Managing Discolored Dentin

Heraeus 360 Newsletter

July 2011

Lee Ann Brady DMD

One of the challenges of completing esthetic dental procedures is managing discolored preparations. I restore teeth on a daily basis that were at one time restored with amalgam, and have that classic greyish black color to the dentin. In addition managing the variety of dark brown colors that come with secondary dentin is an equal challenge. Most of our esthetic restorative materials, like composite and porcelain tend to be translucent. The classic result when I combine a discolored prep with a translucent restorative material is a dark shadow where the underlying tooth is dark, or an entire restoration that is low in value and high in chroma.

One of the techniques I have used in order to assure an exquisite esthetic result in these clinical scenarios is to mask the darkened dentin with a layer of opaque composite. The challenge of traditional opaque composites has been that they are high in value and don’t offer a range of chromas to match the existing dentin. With this in mind when discolored dentin is present I will prep away additional tooth structure to create space for the opaque layer and composite to mask it. The final esthetics are obtained by managing the correct combination of composite shades over this layer, to get a final result that matches the tooth in value, hue and chroma.

The new chromatic shades of Venus Diamond composite have overcome these challenges. Their masking ability in very thin layers is incredible and allows me to prepare the tooth more conservatively. The range of available chromas allows me to perfectly match the existing dentin in both value and shade. I utilize the Venus Diamond chromatic shades to restore the tooth to an ideal prep shape and color. Once this layer is cured I no longer have any color issues to “manage”, and acquiring an exquisite final result is as simple as if the prep were never discolored to begin with.

In addition to direct composite, this technique will allow you to achieve exquisite results when doing indirect porcelain restorations.  Prior to taking final impressions mask the discolored dentin with a thin layer of the chromatic composite. At the seat appointment these small areas of composite need to be prepared with air abrasion, in addition to etching the natural tooth structure. This will ensure excellent bond strengths.

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