Color modifiers and opaquers

Simulates craze lines

Yellow-brown Masks blue tetracycline stains Blue, gray, violet Simulates translucency
Decreases value or brightness White Increases the brightness of any color modifier
Simulates craze lines
Simulates enamel hypocalcifications; white spots
Masks yellow spots Red, pink Simulates gingival tones
Enhances vitality
Masks blue tetracycline stains

CLINICAL TIP

Because most color modifiers have high chromas, they must be diluted with a low-viscosity resin before use.

Yellow and yellow-brown

Yellow and yellow-brown shades are most often used in the cervical third of the crown (Fig. 4-1). Sometimes they are used along proximal surfaces to create the illusion of narrowness (see Chapter 2).

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FIGURE 4-1 ​ A, Preparation of the maxillary right first and second premolars for direct bonded veneers. B, The color of the cervical third of the veneers must harmonize with the adjacent teeth. A diluted yellow-brown color modifier was placed on the cervical third and overlaid with shade A-3 composite. C, Color harmony from the maxillary right first molar to the maxillary right canine has been established.

They can also be used to simulate craze lines. Because yellow is the complementary color of violet, it is effective in neutralizing and masking blue-gray tetracycline stains (see Chapter 2). Yellow can also be used in combination with white to mask brown tetracycline stains.

Blue, gray, or violet

Blue, gray, or violet shades are used on the incisal third of the tooth to simulate translucency (compare Fig. 4-2). They can also be used to reduce value (brightness).

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FIGURE 4-2 ​ A, Intrinsic yellow discoloration of maxillary left central incisor. B, White color modifier was used to mask the yellow background, and blue color modifier was added to the incisor to simulate translucency.

White

White is used to increase the value (brightness) of any color modifier. It can be effectively used to simulate craze lines and enamel hypocalcifications (Fig. 4-3) and to mask yellow stains (Fig. 4-4).

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FIGURE 4-3 ​ A, Fractured distoincisal angle. Adjacent teeth have white hypoplastic enamel areas. B, A layer of Multifill VS (Heraeus Kulzer, Inc.) is placed on the lingual wall and polymerized. C, Creative Color white is added to simulate the hypoplastic areas. D, The completed restoration. Source: (Courtesy Dr. William Mopper, Glenview, IL.)
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FIGURE 4-4 ​ A, A maxillary right central incisor with intrinsic yellow discoloration. B, White color modifier is used to mask the yellow background.

Red or pink

Red or pink simulates gingival tones, enhances vitality, and can neutralize blue tetracycline stains (see Chapter 2).

Class III and class IV restorations

Truly “invisible” Class III and Class IV restorations are possible only through proper cavity preparation in conjunction with proper color matching (Fig. 4-5). Blending the color of the restorative resin into the color of the tooth is essential. Color modifiers are indispensable in fine tuning the definitive color.

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FIGURE 4-5 ​ A, Preoperative view of discolored Class III composite resin restorations. (Courtesy Dr. William Mopper.) B, Postoperative view of invisible restoration. (Courtesy Dr. William Mopper.) C, Typical Class III preparation with a through-and-through loss of both the facial and lingual enamel. The line denotes the cross-section area of subsequent drawings.

In Class III or Class IV cavity preparations involving a through-and-through loss of both the facial and lingual enamel, the definitive restoration can exhibit undesirable “shine-through” (Fig. 4-5 C).

This shine-through occurs because the missing lingual tooth structure is replaced by a composite resin that is more translucent than the original dentin. The result is a visible outline of the restoration. Shine-through can be prevented by careful cavity preparation, the judicious use of color modifiers and opaquers, and a “sandwich” of various types of composite resins.

Armamentarium.

• Standard Composite Resin Restoration dental setup

• Rubber dam

• Cotton rolls

• Explorer

• High-speed handpiece

• Low-speed handpiece

• Mouth mirror

• Periodontal probe

• 2 × 2 gauze

• Mylar matrix strips

• Wooden or plastic wedge (optional)

• Assorted round carbide dental burs

• Flame-shaped, tapered, and ovoid coarse diamonds for cavity preparations.

• Oil-free pumice

• Rubber prophy cup

• Cavity liner (optional)

• Acid etchant

• Bonding agent of choice (see Chapter 3)

• Composite resin placement instruments (e.g., 8A, Hu-Friedy Mfg. Co., LLC; #8, Brasseler USA; IPC-I, Premier Dental Products, Inc.; Goldstein Series 1-4 and mini 1 and 3, Hu-Friedy Mfg. Co.)

• Hybrid composite resin of choice (see Chapter 5)

• Microfilled composite resin of choice (see Chapter 5)

• Diamond finishing burs (e.g., ET-9-Carbide – Diamond and ET-OSI ovoid carbide burs; Brasseler USA OR Carbide Flame H246-009 – Premier Dental Products)

• For microfilled composite resins, low-speed, water-cooled diamond burs are best for trimming and finishing. For small-particle hybrid composite resins, high-speed tungsten carbide burs and low-speed, water-cooled diamond burs are recommended.

• 12-fluted carbide finishing burs (e.g., ET-9-Carbide and ET-OSI ovoid carbide burs; Brasseler USA OR 2015153 (Fine) – Premier Dental Products)

• Finishing and polishing disks (e.g., Sof-Lex, 3M ESPE; Super Snaps, Shofu Dental Corp.; or Flexi-Discs, Cosmedent, Inc.)

• Finishing and polishing strips

• Metal backed (e.g., Compo Strips, Premier Dental Products, Inc.) or plastic backed (e.g., Soft Lex, 3M ESPE; Flexi Strips, Cosmedent, Inc.; Jiffy diamond strips, Brassler USA)

• Polishing Kit (EP200 Esthetic Polishing Kit, Brasseler USA)

• Rubber wheels, cups, and points containing abrasives

• Medium-grit rubber wheels for prepolishing (e.g., Burlew, Jelenko), or complete systems (e.g., CompoMaster/ CompoMaster Coarse Polishers, Shofu Dental Corp.; OR Astropol , Ivoclar Vivadent; ET Illustra Composite Polishers, Brasseler USA; Venus Supra Polishing System Heraeus Kulzer Inc., USA; Top Finisher System, Cosmedent, Inc.; Enhance Finishing System L.D. Caulk Co.

• Composite resin polishing paste (containing aluminum oxide)

• Dry felt wheel (Felt Wheel Keystone, Inc.)

• Padded discs (e.g., Flexi Buffs, Cosmedent, Inc.)

• Color modifiers and opaquers

• Color modifiers: yellow, yellow-brown, white, blue, gray, violet (e.g., Effect Color Heraeus Composite Tints and Opaquers, Heraeus Kulzer, Inc.; Creative Color, Cosmedent Inc.; Kolor + Plus Kerr Corp; Artiste Maverick Tints, Pentron Clinical Technology; Bisco’s Characterization Tints, Bisco, Inc.

Clinical technique.

1. Administer anesthetic (optional).

2. Cleanse the tooth and neighboring teeth with pumice.

3. Determine the appropriate shade while the teeth are wet with saliva.

4. Isolate the lesion with a rubber dam.

5. Prepare the cavity in a conventional manner (Fig. 4-6 A).

6. Round the cavosurface angle and place a long bevel to create an invisible transition from resin to tooth (Fig. 4-6 B).

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FIGURE 4-6 ​ A, The cavity is prepared in a conventional manner. B, The cavosurface angle is rounded, and a long bevel is placed to facilitate an invisible transition from resin to tooth. C, An opaque composite resin is placed on the lingual portion of the restoration. This step is followed by placement of color modifiers or opaquers (if necessary) and completed with a facial veneer of a microfilled, microhybrid, or nano composite resin. D, Maxillary central incisors in open-occlusion relationship. E, A lingual wall of Multifill VS was first created. Durafill VS (white) was then used to simulate white hypoplastic enamel areas. A Multifill VS (incisal) overlay on the facial surface completed the restoration.

CLINICAL TIP

If the enamel is very translucent, create a longer and deeper bevel. If the tooth is more opaque, the bevel can be shorter and less pronounced.

7. Place a pulp protection as necessary. Place dentin-bonding agent according to the manufacturer’s instructions.

CLINICAL TIP

Avoid the use of opaque lining materials beneath very translucent enamel. They interfere with the transmission of light through the enamel into the underlying tooth structure or composite resin.

8. To prevent “shine-through,” place a more opaque hybrid composite resin in the lingual portion of the preparation.

9. Build up the resin to the level of the original dentoenamel junction.

10. If necessary, place custom tinting resins over this layer and blend the background color of the resin with the color of the tooth (Fig. 4-6 C).

CLINICAL TIP

Always apply color modifiers in very thin layers and be certain to observe the required curing time for each layer. Thicker layers result in incomplete curing and uneven layers caused by pooling of the material.

CLINICAL TIP

Chroma (intensity) must be appropriately diluted with a bonding resin to create a tooth-colored hue.

CLINICAL TIP

Place custom tints, such as gray, blue, or violet, to simulate incisal translucency in Class IV restorations. Place yellow or yellow-brown custom tints for fine tuning the background color. Place white for increasing value (Fig. 4-6).

11. To complete the restoration, fill the remaining facial portion with a translucent microfilled composite resin.

12. Contour the restoration.

13. Prepolish the restoration with rubber wheels or cups.

14. Smooth with a microfine diamond in a low-speed handpiece with water cooling.

15. Polish with disks or strips.

CLINICAL TIP

An excellent definitive high gloss can be obtained by using a dry felt wheel or padded disk without paste on the dry composite resin surface.

Diastema closures

A microfilled composite resin is the material of choice for diastema closure because of its excellent polishability and enamel-like luster (Figs. 4-7 A and B). If the diastema is very large, the lingual surface of the composite resin could be subjected to high functional stress in patients with heavy centric contacts. In these situations, the dentist may elect to use a hybrid composite resin for the entire restoration or a hybrid on the lingual portion overlaid on the facial surface with a microfilled composite resin. Shine-through is usually not a problem in diastema closure because of the labiolingual thickness of the add-on composite resin in the body area of the clinical crown. In many situations some translucency is desirable because the composite resin thins out at the incisal edge. If shine-through is a problem, follow the procedure described for the Class III and Class IV restorations.

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May 29, 2015 | Posted by in Esthetic Dentristry | Comments Off on Color modifiers and opaquers

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