Adding Incisal Length With Composite
I often find composite an ideal material to use to add incisal length. I sometimes use it as a provisional or test drive prior to bonded porcelain, and other times as a definitive restoration.
However, one big drawback is it can be both labor and time intensive. I’ve learned from experience that a little planning ahead not only saves a lot of time but also yields much more predictable results with less stress.
Planning checklist:
1. Do a diagnostic wax-up up of your desired results. You can do this yourself if you enjoy this sort of thing, or you can have this done by your lab. It’s critical that this wax-up meet both your esthetic and functional goals.
2. Fabricate an index of your wax-up that your can transfer to the mouth. I find that using a silicone putty such as Zhermack Platinum 85 works well but there are many options available. The key for me here is that the material be able to register great detail and yet be very stiff so as not to distort when it’s transferred to the mouth. It’s also important to make sure that it extends onto enough adjacent areas that you will not be changing in order to provide positive definitive seating in the mouth.
3. Select your shade(s) at the very start of the appointment to avoid any color shift of the teeth due to dehydration. If you are adding back dentin and enamel I find the best results by using at least one dentin and one enamel color.
4. Prepare the teeth as needed by rounding any sharp corners and bevel the facial surface of the areas you will be adding to. Doing this will help your bonding blend in and become more invisible.
5. Place the matrix of the wax-up to the mouth and simply add in your dentin and enamel shades where they belong. One tip to avoid bonding adjacent surfaces together is to build up every other tooth first, placing Teflon tape on the teeth you don’t want to bond. After the first set of teeth are bonded you can then bond the second set of teeth with tape placed over the first set to prevent you from bonding things together.
When you’re finished your color will look as though it’s off because the teeth have dehydrated and shifted color during your appointment. Don’t panic; the teeth will rehydrate with time and return to the color you matched at the start of the appointment.
John R. Carson, DDS, PC, Spear Visiting Faculty. [ www.johnrcarsondds.com ]
fantastic
Thanks, glad you enjoyed it.
Very nice article, thank you john.
You are very welcome, glad you enjoyed it.
Nice Post John, I like your idea of teflon tape. However, I’ve never used it. Do you have any images showing how you would isolate the adjacent tooth using this tape without it bunching up or creasing. I’m excited about this option. It must save you a ton of time in the chair finishing your composites on these cases.. thanks,
John
John, I do have some photos of this if you send me you email address I can send them to you, my email is carsondds@earthlink.net the trick is to hold is tight as you pull it through the contact like floss you can then stretch is out as needed and wrap it around the tooth and its so thin you don’t have to worry about every little crease, the smoother the better but crease free is not.
Glad you enjoyed it, and as I said send me your email and I will send you the picture,
John
John, sorry just saw I do have your email, however I do not have the photo and home, I will plan to send it out tomorrow.