Contours Matter

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As dentists we often get fixated on material selection and shade.  But we are most often overlooking a more important aspect of quality restorative dentistry – contours and shape.

Contours can make or break the aesthetic perception of a case!

I would like to share with you a case that is far from perfect – before or after – but shows the difference understanding contours can make.

Regina recently came to our office unhappy with composite bonding done on tooth #8.  She was specific about how the teeth didn’t look the same size.  She also mentioned the color as well, but that wasn’t primary concern.

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As you can clearly see the shape of #8 makes the restoration look wider and is also putting pressure on the papillae.

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In looking at the facial shape in a mirror (i clearly need some new dental mirrors) you can see the mesial line angle is angled towards #9.  This also makes #8 look much wider than #9.

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The first step was to use a diamond disc (Meisinger USA) in a straight handpiece at 2000rpm to adjust the mesial line angle and to slowly and carefully adjust the overcontoured papillae area.  In retrospect, I angled this too much – as you will see in the final pictures.

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Then a metal sanding strip is used to continue contouring the papillae area.  Care should be taken to minimize trauma to tissue and to not overcontour the line angle – which I also did here.

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Next flexible sandpaper discs are used in a low speed at about 2000rpm to begin final shaping and polishing.

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After contouring is completed diamond polishing paste is used with a bristle brush to achieve a nice smooth surface.

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Here is a scratched mirror view showing the difference in the contact area contours.

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Here you can see the recontoured composite resin.  Once again I’d like to point out that I overcontoured this.  At this point it would be very plausible to come back and use a contoured sectional matrix band and establish proper matching contours.  Luckily the patient was very pleased with this and didn’t ask for that!

Contours can make or break a case – direct or indirect.  The same thing goes for your CEREC restorations.   Start taking photography of your work and developing a critical eye so you can get better!

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