Brian is a 15 year old patient who presented to my office with badly decayed teeth after having worn braces for approximately 2 years. Visually, there is no way to determine the extent of decay in each tooth, other than saying that it was extensive. I informed Brian and his mother that any or all of these teeth could require future root canal therapy Once I felt that Brian understood the gravity of his dental situation I was able to begin the restoration.
I used 37% phosphoric acid on the teeth followed by a bonding agent. Then I placed a flowable composite, shade A1, on the dentin surface as well as a slight amount on the enamel, making sure that it was not at the margins of the restoration, and cured for 30 seconds. Note: In my office, all work is done using a Global surgical microscope.
I build out the remaining area of the restoration until I was just shy of full contour. This was done using Cosmedent’s Renamel Microfill shade A1. The contour can be seen very easily from looking at a mirror view from the incisal, a key component to making the restoration look natural.
I then placed the white opaque from Cosmedent’s Creative Color Kit using an IPC instrument. This thin bladed instrument allowed me to manipulate the white opaquer in such a way to give it a natural appearance beneath the surface of the final layer of material. After curing the ‘decalcification’ for 30 seconds, I placed the final layer of composite, again Renamel Microfill A1. I placed enough composite for the final layer in order to be able to polish the material to its proper luster. The material was light cured for 40 seconds. I polished the restorations by first using a 12 blade trimming and finishing carbide, then using Cosmedent’s FlexiDiscs. In cases where the teeth have surface texture, it’s important to not over-polish the composite as that would make the surface too smooth and would not blend well with the tooth to give the most natural appearance.