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PAULO MONTEIRO
PREPARED TEETH
ISOLATION: HOW, WHEN
AND WHY

DIRECT ANTERIORS - CASES - SHADEGUIDES - TIPS AND TRICKS

THE DAILY RESTORATIVE GAME: EVERY STEP COUNT!

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Currently our patients are becoming more demanding with dental treatments and the final aesthetic
outcome.
The composite resins and the dentin adhesives occupy a very important role in today dentistry,
because they are easy to use and have a very acceptable clinical behavior.
In this clinical case I intended to describe a simple and predictable clinical sequence, to ensure the
patient expectations with direct composite resins in anterior teeth.

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CASES OF THE WEEK

JAN 18 TO JAN 24
Adam Zawadka
Marc Kaloustian
Marino Sutedjo
Ivan Mirovic

Initial situation.
A patient came to my clinic to improve the restoration of the tooth 11 and 21 made a few months ago.
As a first option, the patient enjoyed making ceramic veneers, for not believing that direct composite

resins can give a natural aesthetic smile.

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Initial situation.
The patient complained mainly with the opacity of the restorations and surface irregularity.
After explaining the advantages and disadvantages of direct composite resin and ceramic veneers,
the patient chose to do both teeth in composite resin material.

ANNIKA KORVO
Styleitaliano has easy recipes that
we can follow. I find it a great
course for the general practitioner
and for the expert.

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Tips to make your posterior

restorations excellent a case
by Janos Grosz
http://www.styleitaliano.org/pr
emolar-approximal-anatomy

Shade selection with Vita Classical shade guide.

It is mandatory to select the shade with the teeth hydrated before rubber dam placement.

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FOUNDERS

Placing the rubber dam.

Walter Devoto
Dr. Walter Devoto Born in
Chiavari on 29/03/1965
graduated in Dentistry in 1991
at Genova University.

With a pencil, the area with the old restorations has been marked for a better understanding when
removing the old composite.

Angelo Putignano
M.D. degree and D.D.S. post
graduate certificate from
University of Ancona-Italy.

FOUNDERS ENDO

Pio Bertani
Pio Bertani is a full member of
the prestigious association...

After removing the old restorations and after making the labial and inter-proximal bevel . The bevel
was done with a red Sof-lex disk to a better conservation of the dental tissues and smoothing the
surface.

Fabio Gorni
Fabio Gorni is an active
member of the Italian Society
of Endodontics and the Italian
Academy...

MEMBERS
Monaldo Saracinelli
Ive been a student of prof.
Fabio Toffenetti and
Riccardo Garberoglio.

Silicone key testing made from a wax-up.

Jordi Manauta
Was born in Mexico City,
where he graduated cum
laude. in dentistry from
UNITEC.

Gaetano Paolone
My passion is aesthetic
direct and indirect
adhesive dentistry in
anterior and posterior
teeth.

Daniele Rondoni
Born in Savona in 1961
where he lives and has

worked in his own

laboratory since...

Vincenzo Musella
Vincenzo Musella
graduated in dental
technician. Proud friend
and student of...

Giuseppe Marchetti
Giuseppe Marchetti was
born in Parma (Italy) in
October of 1972 and
graduated from...

Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Giovanna Orsini
Giovanna Orsini is a well
known researcher in Italy
and internationally.

Paulo Monteiro
My passion for esthetic
dentistry began when I
attended the last year...

Bonding procedures.
The selective enamel etching technique was used.

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Patrizia Lucchi
Patrizia Lucchi Graduated
in Dentistry cum Laude in
1995 at the University of
Verona

Anna Salat
Dr Anna Salat graduated
with a degree in dentistry
from the International
University of Catalonia

Giulio Pavolucci
After graduation magna
cum laude in Dentistry, I
started focusing my daily
work on...

Marcos Vargas
Dr. Marcos Vargas
attended Cayetano
Heredia University School
of Dentistry in Lima...

Stefan Koubi
Dr. Koubi graduated from
University of Marseille
where he...

Bonding procedures.
A universal adhesive was used on enamel and dentin (Scotchbond Universal). It is important to use
more than one adhesive increment and at the end applying lightly air until seeing no movement of
the adhesive on the tooth surface. Then light cure.

Engin Taviloglu
Dr. Taviloglu graduated
from ?stanbul University
School of Dentistry in...

Dimitar Filtchev
Co-founder of the Laser
Dental Center and the
Implant...

Angie Segatto
My commitment to arts has
determined my
specialisation.

Kilian Molina
Kilian is required as a
regular lecturer in indirect
restorative...

Gregory Camaleonte
I was born in 1980 in
Marseille-France and i have
graduated in 2006 from...

Caroline Werkhoven
Caroline Werkhoven
graduated in 2002 at
ACTA, the dental faculty in
Amsterdam..

Ajay Juneja
Ajay Juneja finished his
BDS in the year 1995...

The palatal enamel was made with a translucent enamel (Filtek Supreme XTE CT effect).

Carlos Fernndez
Villares
Member of SEPES Spanish
Soc...

Sulivan Leite
Sulivan Leite graduated
from the Ribeirao...

Maciej Zarow
Author of book edited by
Quintessence: EndoProsthodontics: guidelines
for clinical practice ...

Dan Lazar
Dan Lazar, graduated from
the Faculty of Dentistry in
2005 in Cluj-Napoca...

Murad Akhundov
Dr. Murad Akhundov
graduated from the
Faculty of Dentistry in
Baku...

Janos Grosz
Graduated summa cum
laude in 2006 from the
University of Szeged,
Faculty of Dentistry,
Hungary...

The interproximal enamel was made with Filtek Supreme XTE enamel A3.
A thin convex posterior matrix were used (in vertical position) to give a natural and anatomic surface
(Garrison Dental).

MEMBERS ENDO
Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Filippo Cardinali
Graduate in Dentistry and
Dental Prostheses at the
University of Ancona in
1992. Active Member of...

Riccardo Tonini
He is active member of the
Italian Academy of
microscopic Dentistry and
Active member of...

For the incisal halo we used Filtek Supreme XTE flow W.

Paolo Generali
Doctor Generali was
graduated from Pavia
University in the year...

Calogero Bugea
Graduate in Dentistry,
Certificate in Oral Surgery.
Active Member of the
International
Piezosurgery...

Clifford Ruddle
Internationally recognized
as a leading expert in all
aspects of clinical
endodontics, Dr. Ruddle is
acclaimed for...

Pierre Machtou
Pierre Machtou was the
first scientific director and
general secretary of the
French Endodontic
society...

Marga Ree
Primary author of several
articles published in
national and international
journals and has ...

Marco Martignoni
Marco Martignoni leads a
private clinic in Rome Italy
and dedicates his practice
mainly to endodontics,
pre-prosthetic...

Massimo Giovarruscio
Massimo Giovarruscio
works in Rome, Bristol and
London, specialising in
Endodontic Treatment
and...

Dentin application (Filtek Supreme XTE dentin A1).

The volume control is essential for the right combination of opacity and a natural outcome.
We use the Misura intrument (LM Arte by Style Italiano) to calibrate the dentin and leaving a 0.5mm
space for the buccal enamel.

The dentin incisal anatomy (mamelons) was made with the LM Arte Fissura before light curing.

To increase the translucency at the incisal edge, a small portion of a translucent enamel (Filtek
Supreme XTE CT effect) was applied between the dentin and incisal halo.

A suitable light curing device must be used for effective polymerisation of the composite resin (Elipar
Deep Cure).

After the composite resin application.

In this case we use the combination of an A1 dentin and A3 enamel, to obtain a final A1 Vita shade
guide. It is always necessary the calibration of the vestibular enamel (0,5mm).
This combination has been described previously by studies and work of Style Italiano group.

Shape and texture is a necessary and important step as all the others in the restorative process.
With a pencil, the primary anatomy has been marked (vertical texture) and angle lines.

Finishing procedures with Sof-Lex disc.

Polishing procedures with Sof-Lex Spiral discs.

Aesthetic appearance after polishing. It stands out the natural shine of the enamel surface.

Final situation.

Final situation.
Natural integration of the composite resins with the dental tissue, giving to the restorations a very
natural look.
The techniques and materials used in this clinical sequence proved to be able to meet the
requirements of the patient and restore the natural aesthetics of the anterior teeth.
1 - Composites in esthetic reconstruction. Toffenetti F, Vanini L. Dent Cadmos. 1986 Mar.
2 -Determination and communication of color using the five color dimensions of teeth. Vanini L1,
Mangani FM. Pract Proced Aesthet Dent. 2001 Jan-Feb.
3 - Paolone G., Orsini G., Manauta J., Devoto W., Putignano A., Composite Shadeguides and Color
Matching. IJED, Vol 9, No. 2, Summer 2014.
4 - Manauta J, Salat A, Layers, an Atlas of composite resin stratification, Quintessence 2012.
5 - Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth
using one dentine shade and a predefined thickness of enamel: a new concept in composite layering-Part II. Odontostomatol Trop. 2014 Sep;37(147):5-13.
6 - The influence of stratification on color and appearance of resin composites. Betrisey E1, Krejci I, Di
Bella E, Ardu S Odontology. 2015 Feb 5.
7 - The effects of finishing and polishing techniques on surface roughness and color stability of
nanocomposites. Gnlol N1, Yilmaz F. J Dent. 2012 Dec;40 Suppl 2:e64-70.

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