Restoration of front teeth
Restorative dentistry of the new millennium is becoming more conservative, and this trend is very convenient for both the dentist and his patient.
Thanks to the latest generation of microhybrid compositions, modern adhesive technology allows even in cases of severe loss of dental tissue, for example, during caries or injuries, to save as much of the remaining tooth tissue as possible.
This, in turn, makes it possible to extend the life cycle of damaged teeth, in comparison with traditional, more destructive methods, for example, metal or ceramic crowns. These conservative solutions allow us to achieve aesthetic results comparable to or several times superior to prosthetics.
Current microhybrid composites have physical properties superior to those used in the past. They meet functional requirements much better and allow you to maintain the characteristics of natural dental tissue for a long period. The Enamel Plus HFO system (manufactured by Mitserium, Italy) includes universal dentins and enamels, each of which has different optical properties designed to simulate natural tissues in order to obtain a more realistic reproduction of natural tissue.
Even more than in the material, the doctor needs a technique based on clear communication and standard step-by-step practice. This refutes the view that the successful result of restoration of the front teeth is supposedly primarily a consequence of the aesthetic and artistic talent of a particular doctor. Such an attitude leads to improvisations, for example, to imitation of natural tissue directly during the treatment of the patient, and sometimes ends in disappointment. It is much more realistic to follow the well-known rational method obtained experimentally over more than 20 years of research and clinical trials. This method must be carefully studied; it requires patience, as well as exercises with artificial and extracted teeth.
This article sets out in detail a technique based on reasonable assumptions that allow us to plan and carry out restoration of the front teeth in the most difficult cases, using standard and repetitive actions that lead to the final predictable result.
The most important stages of the method are color determination and filling in the color table.
When working with teeth, five aspects must be distinguished: saturation, brightness, intensity, opalescence and characterization.
First, the basic saturation (color shade) is determined by the internal dentinal body. The system has four colors: A, B, C and D. Bearing in mind that shade A is the middle shade of natural teeth, we developed Universal Dentins (UD) with seven shades (1, 2, 3, 3.5, 4, 5, 6 ) The basic shade of the teeth (BC) determines the average shade from the neck of the tooth to the incisor and correlates with the age of the patient. In young patients, shade 1-2 is most often found (UD1-UD2), in adults – from 2 to 3 (UD2-UD3), and in elderly patients – 3-4 (UD3-UD4). In the left column of the Color Table (Color Chart) four basic shades are shown (BC – 1, 2, 3, 4), and on the right are the names of the masses that exist in seven shades.
Then, the brightness is determined, which determines the degree of luminescence of the hue: black has a zero glow, and white has a maximum glow. The value depends on the thickness, water content and salinity of the enamel. The thicker the enamel layer, the lower its mineralization, the greater the brightness for a given tooth, for example, in children with plaster white teeth.
In elderly patients, on the contrary, the enamel becomes thinner, revealing more mineralized layers that look like glass with a prevailing gray color. We distinguish three types of enamel (children, adults and elderly patients): high brightness (GE 3), medium brightness (GE 2) and low brightness (GE 1). The Color Table contains three values (1, 2, 3), which correspond to low (1), medium (2) and high (3) brightness of the enamel. These three numbers are represented by tones from gray (1) to cold white (2) and milky white (3) to remember the correspondence to the value. The most suitable area for determining this value is the middle third.
In the third place, the intensity is determined, classified by four groups, according to the following forms: spots, clouds, snowflakes and horizontal stripes. These groups are located in the Color Chart for a better classification. White saturated spots are located in areas of hypomineralized enamel and are found on the dental tissue of children and young people. In the Color Table, the numbers 1, 2, 3, and 4 are indicated for classifying this form; the letters W-M indicate the shades of white that exist in natural teeth: W – cold white, M – a warmer milky shade. The suggested masses for reproducing these shades are IW (cool white) and IM (warm white).