Controlling Composite Surface Texture A Cost-Effective Repair of a Mesial Incisal Fracture by Clifford Van Putten, DDS

1. A Cost-Effective Repair of a Mesial Incisal Fracture
By Clifford Van Putten, DDS
Key Words:
gloss, polish, fluorosis, nanocomposite,
AACD Accreditation Case Type IV

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Copyright © 2017. All rights reserved. No part of this slideshow may be reproduced,
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3. About the patient:
• Healthy 18-year-old male patient
• Traumatic childhood dental injury
• Full orthodontic treatment completed
• Unattractive tooth #8
• No other dental issues
INTRODUCTION
Preoperative smile showing a fractured right
central incisor.
This slideshow underlines the importance of manipulating the final
surface gloss in a restoration the same way a clinician controls other
factors such as materials, layering, surface texture, anatomic form,
translucency, and color.

4. Enamel and dentin were both lost.
Surface scarring due to orthodontic etched
attachment removal was noted. The decision
was made to recreate anatomical features
similar to the adjacent central incisor in the
new composite restoration rather than to
polish off the surface morphology.
Diagnosis and Treatment Plan
The fracture of the mesial incisal included
approximately 20% of the vital right
central incisor.

5. Problems with a restorative treatment
of a traumatic injury can be
very distressing to a patient.”
“

6. A sample selection of composite dentin
and enamel shades and modifiers was
applied to the central incisor and cured
to develop a plan for material selection,
position, and thicknesses.
Treatment
Color map of the planned three-dimensional
composite placement.
(Illustration by Stephanie Milanowski, Grand Rapids, MI)

7. A nanohybrid composite was used because
the universal enamels are achromatic and
vary only in value. Optical properties of
dental composites have been improved by
using nanoparticles in the space previously
occupied only by resin.
Optical improvements have sacrificed neither
mechanical strength nor wear resistance.
Because individual nanoparticles are smaller
than the wavelength of visible light, nano-
composites made from these particles exhibit
extremely high translucency.
Composite Selection
Diamond-polished Filtek Supreme XT (3M ESPE;
St. Paul, MN) at 3000x magnification; note the
surface scratches and sheared-off filler and
nanoparticles.
(Image reprinted with permission of Dr. Tatsuo Endo;
Sendai, Japan)

8. Success of the final restoration depended upon these elements:
• Depth and the intensity of chroma
• 3D position of the white decalcification spots
• Degree of transparency
• Overall value
Subsequent layers were built up, coated with a glycerin gel and then cured. Coating
eliminates the oxygen-inhibited layer and produces maximum surface hardness.
Preparation and Layering
Tooth #8 was prepared and etched, and adhesive was applied and light-
cured. The first layer of composite was very thin and extended to the
incisal edge.

9. The lingual surface was contoured and shaped. Interproximal contouring
and final polishing were completed. The incisal edge and embrasures were
adjusted for protrusive and excursive movements.
Contouring and Polishing
The patient was instructed in home care and scheduled to return for final finishing
and polishing.

10. Mimicking the surface texture proved to be a
challenge that necessitated multiple trials in vitro. A
duplicate tooth was fabricated in the laboratory,
utilizing the same materials and shades used on the
patient.
Trial runs were conducted to create the highest
surface polish based upon the parameter of gloss
while maintaining secondary anatomy (gloss is the
property that indicates how well a surface reflects
light in a specular [i.e., mirror-like] direction).
Discussion
A high level of gloss was achieved with
diamond paste in the laboratory’s practice
tooth with secondary anatomy.

11. …sculpting artificial materials to mimic the
absorption and the glossy reflection of light
from natural teeth is an art.”
“

12. In the trial run, a high gloss surface texture was
achieved to a roughness of approximately .2 µ.
Tertiary anatomy needed to be developed by
cutting shallow furrows on highlights and
deeper furrows on concavities. Polishing paste
was reapplied at a slow speed until surface
polish was developed.
Tertiary anatomy added with coarse
diamond and polished.

13. The same sequence was repeated with the patient,
pausing frequently to evaluate the amount of surface
texture and gloss.
The preoperative fracture, 1:1 view. The postoperative restoration
with polished secondary
anatomy.
The final restoration with tertiary
anatomy added.

14. Developing and maintaining gloss (i.e., specular highlights) is
possible with the reduction of interstitial spacing by the addition
of nanoparticles. Nanoparticles in dental composites allow for
more surface gloss and enamel translucency than is needed for
some clinical situations.
Summary
Preoperative and postoperative 1:2 retracted views.

15. Rather than always polishing the restoration to be as shiny as
possible, less gloss may be desired, as it was for this case.
Decisions regarding these variables add to the deliberative nature
of esthetic composite placement.
Preoperative and postoperative full-face views.

16. Everyone is able to form opinions as to beauty,
attractiveness, or striking appearance of things they
see. Gloss is one of the major factors in appearance.
~Richard S. Hunter
“
”

17. Dr. Van Putten maintains a private practice in
Hudsonville, Michigan. He is an inventor and
dental patent holder.
Disclosure: The author did not report any
disclosures.
This slideshow is an excerpt from the original article
published in the Journal of Cosmetic Dentistry (jCD) titled,
Controlling Composite Surface Texture: Cost-Effective Repair
of a Mesial Incisal Fracture. The jCD is an exclusive member
benefit of the American Academy of Cosmetic Dentistry.

18. Joining the American Academy of
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