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    How to create restorations that look great seven years later

    A look at how one practitioner created a great restoration that still maintains great esthetic quality seven years later.

    Sometimes we hand a patient a mirror after a successful restoration and tears of joy flow as they smile — they can’t believe the way their life is about to change. These are the reasons we went to dental school. Once gray and discolored teeth are now brilliant and white. These are the moments that transform lives.

    As clinicians, we are privileged to work in a profession that allows us to recreate smiles on a regular basis. Whether it is a single tooth #8 that needs to be restored because of a bicycle accident or an entire complement of anterior teeth a mother wants looking good for her daughter’s wedding photographs, we must be able to reproduce nature in reliable and repeatable processes.

    But in the back of our minds, as we hand the patient the mirror to revel in a newly restored smile, we ask ourselves, “How long will it look that good?” and, “Can direct composites stand the test of time?”

    This article intends to demonstrate that, yes, they can and will. With new revelations in particle size, filler type and amount, we can confidently offer our patients less expensive options that are reliable, esthetic and, now, durable.

    What would you think about a material that is universal to both anterior and posterior applications, polishes well with just about any available polishing materials and will still look the same nearly 10 years later? The case below will highlight just such a product. In my practice, located in a non-urban setting, it is required of me and my team to restore teeth in ways that some would profess to be “less than ideal.” It has been my experience that the lifespan and durability of the material showcased in the photos to follow will change your treatment plans and expand the options you offer your patients.

    The product that I use daily was introduced 25 years ago by Tokuyama Dental America. Estelite Sigma Quick® is a supranano-filled, spherical composite. The average particle size is 200 nanometers and are all spherical, which allows it to be a truly universal composite. Using one or two shades combined in anterior restorations produces a chameleon effect that newer composites cannot match. Patients are consistently pleased, and the results are predictable and strong.

    A new patient presented with concerns of esthetics. He was a self-proclaimed drug abuser for many years. Past medical history included long-term orthodontic bracket retention while using illicit drugs and also not under a clinician’s care. The patient removed most of the brackets on his own with at-home tools and pliers. Since removal of the orthodontic bands, the patient has completed a drug and lifestyle rehabilitation program that resulted in a life change. He is now interested in long-term oral health and well-being.

    The pre-operative photos presented highlight teeth #9, 10 and 11 prior to preparation for restorations. Notice the large areas of decalcification and decay present around the former bracket locations. Socioeconomic status did not allow the patient the financial option of porcelain veneers.

    Figure 1Fig 2

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