Oral Health Group

Simple Esthetics with a Modern Material

March 1, 2010
by Simona Cuevas, DDS

Today’s esthetic dentistry aims to replace damaged or malformed tooth structures with artificial materials that have been tested and proven to posses biological, functional and physical properties very similar to natural teeth.

The newest generation of nanofilled composite resins offers excellent esthetic potential and great longevity without the need of unnecessary tooth structure removal.


The multitude of shades, translucencies, opacities, and available color effects combined with skilled placement techniques almost guarantee incredibly beautiful results which closely mimic natural dentition.

Nanofilled composites present similar mechanical and physical properties to those of microhybrid composites, yet their polishablity and gloss retention surpass all other known composites.

The main example of a cosmetic nanofilled composite is Premise by Kerr Corporation.

Traditional restorative objectives have not changed over time. They were simply implemented based on the esthetic demands of an increasing number of patients. Composite resins have become the material of choice for conservative, esthetic restorative approaches. The contemporary practitioner is ultimately challenged to replace missing or esthetically inadequate tissues or to modify their configuration by applying on the patient’s teeth an artificial material, which must simulate the appearance of natural tissues. The natural layering concept together with an overall esthetic approach has enabled the achievement of this objective in a predictable way. Esthetic dentists have long advocated the freehand placement of various opacious, body, and translucent composite materials onto the air-inhibited layer of a previously cured increment. It is the presence of a 3-m to 5-m layer of unpolymerized resin on the surface that provides the organic coupling sites for the additional increments. While layering composites in this fashion is optimal, the complexities of predetermining the exact thickness, placement, and shape of each layer and opacity complicate freehand layering.

Case Presentation

A 25-year-old female patient presented with a darkly stained class 4 composite on tooth #8. She desired to eliminate the unsightly restoration and improve the general appearance of her dentition and smile overall. The rest of her dentition was unrestored and healthy, although dark in color with uneven tissue architecture. Vital bleaching, tissue recontouring and replacement of the class 4 composite on tooth #8 would promise a very conservative approach to her smile rehabilitation.

The patient was fitted with custom-made bleaching trays that she used with a 16% carbamide-peroxide bleaching gel for two full weeks. After satisfactory bleaching results were achieved, the patient returned for minor tissue recontouring. A week later, she presented to the office for her final appointment of the class 4 composite replacement. After removal of the old composite, no additional healthy tooth structure was removed. The missing tooth structure was rebuilt with a body shade of the submicron nanohybrid composite Premise (Kerr). The full contour was achieved utilizing a freehand technique. The tooth was built to full contour and comparatively analyzed to the adjacent teeth in order to assure that the final restoration would be of appropriate length in relation to the esthetic objectives and limitations of the patient’s occlusion. Final facial and incisal contours were then achieved by overlaying a translucent enamel layer. The restoration was then light cured, finished, and polished with Kerr OptiDiscs.

The patient was very satisfied by the esthetic transformation achieved!


It is my firm belief that by using well-tested modern restorative materials and implementing proper diagnosis, even with only moderate skill level, any dentist can achieve extraordinary esthetic results with minimal chair time. OH

Dr. Cuevas is a graduate of the University of Texas Health Science Center; San Antonio.

She is the president of the Institute of Esthetic Dentistry in San Antonio, TX where she practices full time. Dr. Cuevas has 13 years of experience lecturing nationally and internationally on the topic of esthetic dentistry. She has authored numerous articles on esthetic dentistry and is a contributing editor to the Journal of Cosmetic Dentistry.

Oral Health welcomes this original article.


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