Composite Restorations: Subtleties in Shade and ... - IneedCE.com

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Figure 13. Finishing of the Class IV restoration Figure 14. Completed Class IV restoration Summary Composite resin restorations now offer reliable, esthetic results, with relative strength and esthetic result depending on the type of composite (nanofilled/microfilled/hybrid) and the specific composite used. It is paramount that shade taking be optimized and a composite selected that fits the desired chairside technique. Recent composites enable the use of single-shade techniques for most restorations, including more challenging cases, reducing chairside time while achieving clinically excellent results. Glossary of Terms Chroma: The actual color of a material Fluorescence: The ability of a material to absorb UV light and produce light that is visible to the naked eye Goniochromatism: The ability of a material to appear to be different colors, depending on the angle from which it is observed Hue: The degree of intensity of the hue (saturation/concentration) Mamelons: The three protrusions on the incisal edge of an incisor that has just erupted Metamerism: The ability of a material to appear to be different colors under different types of light conditions Opacity: The ability of a material to appear dense and to block objects and colors showing through from behind the material Opalescence: The ability of a material to exhibit a shimmer or a milky appearance Translucency: The ability of a material to permit the transmission of light through it Value: The degree of lightness/darkness of a material References 1 Small BW. Direct resin composites for 2002 and beyond. Gen Dent. 2002;50(1):30-3. 2 Baratieri LN, Araujo E, Monteiro S Jr. Color in natural teeth and direct resin composite restorations: essential aspects. Eur J Esthet Dent. 2007;2(2):172-86. 3 O’Brien WJ, Hemmendinger H, Boenke KM, Linger JB, Groh CL. Color distribution of three regions of extracted human teeth. Dent Mater. 1997;13(3):179-85. 4 http://en.wikipedia.org/wiki/Munsell_color_system 5 Cook WD, McAree DC. Optical properties of esthetic restorative materials and natural dentition. J Biomed Mater Res. 1985;19(5):469-88. 6 Paravina RD, O’Neill PN, Swift EJ Jr, Nathanson D, Goodacre CJ. Teaching of colour in predoctoral and postdoctoral dental education in 2009. J Dent. 2010 Jul 3. Epub ahead of print. 7 Kim SJ, Son HH, Cho BH, Lee IB, Um CM. Translucency and masking ability of various opaque-shade composite resins. J Dent. 2009;37(2):102-7. 8 Yu B, Lee YK. Difference in opalescence of restorative materials by the illuminant. Dent Mater. 2009;25(8):1014-21. 9 Sant’Anna Aguiar Dos Reis R, Casemiro LA, Carlino GV, Lins EC, Kurachi C, Bagnato VS, Pires-De-Souza Fde C, Panzeri H. Evaluation of fluorescence of dental composites using contrast ratios to adjacent tooth structure: a pilot study. J Esthet Restor Dent. 2007;19(4):199-206; discussion 207. 10 Chirdon WM, O’Brien WJ, Robertson RE. Mechanisms of goniochromism relevant to restorative dentistry. Dent Mater. 2009;25(6):802-9. 11 Paravina RD, Westland S, Imai FH, Kimura M, Powers JM. Evaluation of blending effect of composites related to restoration size. Dent Mater. 2006;22(4):299-307. 12 Palaniappan S, Bharadwaj D, Mattar DL, Peumans M, Van Meerbeek B, Lambrechts P. Three-year randomized clinical trial to evaluate the clinical performance and wear of a nanocomposite versus a hybrid composite. Dent Mater. 2009 Nov;25(11):1302-14. Epub 2009 Jul 3. 13 Geitel B, Kwiatkowski R, Zimmer S, et al. Clinically controlled study on the quality of class III, IV and V composite restorations after two years. J Adhes Dent. 2004;6(3):247-53. 14 Terry DA, Leinfelder KF. An integration of composite resin with natural tooth structure: the Class IV restoration. Pract Proced Aesthet Dent. 2004;16(3):235-42; quiz 244. 15 Terry DA. Direct applications of a nanocomposite resin system: Part 1 – The evolution of contemporary composite materials. Pract Proced Aesthet Dent. 2004;16(6):417-22. 16 Mitra SB, Wu D, Holmes BN. An application of nanotechnology in advanced dental materials. J Am Dent Assoc. 2003;134(10):1382-90. 17 Kim SH, Lee YK, Lim BS, Rhee SH, Yang HC. Metameric effect between dental porcelain and porcelain repairing resin composite. Dent Mater. 2007;23(3):374-9. 18 Lee YK, Kim JH, Ahn JS. Influence of the changes in the UV component of illumination on the color of composite resins. J Prosthet Dent. 2007;97(6):375-80. 19 Curd FM, Jasinevicius TR, Graves A, Cox V, Sadan A. Comparison of the shade matching ability of dental students using two light sources. J Prosthet Dent. 2006;96(6):391-6. 20 Dental product spotlight. Dental shade guides. J Am Dent Assoc. 2002;133;366-7. 21 http://en.wikipedia.org/wiki/Munsell_color_system 22 Browning WD, Contreras-Bulnes R, Brackett MG, Brackett WW. Color differences: polymerized composite and 8 www.ineedce.com
corresponding Vitapan Classical shade tab. J Dent. 2009;37 Suppl 1:e34-9. 23 Terry DA. Color matching with composite resin: a synchronized shade comparison. Pract Proced Aesthet Dent. 2003;15(7):515- 21; quiz 522. 24 Paravina RD, Kimura M, Powers JM. Color compatibility of resin composites of identical shade designation. Quintessence Int. 2006;37(9):713-9. 25 Samra AP, Pereira SK, Delgado LC, Borges CP. Color stability evaluation of aesthetic restorative materials. Braz Oral Res. 2008;22(3):205-10. 26 Chalifoux PR. Composite tints: mixing composite materials to alter color and techniques to simulate hypocalcification and craze lines. Compend Contin Educ Dent. 2004;25(8):583-4, 586, 588 passim; quiz 592, 613. 27 Arikawa H, Kanie T, Fujii K, Ban S, Homma T, Takahashi H. Optical and color stabilities of paint-on resins for shade modification of restorative resins. Dent Mater J. 2004;23(2):155- 60. 28 Paravina RD, Westland S, Kimura M, Powers JM, Imai FH. Color interaction of dental materials: blending effect of layered composites. Dent Mater. 2006;22(10):903-8. 29 Fahl N Jr. A polychromatic composite layering approach for solving a complex Class IV/direct veneer/diastema combination: Part II. Pract Proced Aesthet Dent. 2007;19(1):17-22. 30 Franco EB, Francischone CE, Medina-Valdivia JR, Baseggio W. Reproducing the natural aspects of dental tissues with resin composites in proximoincisal restorations. Quintessence Int. 2007;38(6):505-10. 31 Terry DA. Restoring the incisal edge. N Y State Dent J. 2005;71(5):30-5. Author Profile Dr. Robert A. Lowe received his Doctor of Dental Surgery degree, magna cum laude, from Loyola University School of Dentistry in 1982. Following graduation, he completed a one year Dental Residency. Dr. Lowe taught Restorative and Rehabilitative Dentistry for 10 years at Loyola University School of Dentistry in Chicago, IL. Dr. Lowe has maintained a full-time private dental practice for 26 years. He is a member of the American Dental Association, a sustaining member of the American Academy of Cosmetic Dentistry, and a member of the American Society of Dental Aesthetics. Dr. Lowe has received Fellowships in the Academy of General Dentistry, International College of Dentists, Academy of Dentistry International, Pierre Fauchard Academy, American College of Dentists, and the International Academy of Dento-Facial Aesthetics. In 2004, Dr. Lowe received the Gordon Christensen Outstanding Lecturer Award for his contributions in the area of Dental Education. In 2005, he received Diplomate status on the American Board of Aesthetic Dentistry. Dr. Lowe has authored several hundred articles in many phases of cosmetic and rehabilitative dentistry, sits on the editorial board of several dental publications, and has contributed to dental textbooks. He is a consultant for a number of dental manufacturers world wide and is active as a key opinion leader in the development of new materials and techniques. Disclaimer The author(s) of this course has/have no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course. Reader Feedback We encourage your comments on this or any PennWell course. For your convenience, an online feedback form is available at www.ineedce.com. Online Completion Use this page to review the questions and answers. Return to www.ineedce.com and sign in. If you have not previously purchased the program select it from the “Online Courses” listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page. Questions 1. Anterior direct restorations in the esthetic zone must _________. a. match the tooth in fine detail b. possess suitable physical characteristics c. possess sufficient strength d. all of the above 2. The most commonly placed esthetic direct restoratives are _________. a. veneers b. composite resins c. amalgams d. none of the above 3. The natural tooth’s shade varies with _________. a. whether enamel and/or dentin is exposed b. the region of the tooth c. the age of the patient d. all of the above 4. In younger patients, enamel and dentin are ________ in the ________area. a. more opaque and less translucent; cervical b. less opaque and more translucent; cervical c. more opaque and less translucent; incisal d. less opaque and more translucent; incisal 5. In newly erupted permanent incisors, the ________ result in a slightly darker, yellowish area at the incisal edges. a. enamelons b. maneloms c. mamelons d. none of the above 6. The deepest colored areas are found _________. a. incisally b. proximally c. cervically d. all of the above 7. Natural teeth with smooth surfaces will appear ________ than those with rough surfaces. a. darker b. yellower c. lighter d. none of the above 8. The three main considerations in color (shade) are based on the system developed by _________. a. Mussella b. Munsella c. Munsell d. Montell 9. The hue is dictated by the _________. a. surroundings b. wavelength of light c. speed of light d. transmittory factors 10. The value is _________. a. degree of lightness or darkness b. dictated by the transmission of light c. dictated by the reflectance of light d. all of the above 11. The degree of light transmission determines the _________. a. translucency b. radiolucency c. transparency d. all of the above 12. The degree of light scattering influences _________. a. Opacity b. Opalescence c. Translucency d. all of the above www.ineedce.com 9
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