Many patients seeking cosmetic consultation do not want a dramatic “makeover.” Instead, they desire enhancement: a more refined version of their own smile, not a transformation into someone unrecognizable. In this case, the patient wanted his smile to feel “more filled out” and desired a “more even” smile. To achieve this goal, the lateral incisors would be enhanced and volume added to teeth Nos. 4, 5, 12, and 13 to better fill the buccal corridors. For patients seeking subtle change, shade matching becomes especially important. OMNICHROMA single-shade universal composite (Tokuyama Dental, tokuyama-us.com) has become one of the author’s favorite materials for creating natural, harmonious results, even for discerning patients. OMNICHROMA works particularly well when matching enamel in the A3 to BL4 range and can provide a greater range depending on the substrate. The author considers OMNICHROMA an ideal material for patients who want improved contours and a slightly brighter smile rather than for cases in which a major shade shift or significantly higher value is desired. Its polishability and optical properties are exceptional. This case effectively illustrates this principle and the author’s process. The outcome was remarkably natural, and the patient was especially pleased that the result was achieved in one appointment, with no enamel reduction and without an obvious “veneer look.”
KEY TAKEAWAYS
- Shade matching is critical when treating patients who desire only subtle changes to their dentition and smile. OMNICHROMA single-shade universal composite is well-suited for achieving natural, harmonious results while helping to streamline the restorative process.
- OMNICHROMA’s paste-like consistency enables good sculptability and allows for the creation of accurate anatomy and lifelike restorations. OMNICHROMA BLOCKER resin composites feature pigments and dyes to supplement opaquing.
- In the technique presented, a mylar matrix was used with OMNICHROMA composites to create a frame around the tooth similar to a Class 1 restoration. The restorations mimicked the anatomy and surface texture of the adjacent teeth for a seamless, natural-looking outcome achieved with a single shade.
Figure 1
Pretreatment frontal view; note the small lateral incisors and uneven buccal corridors.
Figure 2
Pretreatment lateral view.
Figure 3
The teeth being treated (ie, the maxillary lateral incisors and subsequently the four maxillary premolars) were cleaned, isolated, and etched. In this case, each tooth was air-abraded and a 00 retraction cord was packed to improve visibility and cleanliness.
Figure 4
After careful application of bonding agent, the incisal edges were bonded in 1.5 mm (incisal edge thickness) increments to the desired length. A 1.5 mm increment is crucial for strength at the incisal edge. OMNICHROMA BLOCKER was also added like a dentin layer to transition the incisal edge with the natural tooth. These incisal edges may be placed either using a putty matrix from a wax-up or freehand if the clinician is confident in doing so.
Figure 5
Mylar can be used as a matrix to create separation. This photograph of a different but similar case involving a central incisor best illustrates this concept. A small amount of flowable composite can be placed for added adaptability around the margins. A small “snake” of OMNICHROMA is compressed around the matrix to create a “frame.” Alternatively, body OMNICHROMA may be added directly using a spatula and the edges tucked with a fine spatula. After curing, the result will be a frame similar to a Class 1.
Figure 6
Example of a clean frame (from Fig 5), highlighted in the blue outline. A frame similar to this was created in the present case on both lateral incisors and then on all four maxillary premolars. Once the frames are established, OMNICHROMA can be added to the center of the frame and compressed.
Figure 7
At this point it is critical to ensure that OMNICHROMA is adapted well to the walls of the frame, or that the margins are well adapted with a small brush if applying the body of composite directly to the tooth. An appropriate amount of OMNICHROMA is spread laterally and to the zenith and incisal edges until the frame is full and sealed. Note that OMNICHROMA may appear “too warm” in color prior to polymerization.
Figure 8
With the frames filled in, the clinician pencil-lines the desired line angles and refines them with medium or light textured discs. Each line angle is carefully marked in the desired area with a pencil, and then medium- or fine-grit discs are used to gently define the desired line angles.
Figure 9
It is important to observe the surface texture of the adjacent teeth and “map” these areas topographically. A carbide bur may be used to gently mimic this anatomy before finishing and polishing. Here, the surface texture of tooth No. 7 is made to mimic that of tooth No. 8.
Figure 10
Posttreatment retracted frontal view showing outstanding result, which, notably, was achieved with a single shade. The OMNICHROMA restorations on the maxillary lateral incisors and premolars are virtually indiscernible compared to the natural enamel on the maxillary central incisors and canines.
Figure 11
Post-treatment retracted lateral view.
Figure 12
Post-treatment smile, frontal view.
Figure 13
Post-treatment smile, lateral view. Fig 14.
Figure 14
Comparison of pre- (left) and post-treatment (right) full-face smiles.
Andrew Ballard, DDS
Developer of the HALO veneer system; Private Practice, Chandler, Arizona