Using Composite Resin in Aesthetic Restorative Dentistry

Part 6 - Reinforcing the lower incisal edge

Instructors:

Buddy Mopper, DDS

Buddy Mopper, DDS

Dr. Bud Mopper is an internationally renowned lecturer in esthetic dentistry with an emphasis on composite bonding using direct application techniques.  Dr. Mopper is in private practice in Glenview, Illinois, where he has been doing minimally invasive dentistry with composite for 40 years.

Dr. Mopper demonstrates how to trough the lower incisal edge

This gentleman has a multitude of problems. Not great problems. His teeth are solid, okay? He's got receded areas with abfractions. He's a grinder. And what we're gonna work on today are the lower anteriors. The centrals and the laterals. What we're gonna do, what we call incisor troughing. It's really incisor reinforcement. What I'm gonna do is I'm gonna built up those incisal edges, so that they're strengthened, and so that he doesn't lose these friable enamel surfaces, the labial and lingual surfaces, because you could see some of them are starting to chip away. But if I reinforce this with incisor troughing with the use of a combination of nanofill, replacing the dentin for strength, and microfill over the top for wear, he's never gonna have to have lower crowns or things of that nature. The problem is, and I discussed this early this morning, there's billions of types of these restorations that people should be doing and they're not doing. And they let their teeth wear away, and it's ridiculous. They not only lose what we call dimension, but they ruin their dentition. And there's nothing worse and more difficult to do, than a lower anterior crown. If a gentle dentist will just take a look at that, and try to reinforce that and educate their patient on what needs to be done, there's so much that can be done with composite like I said earlier, it's unbelievable. And this is one of the really great things that you can do for a patient. It's also, it's a profit center for your practice, and it's overlooked. And it's neglected, and then you end up having to do something that's a lot more destructive to the tooth structure, and it isn't necessary. So, this is why I'm big in minimally invasive dentistry, and this is I think, minimally invasive dentistry at its finest. So that's what we're gonna do today. We already have the patient numbed, and I'm ready to start. The bur I prep it with, I have two burs. It's all part of this kit that I helped design for Brasseler. It's their burs, I just put it together. And the two burs I use are microburs. And I have several microburs in my system. And this is a flame-shaped microbur that we're gonna use to penetrate the tooth surface. Now I use, for this one, for this prep, I use low speed, actually, lowest speed, high torque. It's in an electric handpiece. So I run it in about 20000 RPMs, but I run it under copious amounts of water. Because the whole thing I'm trying to do here, is to protect the integrity of these labial and lingual walls. I don't want them to fracture, because that's what's gonna maintain this stuff in. And when I used to use other systems like a carbide bur system or something like that, I'd get shattering of the bur, and I'd end up breaking them away. Then I used, started to use air abrasion. And with air abrasion, I'd get the sand all over the place. That wasn't controllable either. With this, I've got complete control with this technique. And so that's why I opted to go with this technique as far as preparation. It's a very simple preparation. There is no beveling, there is nothing. It's penetration, [1:01:45] right out of the box at the floor, and then adding the material in. And it's a very easy procedure to do. And it's a great procedure to do for the patient. Now we're gonna do our preps at the same time. I'm using a flame-shaped microbur. So this is the first prep. And all I'm gonna do is broaden out the base and clean out some excess you see in there, on those anterior teeth. You notice how friable the enamel looks. But it really isn't. Those enamel, that enamel is very strong. And when you can put something in it that adheres to it, you're gonna maintain those things like crazy, because it's gonna act just like dentin, sticking to it. So that's the . . . and everybody says, “How deep do you take it?” Well, I'm going in there, at least probably, I would say, it's at least a millimeter, maybe a little bit different. Doesn't make any difference, we're not getting close to the pulp or anything else. We want enough bulk in there, so it blocks out everything, and it gives it support. So that's basically it. And you look at those canines, we're eventually gonna do those because he's got wear in those canines. But I don't wanna do it now, 'cause I'm gonna, it has to do with the relationship to how I develop his canine rise and everything else. So we're working with these lower end anteriors right now. We're not gonna change their length at all. Because we don't want to change centric, we don't want to change its occlusion, all we want to do is get them in nice contact so it can incise well and maintain the length of the teeth that he has. Basically that's it.
[1:04:22] So I'm using this cut to trim the dentin, or just the plain enamel wall with it. Been trying to get out any stain or anything like that. That's it. That's it, done. Now, what I do, is you can do pretty much multiples on this, and we can etch it at the same time film . . . but here's the way we do it. Let me have the strips. I use a metal strip, in between on these. Okay. Got it. Now, if you try to put Mylar strips in between here, like multiples, you couldn't do it. Metal is thinner, and as you add to the cut, you know, as you do it, it gets [1:05:43] tiring. Now, can you torque this for me? She's gonna torque this a little bit so I can get, just open the, she'll just open the contents. No no, this one. All right, you can wash the etching off. Meanwhile, leave the bands on. Get the bonding adhesive. Polymerize that. So there's not much [1:06:45] value about what I do, you know? And you know, the idea that you need rubber dam and stuff like that for anteriors is ridiculous. You can't see tooth against tooth, or tooth against resin, that's why I don't use it, okay. And isolation is really good. And actually, this stuff really penetrates a really . . . really is almost . . . it is resistant to water more than people think it is. It's amazing stuff. I'm gonna take a little bit of this, I'm gonna put it in here like so. So what we're doing, is we're putting in the dentin reinforcement, which is the NANO, and I'm gonna indentate that. In other words, I'm gonna make it concave, so that I put my final surface . . . is my microfill, because I'm gonna get the best wear with microfill. So that's gonna give me the . . . you can either use microhybrid or NANO, whichever one you think is gonna give you the more opacity. I think this is gonna be good, what do you think? You think we're getting enough opacity with that? Looks pretty good, doesn't it? Yeah. I think so. Uh hmm. Looks good actually. Let me have a hybrid for the next one, just for a second, before you polymerize this. I wanna take a look. Yeah, it's the same thing, yeah. Uh huh. I might want to use the microhybrid on this, because of the depth of it. Don't polymerize that yet. Before I polymerize it, I'll put it over on this side, on this too. I'm gonna see which one is the best. Now all I'm doing is determining the amount of black out I get. I want good black out, so there's no incisor translucence coming through. And like I say, NANO is more translucent than the microhybrid, whereas the microfill is the most translucent. Okay. Polymerize it. Go. Can I have a 5/8?
Uh hmm. I think we're better off with a 5/8. 5/8? 5/8. Try it. Holy cross, you can level with that. See that's better, you see it? Sometimes bigger is better, not smaller is better. Because it gives you access that you didn't have before.
There's no doubt in my mind that he will never have crowns. If he stays with me, he will never have crowns. Because even if he wears a night guard now . . . but, and I don't know when that wear started. He wasn't my patient, okay? But the thing about it is, is that if you restore the integrity of that incisor edge, and you follow it along, if you've got microfill over the top, you will see, there will be very little wear there.

All I'm doing is finishing the proximal surfaces. I started with a diamond strip. And now we're finishing with a fine, superfine aluminum oxide strip in the inner proximals. And just making it so that there's . . . we'll get everything as smooth as we possibly can, so it's comfortable for the patient. And that's what these things do. It actually polishes the proximal surfaces, and they really, what this is really doing actually, 'cause there's not too much stuff on the proximals. It's really just taking any excesses off. Which could be either bonding adhesive or it could be some material. They're on the proximal surfaces. 'Cause here, we just really restored the incisor edges. Sometimes, material gets into these areas and you have to take it off. I wanna make sure it's not there. Can I have a diamond strip here for a second? Okay, now let me have those . . . that's it. Give me that floss. Just to check it out.