We all have patients for whom the esthetics of their dentistry is not something they care much about. However, when it comes to a filling or composite repair on a front tooth, they are not in the majority. One of the criteria for clinical success when using composite in the anterior teeth is the inability to differentiate it from the natural teeth. Patients expect that when they stop by the first mirror after you sit them up, they will not be able to tell where the composite is. This presents us with two challenges, using the right blend of shades so we match the tooth exactly, and overcoming the fact that the teeth change in appearance during the dental appointment. One of the outcomes of isolation during a dental appointment is dehydration of the natural teeth. When teeth dehydrate is has a measurable effect on the appearance of the teeth. The value of the teeth increases, the chroma decreases. The hue can be modified slightly and the incisal translucency will appear to decrease.
One of the first things we need to do is decide what shades of composite we will be combining or using at the beginning of the dental appointment. I follow several steps as part of my shade matching process for composite. I begin by selecting the shade of the natural teeth utilizing shade guides, corrected light and an EasyShade. Once I have this information I select the combination of composites I will need to create a matching appearance. This process is dependent on the size and shape of the restoration as well as knowing the color blending system for your composite. I then place small amounts of the composite I have chosen on the labial surface of the teeth, in varying thickness to see if it blends. For more complex esthetic procedures like class four repairs, diastema closures and composite veneers we schedule a follow up appointment to evaluate and possibly tweak the shade match once the teeth rehydrate.
The next thing I do before I begin is help the patient understand the process we have employed to match their new composite to the teeth. I show them the composites we have chosen against the teeth, the matching shade tabs and photograph this step. Then I make sure to explain how teeth dehydrate and the impact it will have on the color of their teeth. I assure them that their new filling will match……tomorrow!
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