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Special Issues
July/August 2021
Volume 42, Issue 1

Isolating, Bonding, and Creating Composite Artistry

Adamo E. Notarantonio, DDS, FICOI, FAACD

A patient presented with a significant dental history regarding teeth Nos. 8 and 9 dating back to age 8. Most recently she had had a traumatic experience when the resin restorations were replaced. The material was overbulked interproximally, causing the papilla to recede and resulting in a black triangle. After removal of the existing resin, periodontal treatment, and replacement of the bonding, the soft tissue returned to normal, but the patient was unhappy with the esthetics of the bonding. After multiple referrals, the patient was sent to the author for Class IV resins on Nos. 8 and 9. She wanted assurance that her papilla would be protected, and that the composite restorations would match the translucency of her other teeth. The author informed her that isolation of individual teeth would be accomplished using a heavy-gauge rubber dam to retract and protect the tissue and establish an ideal field for bonding and restoring. The bonding agent of choice was All-Bond Universal® (BISCO, bisco.com), and a total-etch protocol was used. Multiple shades of resin were utilized to mimic the natural colors and effects present in the patient's dentition. Meticulously combined, these techniques allowed for delivery of high-quality esthetic restorations that will stand the test of time.

Key Takeaways

Use of a rubber dam for closing diastemas and/or Class IV fractures with composite resin helps prevent moisture contamination and enable sufficient gingival retraction.

All-Bond Universal provides clinicians the versatility to bond via self-etch, selective-etch, or total-etch depending on the preparation design and amount of dentin exposed during preparation.

Understanding the colors in a resin system, along with using a systematic approach to layering resin, allows maximum esthetic results to be achieved.

About the Author

Adamo E. Notarantonio, DDS, FICOI, FAACD
Clinical Instructor, Honors Aesthetic Program, New York University College of Dentistry, New York, New York; Private Practice, Huntington, New York

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