This page is under construction at the moment
Over the last 50 years, anterior restorative dentistry has become more conservative, stronger, and more esthetic. Preparations have changed only in a minor way, and this page will detail these relatively small number of changes, as they apply to:
- Incipient Class III -new minimalism through smaller burs
- Extensive Class III- improvements in the esthetics of preparations that puncture both lingual and facial walls of enamel- frequently called “Through and Through” Class IIIs
- New thinking about bevels-viz., bevels that improve adhesion vs bevels that only attempt to hide facial margins.
50 years of materials progress
The restorative side of Anterior composites has hugely expanded.
- Resins and adhesives are better.
- Curing lights are more powerful
- Dentin bonding now recruits dentin into the bonding scheme, for greater strength and improved esthetics, relative to the enamel-only paradigm of the early days of composite resin, 1972- 1992,when dentin was covered by 2-part quick-set calcium hydroxide products.
- Cosmetic materials have proliferated to an amazing extent to improve initial match in shade,hue,chroma and saturation
- Polish is glossier and is retained longer as filler particle size has shrunk from macro to micro to hybrid to nano
- New resin molecules have been exploited beyond Bis-GMa, viz., UDMA and TEGDMA, etc.
- Lighter shades have been developed to match bleaching outcomes along with non-yellow photo-initiators other than benzoyl peroxide
- Opacity is better controlled by using blocking resins or dentin shades.
Operative improvements
While basic preparations remain the same, we have choices of smaller burs to make smaller initial openings such as 329/330, burs in the 169L 170L/1169L/1170L families, and the fissurotomy family of burs.
Matrixing
Thick, flat transparent mylar matrixes have been supplemented by thinner blue transparent matrixes to improve placement. Curved clear and blue transparent matrixes have developed to improve proximal contour.
A device, the Bandbender,developed to make custom posterior contoured matrixes, is also available to create custom curved anterior proximal surfaces held by the Tofflemire retainer. This is beneficial in anterior dentistry to meet three conditions:
- When the gingival margin is so deeply subgingival that interproximal wedging becomes impossible
- When the stability of the matrix is enhanced by circumferential tightening and possibly wedging the non-restorative interproximal
- When the volume of resin to place demands incrementing.
Thin custom curved matrixes from the Clark BioClear system meet the needs of a variety of extensive reconstructions including diastema closure and black triangle blockout.