Clinical steps - FGM-Dental: Startseite

clinical case
White Post
Direct composite veneers with
Opallis: Clinical steps
Dr. Sanzio Marques
MS in Restorative Dentistry (FO-UFMG); Specialist in Dental Prothesis (FORP-USP);
Author of the book intitled “Estética com resinas compostas em dentes anteriores:
percepção, arte e naturalidade”; Coordinator of the Course of Excellence in Esthetic
Dentistry of IEO - Belo Horizonte, Brazil; Coordinator of the Course Mastering the Art
with Composite Resins of IEO – Belo Horizonte, Brazil.
www.sorrisobelo.com.br
INTRODUCTION
Teeth with severe darkening need enough space for opacification of the undesirable color and still allow
a sufficient depth (light penetration in subsequent layers) for performing a natural restoration. The clinical
common sense supposes the prior cementation of glass fiber posts for strengthening purposes in cases of
severe loss of the dental structure. In this article we described the step-by-step placement of direct veneers
in two endodontically-treated maxillary central incisors with a severe darkening.
1, 2 and 3. Initial picture showing the severe darkening of teeth 11 and 21.
4. Measurement of the fiber post length
by means of a largo drill and a stopper. A
minimum of 5 mm of gutta-percha should
be left in the intact delta apical area. A good
radiographic examination is crucial at this stage.
5, 6, 7 and 8. Palatal view of the central incisors, removal of the root canal filling with a
Largo drill and root canal preparation with the special preparation drills from the kit of fiber
glass post White Post DC (FGM), according to sizes previously selected on the radiographic
evaluation. Two DC3 fiber posts were selected for this clinical case.
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7. 8. 9 and 10. Testing the adaptation of the posts
inside the prepared root canals. The exceeding
coronal portion was cut-off.
FGMNews Magazine - Edition # 3 - January 2011

clinical case
White Post
10.
11 and 12. Surface treatment of the fiber post. The fiber posts were cleaned with alcohol. With
the aid of a Cavibrush (FGM) the silane Prosil was applied and left on the surface for 60 seconds.
13, 14 and 15 . Treatment of the root canal and pulp chamber. Acid etching with 37% phosphoric acid for 15 seconds, acid removal and water
rinsing with a hypodermic syringe with fine cannula. The root canals were dried with absorbing paper cones and the dentin was left moist before
adhesive application.
16, 17, 18, 19 and 20. Application of a dual-cured adhesive system. The primer was applied and the excess were removed with absorbing paper
cones and a stream of air. Then, the primer was light-cured. The mix of base and catalyst of the adhesive was applied followed by removal of
excess with absorbing paper cones and an air stream.
19.
20.
21. A lentulo drill is used to transfer the
AllCem resin cement (FGM) to the root canal
after mixing the base and catalyst pastes.
22 and 23. Placement of the fiber glass posts White Post DC (FGM) and resin cement light
curing for 60 seconds.
24 and 25. An increment of the composite
resin Opallis (FGM) to seal out the pulp
chamber is being light-cured.
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clinical case
White Post
25.
26 and 27. Stone model of the upper arch obtained from an alginate impression. The stone
model was waxed-up in order to re-establish the cervical–incisal dimension of the worn incisal
edges of teeth 11 and 21. A silicone guide was constructed with a using a putty addition
silicone impression material to aid the restorative procedure.
28. Placement of the retraction cord Pro
Retract 00 (FGM) in the gingival sulcus to
reduce the possibility of contamination
of restoration by gingival fluid once the
restoration was performed under a modified
rubber dam isolation.
29 and 30. Preparation of a marginal groove to guide the reduction of the enamel on the buccal
surface.
31, 32 and 33. Reduction of buccal and incisal enamel. The amount of structure reduction was checked witht the silicone guide (approximately
2 mm). The preparation was finished with Diamond Pro disks (FGM).
34. A layer of the most opaque resin from
the Opallis kit (shade OW) was placed on
the preparation and light-cured to test its
ability to mask the tooth discoloration. We
concluded that this layer would not mask well
the discoloration unless we placed a thicker
increment. However the latter approach would
reduce the depth of the following composite
layers producing a restoration with a dull
aspect and without a natural appearance.
35 and 36. Finished preparation with the operative field properly isolated. Observe that we
controlled a small bleeding in the gingival margin with the FGM hemostatic agent.
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FGMNews Magazine - Edition # 3 - January 2011

clinical case
White Post
37, 38 and 39. Acid etching of the prepared suraces with Condac 37 (FGM) for 15 seconds, followed by the application of a two-step adhesive
and light-curing.
39. 40.
40, 41 and 42. A small increment of translucent enamel (T-Blue shade, Opallis, FGM) was placed on the silicone guide for reproduction of the
palatal and incisal enamel.
43 and 44. Application of an opaque layer of the Creative Color Opaquer Pink to mask
the dental structure discoloration. A thin layer of this opaque paste were able to mask the
discoloration. This would only be possible with OW resin if a very thick layer were used. Then,
we employed subsequent composite layers using more translucent resins, gaining in beauty and
naturalness.
45. Placement of a thin layer of the opaque
composite Opallis OP (FGM) to reproduce the
dentin structure.
46 and 47. Opallis DA4 was used to increase the chroma of the cervical region. Opallis DA2 was
used in the medium and incisal thirds, keeping the design of the incisal mamelons.
48 and 49. A thin layer of Opallis T-Blue
(FGM) was placed in the incisal edge around
the dentin mamelons. Observe the subtle
effect of translucency and opalescence after
polymerization of this layer.
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clinical case
White Post
49.
50 and 51. Characterization of the composite restoration with colored tints. The white tint was
painted to simulate enamel hypoplasia and the ochre color to reproduce counter-opalescence.
52. Buccal enamel is being reproduced with
a Opallis E Bleach and Opallis VM (medium
value) (FGM).
53. Final light-activation after placement
of a thin layer of Oxiblock (FGM) to reduce
the oxygen inhibition and allow a better
polymerization of the superficial composite
resin layer.
54.
54, 55 and 56. The cervical excess was removed with a sharp blade (#12). With the same blade,
we performed a kind of interdental cut, followed by a twist with a spatula to separate the teeth.
57.
57, 58, 59 and 60. Determination of the basic format of the teeth with the coarse-grit Diamond Pro disk (FGM).
61 - 69. The surface texture and the shiny of the enamel surfaces were reproduced using the Diamond Pro (FGM) disks along with diamond burs
and aluminum oxide paste with Diamond Flex (FGM) felt disks. In the interproximal areas, the Epitex polishing strips were used.
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64. 65. 66.
67. 68. 69.
70 - 72. Excellent esthetic result obtained with the placement of direct composite veneers with Opallis composite. Observe the natural aspect
and similarity with the other patient’s teeth.
73 and 74. Natural fluorescence and opalescence of Opallis composite (FGM).
75. Final clinical aspect. 76. Initial clinical aspect.
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