Inlays, Onlays, Crowns, and Veneers ... Direct Anterior Restorations

Direct composite restorations have been and will continue to be a restorative option for a considerable number of anterior reconstructive cases. To achieve the optimal esthetic and functional result, the clinician must have a comprehensive knowledge of adhesive dentistry, including the properties of composite resins, proper tooth preparation techniques, the optical properties of the natural tooth, and the four dimensions of color. This presentation demonstrates the polychromatic layering of color through the correct implementation of materials and techniques to fabricate restorations that are harmonious with the opposing dentition. Continuing technological breakthroughs allow the clinician to implement and maximize new products in attaining more predictable and aesthetic results as demonstrated by this methodological protocol of incremental application of composite resins and modifiers to create a final restoration that mimics nature.

Understanding The Dimensions Of Color - This right side of the brain description and re-defining of color into primary and secondary optical properties gives the clinician a better understanding of developing color in restorations from "inside out."

• Primary Optical Properties - Hue, Chroma, and Value
• Secondary Optical Properties - Translucency, Opacity, Opalescence, Iridescence, Fluorescence, and Surface Glos

• Adhesive Preparation Design
• Development of Body Layer
• Internal Characterization with Tints
• Development of Artificial Enamel Layers
• Shaping and Contouring
• Polishing

As described in Enhanced Resilience and Esthetic in a Class IV Restoration. Compendium/Suppl. No. 26 2000; 19-25.
Direct Composite Resin Restoration of Adolescent Class IV Tooth Fracture: A case report. Pract Periodont Aesthet Dent 2000;12(1):23-29.
Direct Reconstruction of the Maxillary Anterior Dentition with Composite Resin: A case report. Pract Periodont Aesthet Dent 1999; 11(3):361-367.

Clinical and Laboratory Procedures Using the Anatomic Stratification Technique for Indirect Anterior and Posterior Resin Systems.

• Components of the Indirect Resin Systems
• Adhesive Preparation Designs For Inlays, Onlays, Crowns, and Veneers
• Laboratory Procedures of Anatomic Stratification Technique
• Precementation Protocol
• Adhesive Technique
• Finishing and Polishing

As described in Clinical Consideration for Aesthetic Laboratory-Fabricated Inlay/Onlay Restorations: A Review. Pract Proced Aesthet Dent 2001; 13(1): 51-58.
Optimal Esthet Results with Indirect Posterior Composite Resins. Compendium 2001; 22(2): 160, 162,164,166,168-169.
Optical Integration with Indirect Posterior Composite Resins: The Natural Inlay. Contemporary Esthetic and Restorative Practice 2002; 6(1): 38,40-42,44,46,50,51.

In the art and science of direct bonding, the clinician continues to strive for the ultimate tooth colored direct restorative material. Considerable progress in adhesive technology and composite resin materials allows for the creation of esthetic restorations that not only preserves, but also reinforces tooth structure. This learning process develops the clinician's chair side skills, and the ability to communicate and interpret information to the laboratory technician and patient.
Direct bonding! Many clinicians think its just adding composite to a tooth, but it is much more! It is understanding color of the substrate, the optical properties of light, the different restorative materials and their thickness and how this influences color and even the refractive indexes of each of these and how they interrelate. And by having an understanding of the dimensions of color and developing our senses through observation of nature we can begin to create more lifelike restorations in both the direct and the indirect world! And most important we can begin to appreciate and understand the ceramist and the information that the ceramist needs because many times the ceramist only has the "Stone Model Without a Face or Personality."