Composite layering technique

A female patient was very nervous when attending a new patient examination. Her primary complaint was the appearance of her front teeth which made her extremely self conscious of her smile. A fear of dental treatment had prevented her from seeking help sooner, so the decay was quite advanced (fig 1).

Examination revealed carious lesions present on teeth 11, 21 and 22. Periapical radiographs of the anterior teeth were free of any apical pathology and vitality testing with standard ethyl chloride gave a positive response suggesting healthy pulps.

After considering the financial constraints and anxiousness of the patient, a treatment which combined minimal cost, invasiveness and treatment time was proposed. Repairing the cavities with direct composite was presented as the treatment of choice.

The first step undertaken was to create a study cast of the upper arch (fig 2). Once the cast was supplied from the lab, a drop of Adper Scotchbond 1XT total-etch adhesive (3M ESPE) was applied to the cavity surfaces and air dried before light curing. To create a mock up of the final restoration, composite which had passed its use by date was applied to the study cast. A small amount of silicone putty was then pressed over the palatal surfaces of the teeth and allowed to set (figs 3 and 4).