How to use SDI's Aura universal composite to correct esthetics [VIDEO]

While the results of orthodontic treatment usually bring big smiles and straighter teeth, there are some side effects that can go along with treatment as well. 

Such was the case with a recent patient. She was a college student who was about to begin nursing school and had finished her orthodontic regimen. However, she was not pleased with the results.

When she looked in the mirror, she saw discolored teeth, white spots and yellowed composites, a prominent upper left canine, inconsistent shapes and papilla, and worn edges of teeth.

She also complained of muscle tenderness and a sense of not having a consistent bite. It was determined that the prominent canine, slight fremitus of Nos. 6-11, and general tooth wear were indicative of occlusal dysfunction, while the discolored cervical composites and generalized “white spots” were indicative of a history of decalcification.

Noting the decalcification, one of the biggest questions at her exam was whether this was still an active problem. A “bioluminescence” test demonstrated a lower than optimum pH in the oral environment. The patient was put on an aggressive remineralization program using CariFree treatment rinses and toothpastes/gels.

For this case, the Aura system was used due to its durability, natural selection of colors, and its ability to allow underlying tooth structure to enhance the composite’s appearance.

Some of the qualities that I appreciate about the Aura system are: 

•  It’s non-sticky. Less uncured resin is used, resulting in creamy handling. 

•  It’s easy to polish to a mirror finish 

•  It has large particles (60 microns). This means high filler loading and strength. 

•  A big bonus is its low flexural modulus. This means better fracture resistance as less stress at the composite interface means less debonding.

•  It has lower polymerization shrinkage.

•  It is a prepolymerized microfilled composite, making it stronger than a standard microfill.

•  It’s easy to polish to high gloss.

•  It has high fluorescence in the dentin and slight in the enamel and contains opalescence (bluish glow in natural light) to match natural enamels. I think this gives life to the restoration.

•  It has superb gloss retention without the “plucking effect” of large particles. 

The patient wanted a shade that was bright but also looked natural. The Aura E1 shade was selected because it was the most whitish/lightest. It has high opalescence with some degree of translucency and was designed to emulate young enamel for those who are 20 or younger.

Step 1: Surface discolorations and previous composites were conservatively removed with a flame-shaped diamond, maintaining the outer enamel and creating room for the forthcoming layer of Aura.

Step 2: Treatment sequence of bonding is begun with tooth Nos. 8 and 10. After outline form and gross contouring, No. 7 and No. 9 were treated in the same fashion. Tooth Nos. 5 and 6 were bonded, followed by Nos. 11 and 12. Aura’s handling properties allowed this be performed very efficiently and effectively.

Step 3: 37% phosphoric acid was placed over the entire labial surface with a 30-second exposure time (since no dentin was involved) and thoroughly rinsed with water for 15 seconds each.

Step 4: A universal bonding resin was placed carefully placed using a microbrush and thinned with a warm air dryer.

Step 5: Each tooth being treated was cured for 20 seconds using SDI’s Radii Plus light with its wide tip. Aura Enamel (Shade E1) was thinly applied and sculpted using Cosmedent’s Titanium IPCT Instrument, placing the gingival half first blending the interproximal. After a 40-second cure, the incisal portion is adapted to the tooth using the anatomy of the incisal edge and adjacent anatomy to guide initial contouring.

Step 6: Gross finishing is achieved with a thin 16 bladed ET 9 bur to clean the gingival margins and establish labial anatomy. Interproximal surfaces were smoothed with plastic finishing strips.

Overall, she was very happy with the results and could finally flash the confident smile of completed orthodontic treatment.