Class V color-matching made easy

Class V, or cervical composite restorations, can be very difficult to color-match and blend into the tooth seamlessly. It is very important to provide a good color-match on these restorations for anterior teeth, especially in the smile zone. To achieve an excellent color-match, it is often necessary to use two or three shades of composite and blend them in a precise manner. The results often vary, leaving the dentist and patient less than satisfied. Over the years, many dentists, including myself, have wished for a composite material with just one shade that would offer excellent results each time.

Case study

A 45-year-old male presented for three class V fillings. Teeth nos. 4 and 5 had cervical abrasions (or erosion), and no. 6 had a defective existing composite filling

Figure 1: Pre-op view showing Class V cervical abrasions on nos. 4 and 5, and a chipped restoration on the cervical area of tooth no. 6. — **Figure 1:** Pre-op view showing Class V cervical abrasions on nos. 4 and 5, and a chipped restoration on the cervical area of tooth no. 6.

that needed to be replaced. Omnichroma, a universal composite material, was selected to restore these teeth due to its ease of handling, strength, and ability to blend the color of the restoration into the natural color of the tooth.^1,2 Now that this material has been around for almost two years, longevity of restoration can be added to its list of desirable characteristics.^3,4

The teeth to be restored in this case had excellent gingival health, and the patient was in good health. The patient was anesthetized with one carpule (1.7 ml) of lidocaine with 1:100,000 epinephrine.

Figure 2: Teeth nos. 4, 5, and 6 had #00 packing cord placed on the facial/buccal margin, the teeth were prepared, and bonding agent was added. — **Figure 2:** Teeth nos. 4, 5, and 6 had #00 packing cord placed on the facial/buccal margin, the teeth were prepared, and bonding agent was added.

The gingival margins were retracted with #00 packing cord (Ultrapak, Ultradent) to keep the gingival margins of the restorations free of fluid contamination. The old restoration on tooth no. 6 was completely removed with a high-speed 330 carbide bur. The cervical lesions were free of decay, so the surface dentin was abraded with a slow-speed round bur to create a fresh surface for bonding. The enamel margin was beveled on all three teeth. It is important to create a greater surface for enamel bonding and allow the composite material to blend into the tooth better (figures 1 and 2).Teeth nos. 4, 5, and 6 were acid-etched (35% phosphoric acid) and thoroughly rinsed with water. The excess water was dried off, leaving the teeth slightly moist. Bonding agent (Bond Force, Tokuyama Dental) was added to all three teeth in two applications. After air-thinning the bonding agent, all three teeth were light

Figure 3: Omnichroma was first added to the buccal of tooth no. 4. Note how much whiter it is than the tooth structure prior to light curing. — **Figure 3:** Omnichroma was first added to the buccal of tooth no. 4. Note how much whiter it is than the tooth structure prior to light curing.

cured. Omnichroma was added in 2 mm increments and carefully contoured and light cured, one tooth at a time.

The composite material will appear too white or high in value at first, but after light curing, the composite blends into the color of the natural teeth. A thin interproximal carver was used to carefully seal the gingival margins of the restorations and follow the contour of the natural tooth. This process is made easier by the handling properties of the composite material, which stays in place and doesn’t slump. The material was thoroughly light cured on all three restorations (figure 3).

Figure 4: Immediate post-op view of nos. 4, 5, and 6, showing excellent color-match. — **Figure 4:** Immediate post-op view of nos. 4, 5, and 6, showing excellent color-match.

The initial step in finishing and polishing was to smooth down the excess material with a high-speed handpiece using a flame-tip diamond bur. The packing cord serves as a visual guide to the position of the gingival margin. Do not leave an excess of composite material subgingivally or chronic inflammation will result.A coarse-grit sandpaper disk was used to help create smooth facial/buccal contours and remove the sharp, irregular composite surface. A fine-grit disk was

Figure 5: At the one-year post-op check, the restoration has maintained its polish and color-match. — **Figure 5:** At the one-year post-op check, the restoration has maintained its polish and color-match.

used to smooth the composite further and get rid of the deep scratches. Rubber cups, followed by a Jiffy brush (Ultradent), were used to create a highly polished surface on the final restorations (figure 4).^5,6

Conclusion

From the one- and one-and-a-half year postoperative images, we can analyze the longevity performance of the restorations. The restorations have proven to be color-stable and retain their polish and structural integrity (figures 5 and 6).

Figure 6: One-and-a-half-year post-op check. — **Figure 6:** One-and-a-half-year post-op check.

References

Fahl N Jr. A solution for everyday direct restorative challenges. Mastering composite artistry to create anterior masterpieces—part 1. J Cosmet Dent. 2010;26(3):56-68. https://www.yumpu.com/en/document/read/45395958/mastering-composite-artistry-to-create-anterior-masterpieces-part-1
Miyasaki MA. OMNICHROMA from Tokuyama Dental. One-shade universal composite redefines clinical versatility. Decis Dent. 2019;5(8):42.
Peyton JH. Show your work: restoring large class III cavities with a one-shade composite. Dental Town. December 2019. https://www.dentaltown.com/magazine/articles/7843/show-your-work-restoring-large-class-iii-cavities-with-a-one-shade-composite
Peyton JH. Class V (cervical) restorations that just blend into the tooth using OMNICHROMA. Dentistry Today. December 1, 2019. https://www.dentistrytoday.com/k2/item/5743-class-v-cervical-restorations-that-just-blend-into-the-tooth-using-omnichroma
Finlay S. Conservative esthetics using direct resin. Inside Dent. 2010;6(5):96-101.
Peyton JH. Finishing and polishing techniques: direct composite resin restorations. Pract Proced Aesthet Dent. 2004;16(4):293-298.

JAMES H. PEYTON, DDS, FAACD, is a 1982 graduate of the University of California, Los Angeles, School of Dentistry, where he is a part-time clinical instructor. He maintains a private practice in Bakersfield, California. He lectures at the Esthetic Professionals Education Center in Tarzana, California, and is a part-time clinical instructor at the Fahl Institute in Curitiba, Brazil. He is an American Academy of Cosmetic Dentistry examiner and a contributing editor for the Journal of Cosmetic Dentistry.