WHAT CONSTITUTE POSTERIOR ESTHETICS?

ANATOMY – POSTERIOR ANATOMY (explain about cusps & ridges?, centripetal technique to minimize shrinkage?)

SIMPLE – SINGLE SHADE COMPOSITE

RESTORATION THAT LASTS – SCULPT EXCELLENT DURABILITY.

• The case for single shade aesthetic restorations

• Simple technique – ability of the composite to be sculpted
• The shape improves the shade – any restoration which is made with natural anatomy would always
look good, even if the shade is not perfect
• Morphology/ shape modifications: Basic and Primary anatomy- maintain correct shape and copy
adjacent tooth
• Polish and retain secondary texture or indentations/depressions, relief of growth lobes
• Tertiary texture- the little lines
• The concept also introduces combining “Injectable composite” ie GUF, and heated paste composite- to
get a more homogenous surface of composite
• Polishing and high gloss retention is essential

The Need for Simplification

Composite systems require mastery of multiple layers of dentin, body, and enamel composites to achieve natural-looking
restorations based on optical properties and tooth anatomy. Because multiple physical characteristics are considered, it is time-
consuming to evaluate material properties and determine suitability for specific cases or areas in the mouth. Simplification
requires a universal direct composite that is esthetically capable of reflecting and refracting light in one shade layer and is strong
enough to survive in the posterior.

Placing tooth colored direct composite restorations is a clinical challenge for even the most experienced clinician. Aside from the
technique sensitivities involved in adhesive bonding, determining a shade (whether single or layered) that predictably and
precisely matches the natural tooth each and every time can be extremely difficult. Shading for most composite materials relies
on a 1950’s technology – the VITA Lumin Shade Guide. The reality is that for many brands, any particular shade, A1 for example,
doesn’t precisely match the VITA A1 shade guide, let alone other so-called A1 materials! This can be extremely frustrating for the
clinician, especially with a patient that is “picky” about esthetic matching. It is even harder when using bleach shades as there is
little to no standardization of those high value materials. Having a universal single shade of composite material that takes the
guesswork out of shade selection and matches the majority of clinical situations is something that is at the top of most clinicians’
wish lists.

Do you believe in aesthetics in one shot? A single shade in direct posterior restorations solves this problem, especially if the selected opacity is

correct, this choice becomes extremely easy as the right opacity is found in the most commonly available composites.

Composite Body shades are medium opacity masses, at the very beginning of the history of aesthetic materials, these were almost the only

choice, dentin or enamel shades did not exist, or they were extremely difficult to find. Little by little complementary masses started appearing.

When composite stratification became a common method, body shades became the “lazy” alternative and many colleagues were commonly

criticized for “not being refined” for using these shades. It was in fact that thousand of colleagues learned by experience that in many cases

layering composites was just counterproductive. The perfect example are the posterior teeth.

Body shades are different among them, even if two shades share the exact same opacity, they may be different while transmitting and blocking

light, with different light scattering features, making one more effective while masking. Optical features are vast and we will discuss them in

following articles.
The author and many of the fellow members of this group agree with the following statement. “Many of the best posterior restorations I have

seen in my life, to my surprise were single shades”.

1. Spreafico R. Direct and semi-direct posterior composite restorations. Pract Periodontics Aesthet Dent 1996;8:703–712.

2. Sieber C. Voyage–Visions in Color and Form. Chicago: Quintessence, 1994.

3. Kataoka S. Nature’s Morphology: An Atlas of Tooth Shape and Form. Chicago: Quintessence, 2002.

4. Winter R. Visualizing the natural dentition. J Esthet Dent 1993;5:102–117.

5. Manauta J. Salat A. Layers, An atlas of composite resin stratification. Quintessence 2012.

A modern conservative approach for direct posterior restorations help us in creating the correct shapes both for preps and for morphology which

can be reached just with the commodity of one body mass. The use of stains is not mandatory but can help in increasing the depth of those

restorations.

In posterior teeth, shape is of outmost importance, shade is not a trouble anymore when choosing the right opacity.

Choose very well your composite, all composites brands are different and even though many of them share the same “name” they have very

different characteristics. In other words some body shades are closer to a dentin while others to the enamel.

One of the main indications for using a single shade strategy, is when shape primes over any other factor. Focusing on the shape, allows us to do
more versatile construction techniques, uniform color and a strong material thanks to less gaps or air bubbles.

Single shade strategy allows the clinician to focus on shape and on specific details of build-up that enhance the quality of the material. Composite

restorations are extremely easy to correct.

1.-www.styleitaliano.org/the-front-wing-technique/
2.-www.styleitaliano.org/single-shade-everyday/
3.- Styleitaliano Pillar Article
4.- Vargas M, A step-by-step approach to a diastema closure, a dual-purpose technique that manages black triangles. Volume 26, No. 3, Fall 2010.
Journal of Cosmetic Dentistry.
5.- Devoto W, Saracinelli M., Manauta J.Composite in everyday practice: how to choose the right material and simplify application techniques in
the anterior teeth. Eur. J. Esthet Dent 2010; 5: 102-124.
6. Opdam NJ, Roeters JJ, de Boer T, Pesschier D, Bronkhorst E. Voids and porosities in class I micropreparations filled with various resin composites.
Oper Dent. 2003 Jan-Feb;28(1):9-14.
7. Hirata R. Shortcuts in esthetic dentistry: a new look into TIPS, 1st ed, Sao Paulo: Quintessence Editiora,2017, 358-367.
8. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012.
9. Leclaire CC, Blank LW, Hargrave JW, Pelleu GB Jr. Use of a two-stage composite resin fill to reduce microleakage below the cementoenamel
junction. Oper Dent 1988 Winter;13(1):20-3.

In an era in which conservative dentistry is almost a universal choice, the actions we do and apply everyday must be fast, easy and economical,
incorporating advantages to the already existing techniques. The front wing technique has had an amazing acceptance immediately after being
taught, and the immediate results we could se from the participants in their hands-on exercises in models was stunning. A series of community
cases will be published in www.styleitaliano.org
The author wishes to thank Walter Devoto and Angelo Putignano for the co-authoring and inspiration in the development of this technique.
Thanks to Leandro Martins (Manaus, Brazil) for sharing and helping during the clinical case performance in his training center in Brazil. To Dan
Lazar and Louis Hardan for helping in the graphics and technique improvements and collaboration.

When restoring a wide diastema, the matrix is very likely to lack cervical support, and hence be crushed. In such cases the most
successful strategy is to back-fill the palatal void without inserting a wedge. The resulting contact point will be enough.

CONCLUSIONS
– Wax-up is of little use in diastema and shape cases.
– Most diastema cases are managed with a single body shade, except when incisal edge is highly characterized or when the
cervical is highly opaque.

– A metallic finishing strip is one of the most fundamental tools for this kind of restorations.

– The front wing technique is easy, fast, predictable and applicable to diastema, shape modifications, direct and semi-direct
veneers and class IV.

BIBLIOGRAPHY
1- Vargas M, A step-by-step approach to a diastema closure, a dualpurpose technique that manages black triangles. Volume 26,
No. 3, Fall 2010. Journal of Cosmetic Dentistry.

2- Devoto W, Saracinelli M., Manauta J.Composite in everyday practice: how to choose the right material and simplify application
techniques in the anterior teeth. Eur. J. Esthet Dent 2010; 5: 102-124

3- De Araujo EM Jr., Fortkamp S, Baratierri LN. Closure of diastema and gingival recontouring using direct adhesive restorations: a
case report. J Esthet Restor Dent. 2009;21(4):229-40.

4- Lacy AM. Application of composite resin for single- appointment anterior and posterior diastema closure. Pract Periodont
Aesthet Dent. 1998;10(3):279-86

5- Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012

6- Leclaire CC, Blank LW, Hargrave JW, Pelleu GB Jr. Use of a twostage composite resin fill to reduce microleakage below the
cementoenamel junction. Oper Dent 1988 Winter;13(1):20-3

What are the problems encountered during composite resin restoration in Class II cavity?
Challenges to the practitioner include: proper adaptation of material to the preparation, bulk-fill versus incremental fill
techniques, polymerization shrinkage and shrinkage stress, depth of cure, and handling of the material.

Posterior composite restorations have been in use for approximately 30 years. The early experiences with this treatment indicated
there were more clinical challenges and higher failure rates than amalgam restorations. Since the early days of posterior
composites, many improvements in materials, techniques, and instruments for placing these restorations have occurred. This
paper reviews what is known regarding current clinical challenges with posterior composite restorations and reviews the primary
method for collecting clinical performance data. This review categorizes the challenges as those related to the restorative
materials, those related to the dentist, and those related to the patient. The clinical relevance of laboratory tests is discussed from
the perspective of solving the remaining clinical challenges of current materials and of screening new materials. The clinical
problems related to early composite materials are no longer serious clinical challenges. Clinical data indicate that secondary caries
and restoration fracture are the most common clinical problems and merit further investigation. The effect of the dentist and
patient on performance of posterior composite restorations is unclear and more clinical data from hypothesis-driven clinical trials
are needed to understand these factors. Improvements in handling properties to ensure void-free placement and complete cure
should be investigated to improve clinical outcomes. There is a general lack of data that correlates clinical performance with
laboratory materials testing. A proposed list of materials tests that may predict performance in a variety of clinical factors is
presented. Polymerization shrinkage and the problems that have been attributed to this property of composite are reviewed.
There is a lack of evidence that indicates polymerization shrinkage is the primary cause of secondary caries. It is recommended
that composite materials be developed with antibacterial properties as a way of reducing failures due to secondary caries. Post-
operative sensitivity appears to be more related to the dentin adhesives' ability to seal open dentinal tubules rather than the
effects of polymerization shrinkage on cuspal deflections and marginal adaptation. (https://pubmed.ncbi.nlm.nih.gov/15680997/)