Learning objectives

The participants will learn:

1. The potential, advantages and disadvantages of direct composites
2. To differentiate which cases are suitable or not for the injection technique
3. How to prepare teeth previous to composites
4. How to make correctly all kind of indications for direct restorations
5. How to build a matrix, inject the composite and cure it
6. The classic analogue and the digital modification for posterior as well as for anterior teeth
7. The simple way, the layering modification and the “Crystal Shell” technique

Course description

The course will cover the necessary knowledge to master anterior and posterior direct techniques. First, the participants will evaluate the model and plan how to prepare the anterior teeth. Afterwards, they will prepare the teeth and then they will have to restore them with different techniques, depending from the indication. From classic wedge and mylar strips use to more sophisticated techniques like the FEM technique, the pulling and reverse pulling to the injection technique. The complete range of indication for composites is going to be covered.

In the beginning, all will start quickly with simple class III to IV, V as the foundation. Then, more modern indications like direct veneers, peg laterals and diastema closures will be done. The second day will start with complex cases that present stains or special optical challenges. Then the direct injection technique will be presented. How to build a proper translucent matrix will be shown. In the posterior region, severely worn dentition will be simulated and restored with the “Crystal Shell” technique. Simple monochromatic and multilayer polychromatic approaches are going to be shown. The advantages of the digital approach is going to be shown. How to finish and polish is going to be demonstrated in detail.
All the steps will be shown by the instructor with an HD camera with high magnification for an explanation of all the details.

Agenda Day 1

Agenda Day 2

About the course

Current and state of the art anterior oral rehabilitation techniques aim for both aesthetic and functional outcomes. During recent years, novel resin biomaterials and clinical techniques have appeared. Nevertheless, the process of making final restorations is still very tedious and time-consuming; demanding highly specific skills and techniques from the clinician. On the other hand, matching the right shade, opacity and form are also challenging. Because of that is is of paramount importance that the clinician understands perfectly the layering concept, how to take the shade and how to mix the composite colour and consistencies in order to get that shade.

Achieving the right opacity by mixing dentin, enamel and effect shades is crucial, since the mouth is dark, which means that our restorations need to achieve the correct value in order to block the darkness, but at the same time to be translucent enough to match the enamel.

On the other hand, the fabrication of the final restorations is often externalized to a dental technician if they are indirectly made, (ceramics or PFM) because the traditional process of placing multiple direct anterior restorations is usually not cost effective in terms of outcome and time invested to fulfil them. Furthermore, traditionally direct restorations are not made using pre-established tooth shapes or contours, making them extremely difficult and single-oriented. The development of materials has historically not contributed either, due to the fact, that according to the literature, only dense resin composites are recommended for direct anterior composite restorations. Filler amount, longevity and tooth looking shades for layering techniques are the main reason why those types of resin are the state of the art material chosen. However, since the 1990s, resin materials have improved vastly both in optical and mechanical properties, making them more versatile within their limitations. New strategies for applying resin composites have arisen, making new techniques possible. Mockups using bis/acryl and injecting flowable composite using transparent matrixes have become more popular for provisionalising and restoring anterior teeth. Originally, the injection technique had the disadvantage of having only one matrix, which was taken from the wax-up. This created a much more difficult excess removal than the modified version we are going to present. The course will help you understand the capabilities of these techniques, especially the newest version and will give you all the tools necessary to master them the classic direct techniques as well the newest version with mouldables and flowable composites.