Last week on Facebook int he chat window across came the question, how do you manage dark dentin when placing composites. This is not the first time I have been asked this question, nor the first time I have asked myself the same thing. One of the key factors in getting an exquisite esthetic result with tooth colored restorative materials is the underlying prep color. Sclerotic dentin and amalgam staining from old restorations are an everyday hurdle to overcome. The question is how to manage these clinically. The majority of our tooth colored restorative materials are translucent, so discolored dentin will show through and create shadowing or alter the overall value and appearance of the finished product. The translucency of composite is very close to that of enamel, so if I can build up my preparation in a way that I have recreated the natural dentin contours, leaving only the enamel layer to replace and accomplish the chroma, hue and opacity of dentin, the rest is simple.
When the dentin is discolored I have two challenges, the first is using a material opaque enough to completely mask the underlying dentin. The second challenge is then replicating the shape and color of the natural dentin prior to placing my final layer. Recently this challenge has become easy to handle and no longer something I even worry about. Several months ago I began playing with the new Venus Diamond Chromatic Shades of composite from Heraeus. I say playing, because that was my outlook on it. Most of the opaque composites aren’t nearly as opaque as I would like, and they tend to be high in value., so require another layer to then correct the shade.
This material was developed looking for a solution to this exact challenge. I was a skeptic, but now I know they did it.
The material comes in four chromas, all of which give the best opacification in thin layers I have experienced. the material has the value and chroma of naturally occurring dentin. When I first received the material I was using it after the same protocol I have always used. thin layer of opaque composite, then a body shade, then finish with enamel. One or two uses and it was obvious this material serves as the opaque layer and the dentin shade perfectly. It didn’t take me very long once I experienced the incredible final esthetics, to start asking my assistant to have the chromatic shades out for every composite restoration, so I could create this perfect reconstruction of the dentin.
My newest addition is using the chromatic shades to cover discolored dentin during inlay and onlay preparations prior to taking the final impression, so I don’t get show through when we seat the final restoration. Next on my radar screen is to use this material as a resin cement by heating it to lower the viscosity, I am just waiting for the perfect clinical opportunity.
Simon Hong says
Nice tip. I had a question that’s a bit off topic. Seeing the size of the prep, would you have considered a ceramic inlay as well? In addition, what kind of verbage do you use with your patients regarding composite filling versus ceramic inlays.
Lee Ann Brady says
Absolutely, this is a perfect situation for a ceramic inlay, milled or pressed, or an indirect composite, either lab fabricated or done with a composite block, milled and then placed with composite as the luting agent.