent teeth are being formed to close spaces, a matrix is placed and composite added.  An opaque lingual wall of composite is used if darkness from the back of the mouth is going to influence composite color.

Final shaping and polishing is achieved with burs, sandpaper disks, rubber wheels, points, cups, and polishing pastes. Mesial distal dimension is measured on the restored tooth and compared to the distal mesial dimension of the adjacent tooth and space. Adjustments are made to the restored tooth with burs or sandpaper disks.  Finishing burs, polishing points, cup and wheels, sandpaper disks, sandpaper or diamond strips, and polishing pastes are used for final surface shaping, contouring and texturing.