Additive Direct Composite Restorations (ADCR) in the Anterior Area
This program is designed for dentists wishing to achieve excellence with direct anterior composite restorations.
The final aesthetic outcome of an anterior restorations depends on the combination of the final form of the restoration with the color selection, tooth anatomy and the thickness of each composite shade. Clinicians should have a precise idea of the form of the final restoration in their mind before starting color selection and composite layering (Deliperi, 2011).
Three mandatory steps are recommended when placing direct anterior composite restorations: 1-pre-op mock and/or wax-up to determine the final form of the restoration
2-shade selection and optical characteristic reproduction based on tooth age
3-evaluation of tooth thickness to manage the three-dimensional layering of dentin and enamel shades
Current evidence-based research supporting this technique will be presented.
The course will cover an additive approach for the restoration of both vital and devital teeth in the anterior area. Tooth whitening procedures will be presented as a mean to preserve as much tooth structure as possible (Deliperi, 2008); a step-by-step protocol will guide clinicians to “go additive” in most direct anterior applications! Participants will learn how to mimic both the mamelon expression, the incisal characterization and the incisal halo.
Particular attention will be given to the non invasive restoration of discolored and structurally compromised teeth as well as teeth resistant to bleaching procedure. A fiber lay down protocol will be presented to increase the fracture toughness of these teeth.
Attendees will also learn how to integrate direct composite and indirect porcelain restorations in a patient smile.
Completion of the course should provide attendees with many tips and tricks they may apply the next Monday in their practice.
Topics covered through demonstration and hands-on experience:
– Silicone Matrix Fabrication
– Criteria for composite choice: single mass vs dual vs polychromatic technique – Shade selection for the cervical, middle and incisal third
- Composite layering protocols for Class IV, diastema closure, composite veneers and thebiomimetic SRDC crown
- Additive composite layering procedure for both vital and devital teeth
- Finishing and polishing: how to reproduce the macro and micro-texture of the natural teeth
- Fiber lay down protocols for structurally compromised teeth
- Understand plus and minus of different composite systems
- Learning specific layering protocols for different composite brand to restore vital and devital anterior teeth
- Compare a direct technique with traditional techniques available for the restoration of anterior teeth (porcelain laminate veneers, zirconia crowns)
- Understand how to replicate the esthetic appearance of porcelain restorations with a step-by step protocol for direct restorations
- Become familiar with a new technique for the restoration of discolored teeth resistant to bleaching
- Learn a fiber lay down protocol to mimic the functional characteristics of the natural dentition when teeth are structurally compromised
Day I: Class IV restorations and Additive Direct Composite Veneers
Guidelines to mimic the optical characteristics of the young, adult and mature dentition in the cervical, middle and incisal third of the tooth
The 3D meticulous management of the body, dentin, trans and enamel shades to achieve both color integration and vitality (color depth) of the restoration in the incisal third
Class IV, diastema closure, composite veneers How to avoid aesthetic failures
Day II, III: Veneers and Fiber lay down protocols for structurally compromised teeth
Stress-reduced direct composite restorations (SRDC) for structurally compromised teeth
How to preserve ultra thin remaining cavity walls via fiber lay down protocols
Combined endodontic access and class IV-Class III restorations
How to mask the tooth discoloration through a prepless approach: contraindication for tooth preparation in shade matching
Day V: Advanced protocols for ADCR
The perio-restorative approach to class V lesions and gingival recession: a combined restorative and surgical approach
Treatment of localized dental erosion in the anterior area via ADCR The Full mouth rehabilitation via SRDC and ADCR protocols
ADCR vs Porcelain Veneers and the combined ADCR-Porcelain veneer restoration approach
Fundamentals of stress reduced direct composite (SRDC) restorations in the posterior area
CLASS SIZE limited to 10-12 people
Following 20 years of clinical experience and success with stress reduced direct composite (SRDC) restorations, this program is designed for dentists seeking for a true paradigm shift in restorative dentistry. The course will present the 100% tooth preservation philosophy based on 1-Occlusion, 2-Conservation, 3-Adhesion and 4-Stress reduction. Current evidence-based research supporting this technique will be presented.
The course will review the development of the SRDC protocol: from the Deliperi & Bardwell JADA 2002 to the Deliperi Operative Dentistry Journal 2012 paper. The 6-step protocol will be analyzed focusing on all the details of each step:
- cavity prep and caries removal endpoints
- structural analysis
- reliable adhesion to enamel and dentin (etch & rinse vs self-etch)
- stress reduction
- occlusal equilibration
Layering and Curing protocols to reduce the C-factor and the stress from polymerization shrinkage will be presented for both enamel and dentin. Participants will become familiar with the Selective Composite Technique: 1- the enamel shell, 2- the dentin replacement and 3- the successive cusp build-up layering techniques. The maturation of the dentin bond concept and the advantage of sculpting restorations before curing will be illustrated. This time saving technique can often result in minimal occlusal adjustment, contouring, and polishing!
This course will also include the direct restoration of structurally compromised teeth by using continuous woven polyethylene fibers. The “wall-papering” protocol will be introduced to reduce the stress, increase the bond and maintain the integrity of the tooth-restoration complex overtime (Deliperi S. wt al. Oper Dent 2017). The continuous fiber supported-stress reduced direct composite (CFS-SRDC) protocol will be reviewed starting from the Deliperi et al J Adhesive Dentistry 2005 to the Deliperi et al Operative Dentistry 2017 paper. Attendees will become familiar with the difference between an adhesive and a biomimetic stress reducing approach. The CMR (Cervical Margin Relocation) in a SRDC protocol will be presented: the one vs two appointment procedure will be discussed along with the issues related to isolation, tissue management and matrix system selection.
The level III of the course will be dedicated to the most advanced protocols in SRDC restorations which will include:
A) The ultra conservative approach for the highly structurally compromised teeth with the introduction of the cusp preservation vs “cusp protection” scenario
B) The continuous fiber supported-stress reduced semidirect composite (CFS-SRSC) restorationsfor the restoration of the “hopeless” teeth
C) The Full Mouth Rehabilitation via SRDC and CFS-SRDC protocols. This section will cover not only the rehabilitation of patients suffering from dental erosion, but also the rehabilitation of those patients with a structurally compromised dentition due to caries, failing existing restorations and tooth fracture via a 100% tooth preservation approach
- Understand a stress-reduced approach for the restoration of structurally compromised teeth with layering and curing protocols
- Compare a stress-reduced direct technique with traditional techniques available for the restoration of Class II restorations
- Understand how to replicate esthetic appearance and the creation of anatomical proximal contacts
- Learn a fiber lay down protocol to mimic the functional characteristic of the natural dentition
- Understand the ultra conservative approach for the highly structurally compromised teeth: cusp preservation vs “cusp protection”
- Become familiar with a SRDC protocol for the full-mouth rehabilitation in patients either suffering or not from TMD