Often in dentistry, patients present with concerns that they want solved but are not necessarily easy to address. Esthetic concerns are the most difficult ones for us clinicians to understand as a patient’s idea of esthetic is very subjective and sometimes difficult for them to express. However, these ideas can be revealed through careful questioning and discussion.
I recently had a healthy non-smoking 35-year-old male patient present to the office with a chief complaint regarding previous composite restorations completed three years prior. To the patient, the restorations never quite “looked right.” He additionally stated that there was a lot of bleeding when he flossed. Looking at Figure 1 and 2, you can understand the main concern of the patient.
To understand the patient’s expectations in addressing his chief complaint, myself and the patient had an in-depth conversation regarding color, shape, and the ultimate end goal. I came to find out that the patient had previously undergone a diastema closure with resin composite restorations between teeth #’s 7 & 8 and 8 & 9 post clear aligner orthodontic therapy.
Unhappy with the outcome, the patient was looking for an improvement with a more esthetic solution. The treatment options discussed with the patient were: no treatment, composite replacement or ceramic with layered porcelain veneers. Each of these treatment options included a discussion regarding a maxillary frenectomy to relieve the high fibrous tissue attachment. Ultimately, the patient’s decision was to proceed with a staged approach of composite restorations, maxillary frenectomy followed by veneers few months later.
Envisioning the idealized size, shape, color, and contours of the patients’ four maxillary incisors were key in achieving an acceptable clinical and esthetic outcome (Figures 3-7). Additionally, the material selection was of paramount importance to make this possible.
Blending hues, values and opacities using traditional resin composites is a difficult task for almost every clinician. As we know, traditional composite resins that rely on dyes and pigments increase complexity and overhead in performing these procedures. However, now, there is an easier answer with a product released in 2019 by Tokuyama Dental.
Tokuyama’s OMNICHROMA entered the dental market with much fanfare and applause. A truly remarkable restorative material, OMNICHROMA is highly esthetic, highly versatile, and easily manipulated. It is indicated for any and all restorative Classes (I-V).
Recognizing its need in the restorative arena, Tokuyama has also introduced OMNICHROMA BLOCKER, OMNICHROMA Flow, and OMNICHROMA BLOCKER Flow. These four products within the OMNICHROMA product family allow clinicians to achieve esthetic and biomimetic restorations in the majority of clinical cases that present to their practice.
OMNICHROMA BLOCKER is a universal opaquer best used when trying to replicate shades between Vita A1 and A3. A darker opaquer is recommended when replicating shades outside of that range. The placement of the BLOCKER is key and a minimum of 0.5mm should be placed only in those areas of the tooth where translucency is not desired. Note in Figure 14 that the BLOCKER is tapered off approximately 1mm away from the incisal edge and includes only a thin shell.
In this case, OMNICHROMA BLOCKER Flow was placed along the gingival margin and then OMNICHROMA BLOCKER was placed to finish the base layer. OMNICHROMA Flow and OMNICHROMA were placed in small increments to achieve the result seen in Figure 15.
To ensure proper papillary rebound post diastema closure of the #8 and #9, it was decided that the patient was to return in one week for a follow-up visit. At this visit, the patient was re-interviewed to confirm their end goal and to check satisfaction with the new restorations. Ecstatic with the results, the patient agreed to continue with recontouring between #9 and #10.
All contouring and polishing was completed using traditional dental burs, Shofu’s Super-Snap Rainbow Technique Kit, Shofu’s Super-Snap SuperBuff Disks and Shofu’s DirectDia Polishing Paste. The key for this case and with any direct composite restorations is to take the time to finish the case properly. The more time spent polishing the more OMNICHROMA will truly “disappear” into the tooth (Figures 19 and 24).
Tokuyama’s OMNICHROMA products have unique physical and chemical properties which allow them to be a truly “universal” solution in almost every clinical situation. OMNICHROMA and BLOCKER, both packable and flowable, allow for a simpler, less technique sensitive approach to the placement of anterior and posterior composites. They allow us clinicians to be confident in our material choice and know that we will be able to achieve high-quality esthetic results consistently in our clinical practice.
I use OMNICHROMA, OMNICHROMA Flow and OMNICHROMA BLOCKER (packable & flowable) for almost all my restorations in the esthetic zone. Additionally, OMNICHROMA products are supremely well-suited for use as a Class V restorative material. By removing the stress in shade management both from an esthetic and an office overhead perspective, I have found that choosing OMNICHROMA as a go-to universal composite becomes an easy decision.
Neville T. Hatfield, DMD MBS, graduated magna cum laude from the Boston University School of Dental Medicine. He completed a general practice residency at the Manhattan Veteran Affairs Hospital, where he provided interspecialty comprehensive prosthetic and surgical treatment to medically complex patients. He leverages that experience in private practice in northern New Jersey and maintains clinical privileges at Holy Name Medical Center in Teaneck, New Jersey.