This presentation was created during a hands-on course on direct restorations held in Pereira, Colombia. Clinical part by Dr. Maksym Belograd, photography by Dr. Lina María Muñoz.
Click the link to learn more about composite restorations.
More than 60% of the success of a restoration depends on the finishing stage.
The tooth’s form and surface morphology determine its visual appearance, while the way light reflects off the surface creates optical effects that make the tooth appear brighter or darker, shorter or longer, wider or narrower.
In the following slides, a simplified step-by-step protocol for the final finishing of a restoration will be presented, demonstrating how to achieve natural tooth surface effects.
Step 1 – Surface leveling with a diamond bur at low speed and without pressure.
The grit size of the instrument determines the final microtexture. If a more pronounced surface texture is desired, medium- or coarse-grit diamond burs (blue or green bands) are used. For subtle accentuation, fine-grit burs (red band) are preferred.
The procedure is usually performed without water cooling, allowing better control of any surface irregularities. After this step, the surface of the restoration should appear matte.
The magnified photo fragment demonstrates the presence of microtexture.
Next step – working on the planes.
It is important to consider the specific inclination of each plane: the cervical plane is convex, the middle plane is flat, and the incisal plane is angled toward the palatal side.
To better visualize and identify the transitions between planes, they can be outlined with a pencil.
It is essential to remember that the extent of the planes on symmetrical teeth should be identical.
The same bur used in the first step is applied, maintaining the inclination of each plane.
Next step – creating the transitional angles.
This stage determines how wide or narrow the tooth will appear visually.
It is important to ensure that the distance between the transitional angles of symmetrical teeth is identical.
For easier visualization of future highlights, these areas can be marked with a pencil.
The transitional angle between the natural tooth structure and the restoration should form a smooth, continuous line.
By creating a slight bevel from the transitional angle toward the periphery, we emphasize the area of the future highlight.
The procedure is performed using the same bur.
Vertical anatomy. This component of the natural tooth morphology is created using a silicone point (for example, Enhance™, Dentsply).
To guide the process, the desired anatomical features can be outlined with a pencil beforehand.
Next step – horizontal anatomy. If you want to emphasize this component, a very simple and effective trick can be used.
At low speed, gently press the silicone point against a scalpel blade to create fine grooves on the surface of the polishing instrument.
Then, by moving the instrument horizontally across the tooth surface, you can reproduce the natural horizontal texture and relief.
Now the restoration surface needs to be polished.
One of the simplest and most efficient tools for quick polishing is a goat-hair wheel, which is first used dry, and then with polishing paste.
Final result.
The author of this presentation would like to express special thanks to Didier Dietschi, Jordi Manauta, and Daniele Rondoni for their protocol.
To learn more about composite restorations, follow the link.