Simple Layering

I industry report _ composite restorations
Simple layering
technique with direct
composite restorations
Author_Dr Valdas Vilkinis, Lithuania
Fig. 1 Fig. 2
_For many years, the trend in restorative den- In recent years, anatomic layering techniques
tistry has been to place only one- or two-shade have been advocated by various clinicians aiming
composite restorations in daily practice. However, to achieve a more natural-looking restoration. The
with this approach, it is difficult to achieve a satis- essence of these techniques is similar: recreate lost
factory aesthetic result in anterior teeth. There are tooth structure layer by layer using composite ma-
great variations in colour value (lightness or dark- terials of different opacities. Some of the techniques
ness), depending on the patient’s age and enamel are rather complex, using numerous shades and
thickness, which affect the overall tooth colour. layers, making them difficult to learn and use in daily
It has been proven that aesthetic restorations can practice.
only be achieved if the different values of natural
enamel are recreated with composite material of a In this article, a simple and predictable restora-
similar translucency. tive technique will be described that concentrates
Fig. 3 Fig. 4
26 I cosmetic
dentistry 3_ 2012
industry report _ composite restorations I
Fig. 5 Fig. 6
on the recreation of dental tissues of natural thick- _Step 3

ness, layer by layer. We believe that special atten-
tion has to be paid to restoring the enamel layer. The old restoration is removed and a wide bevel
The image below, with a cross-section of a natural preparation has been made on the labial and palatal
incisor, demonstrates why it is so important to surfaces (flame shaped burs) (Figs. 5 & 6).
concentrate on recreation of this outermost layer
(Figs. 1 & 2).
If you prepare the tooth with wide bevels on the

labial and palatal surfaces (black imaginary prepa-
ration line) around two thirds of the restoration
volume would be constituted of enamel. Enamel
determines the value of the dental shade, being
lighter (higher value) or darker (lower value), while
the dentine determines the hue and chroma of the
dental shade. Enamel becomes darker as individu-
als age, so it is necessary to have several translu-
cent composite shades that can mimic the ageing Fig. 7
enamel.
_Step 4
For a natural-looking anterior restoration, the
most important step is the recreation of the enamel A rubber dam and transparent matrix strips are
and therefore we recommend that you start by placed (Fig. 7).
determining the value. The entire clinical procedure
for this restorative technique is described step by _Step 5
step in the following example. Suppose the tooth
#21 exhibits an inaesthetic restoration of the inci- Firstly, the palatal layer of a translucent com-
sal edge, which would be replaced as follows: posite material, G-ænial IE (GC), can be positioned
by means of a silicon index or by bending the trans-
_Step 1 parent matrix band strips and sculpting the palatal
When determining the value, decreas-

ing the ambient lighting in the operatory
room is advised in order to concentrate
on the incisal edge and middle part of the
neighbouring tooth, where the enamel is
thick, allowing you to determine its colour
(Fig. 3).
_Step 2
The hue and the chroma are determined

from the cervical area of the crown, where
the enamel is thin and the colour of the
Fig. 8 Fig. 9
dentine shines through (Fig. 4).
cosmetic
dentistry 3
_ 2012 I 27
I industry report _ composite restorations
surface morphology of the tooth.

The final gloss was achieved by
means of a Gradia Diapolisher (GC).
The final image of the restoration
reveals good translucency and a
lifelike incisal edge (Figs. 12 & 13).
_Conclusion
Fig. 10 Fig. 11
This technique uses only four or
five different layers of a composite
material in three or four opacities,
and yields a predictable result. For
this reason, it can be used in daily
practice for every Class IV or bro-
ken incisal edge restoration.
The composite material blends

with the natural tooth structure
so well that the preparation line is
Fig. 12 Fig. 13 invisible and the restorations are
well integrated. The extent of the
surface by hand. In order to hide the transition line anatomical layering depends on the class and size
between the tooth and the translucent composite of the lesion. With small Class III and Class V resto-
material, a thin band of the opaque G-ænial in spe- rations, it is easier to achieve good aesthetics with
cial shade AO2 is applied inside. This layer should one or two layers of the composite material. How-
not be extended too far to the end of the incisal edge ever, with large Class IV restorations, use of this
or the gingival preparation line to avoid the opaque technique should be routine, along with a compos-
material shining through (Fig. 8). ite material featuring a wide range of translucent
shades, natural opalescence and fluorescence to
_Step 6 recreate a natural appearance._
The rest of the dentine layers and mamelon

structure are created with G-ænial in shade A2. This _about the author cosmetic
dentistry
layer should also be thin and even more thinned
out in the area of the incisal edge, so as not to block Dr Valdas Vilkinis was born
the natural translucency (Fig. 9). in 1965 in Kaunas, Lithuania.
He obtained his dentistry
_Step 7 degree at the Kaunas
University of Medicine in 1991.
On top of this, a thin layer of very translucent After graduating, he served
G-ænial TE extending to the end of the incisal edge as a clinical instructor at the
is placed to mimic the sclerotic dentine layer (Fig. 10). Faculty of Dentistry at the
This layer helps to create a depth effect and there- Kaunas University of Medicine until 2000. From
fore the incisal edge looks more natural. Note that, 1993 to 1994, he undertook a postgraduate course
at this stage, sufficient space has been left for the on cariology, preventive and operative dentistry,
thick outermost translucent layer. and endodontics at the Royal Dental College
of Aarhus at Aarhus University in Denmark.
_Step 8 He defended his doctoral thesis in 2000.
The outermost translucent layer is created in He has worked in private practice in Kaunas since
the same external special shade used to form the 1999. Dr Vilkinis has served on the editorial board
first palatal layer, G-ænial IE (Fig. 11). of the Journal of Oral and Maxillofacial Research
since 2010. He has held a consultancy agreement
_Step 9 with GC Europe since 2000. He also lectures and
offers hands-on courses on restorative techniques
The restoration is polished with diamond and in Lithuania, Latvia, Estonia and Finland.
Sof-Lex discs (3M ESPE) to recreate the natural
28 I cosmetic
dentistry 3_ 2012
Cyprus
28-29/09/12
INTERNATIONAL CONGRESS IN
IMPLANTOLOGY AND ESTHETIC
DENTISTRY
LECTURERS
OLIVER BRIX ISTVAN URBAN
Germany Hunga
gary
DANIEL EDELHOFF PANOS BAZOS
ermany Greece
EGON EUWE GEORGE GOUMENOS
Italy
l reece
VASILI KAITSAS STAVROS PELEKANOS
taly
l Greece
ANGELO PUTIGNANO ILIA ROUSSOU
Italy Greece
Hilton Park Nicosia

Griva Dighenis Avenue,
Nicosia, Cyprus 1507
Web: nicosia.hilton.com
Information & Registration for Greece:

Omnipress
Tel: +30 210 222 2637 +30 210 213 2084
info omnicongresses.gr
www.omnicongresses.gr www.omnipress.gr
ORGANIZED BY SPONSORS MEDIA SPONSORS
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I industry report _ composite restorations

on the recreation of dental tissues of natural thick- _Step 3

If you prepare the tooth with wide bevels on the

When determining the value, decreas-

The hue and the chroma are determined

surface morphology of the tooth.

The composite material blends

The rest of the dentine layers and mamelon

Hilton Park Nicosia

Information & Registration for Greece:

ORGANIZED BY SPONSORS MEDIA SPONSORS

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