March 6, 2024
Dr. Lois Duerst, DDS

Simplicity at your fingertips: A template for smile makeovers

Direct composite restorative procedures can be challenging, particularly when it comes to esthetic cases. Discover how new techniques and tools can help you achieve incredible results efficiently, conservatively, consistently, and predictably.

Direct composite dentistry is far from new, but it has become increasingly popular as patients seek more esthetic, conservative treatment options. Composites, tools and techniques have improved in recent years, enabling more clinicians to take advantage of the benefits direct composite restorations offer. But while some clinicians are comfortable with freehand techniques, others may be reluctant to tackle certain cases – particularly for large areas in the anterior.

Success at hand: Benefits of direct composite techniques

Direct composite dentistry is a conservative approach focused on preserving natural tooth structure, in keeping with a minimally invasive treatment philosophy. This also makes it appealing for patients concerned about cutting down teeth.1 It’s also relatively low maintenance and reversable – composite can always be added to, removed, or adjusted. A great choice for many clinical situations, this strategy isideal for patients with worn teeth and for restoring symmetry by filling spaces between teeth.2,3 Plus, direct restorations are often more affordable compared to more aggressive interventions and may not require anesthetic. With all these advantages added together, it’s no wonder additive dentistry is an appealing opportunity for both practitioners and patients alike.

Easier said than done: Challenges of traditional direct composites

So what keeps some clinicians from performing esthetic anterior composite restorations? In a word, consistency. It can be difficult, time-consuming and stressful to predictably create anatomically correct, esthetic tooth forms. Not every clinician is able and willing to take on that challenge. While some simply aren’t comfortable working freehand, others may struggle with specific steps such as achieving symmetry, midlines or contours, or the time and labor required to become proficient at high esthetic restorations. The time commitments don’t stop after learning the technique, either. Hand sculpting, contouring, finishing, and polishing anterior composites can be time intensive and therefore cost prohibitive, posing a barrier for clinicians and patients.

More straightforward procedures, like closing a diastema or two or reshaping a single tooth, are easier to tackle freehand. As you increase the workload with multiple teeth or spaces, however, additive composite procedures become more challenging – and less accessible. If these barriers to entry could be lowered, more clinicians could take advantage of this minimally invasive technique while delivering excellent outcomes.

New materials, new techniques, new smiles

Conservation, efficiency, and superior results: these goals are not mutually exclusive. On the contrary, newer techniques and materials can help clinicians achieve them more consistently.3 Today’s advanced composites enable efficient and esthetic direct restorations with patient-pleasing outcomes. To date, much of the innovation in composite dentistry has been the materials themselves, as filler type and size have evolved.3 Modern nanocomposites such as 3M™ Filtek™ Dental Restoratives offer long-lasting strength, color stability and polish retention. However, none of these material advancements can reach their full potential without predictable techniques.

Where freehand additive dentistry is highly skill-dependent, matrices help reduce technique sensitivity by allowing clinicians to predictably establish tooth form. While the use of matrices is not new, they have traditionally been best suited for single-tooth restorations. However, like composites themselves, matrix systems have also evolved. Matrix designs have improved to allow for more accurate contours, better contacts, and more complex situations. And the advent of customized, patient-specific matrices has created a solution for treating multiple diastemas, reshaping multiple teeth, or treating wear cases – while also allowing clinicians to plan the size and shape of the restoration ahead of time.4 Among these innovations is the 3M™ Filtek™ Matrix system.

An industry first, with incredible results: 3M™ Filtek™ Matrix

The Filtek Matrix was designed to take the guesswork out of the direct composite procedure and eliminate many of the issues associated with the workflow. It’s a customized, patient specific matrix system that offers an industry-first digital solution for direct restorations with esthetic anterior composites. Each FiltekMatrix starts with submitting a digital or traditional impression of the case along with a prescription form. 3M then creates a patient-specific smile design to be reviewed by clinicians.

Once approved, 3M prints a 3D matrix of the digital smile, which serves as a timesaving template for creating ideal contours, symmetry, and a natural shape of the teeth. The additive nature of the technique also gives the clinician freedom to adjust contours during finishing or by adding or removing composite. Plus, the whole process only requires two patient visits: one for photos and the scan or impression, and one for placing the composite. In fact, after using the Filtek Matrix, 90% of clinicians rated the new procedure much faster than the traditional freehand method.5

Stunning smiles: Step-by-step

The Filtek Matrix simplifies and streamlines the direct composite restorative procedure from start to finish while ensuring efficient, consistent, conservative, esthetic results:

      1. Diagnose and Scan
        Submit either a scan or physical impression (depending on location), using a digital prescription form and smile design library.

     

      1. Restoration Design
        Dentists do not have to design their own restorations; based on their input, a 3D digital smile design is typically returned in 1–2 days for the clinician’s approval. The clinician can then transfer a digital wax-up directly into a patient’s mouth. The ability to preview the end results can also help with patient acceptance.

     

      1. Matrix Design
        Once the restoration is approved, 3M will custom design a matrix specifically for the patient.

     

      1. 3D Printing and Post-Processing
        A custom rigid matrix is then 3D printed based on the digital prescription. After accepting the digital design, the matrix is delivered fully assembled and ready-to-use – allowing clinicians to take full advantage of same-day additive dentistry, with the precision and control of a removable rigid mold.

        3M also provides case-specific clinical notes to help with chairside placement, including overlays and heat maps to indicate where and how much composite will be added.

     

      1. Chairside Matrix Placement and Use
        The Filtek Matrix arrives ready to use. The matrix itself is designed to establish the vertical midline and create tight, separable contacts without wedging. Its doors allow the use of both flowable composites for the gingival margin and universal composites – and have engineered vents to minimize flash and help ensure a proper fill.

        The clear, medical-grade resin allows light curing through the matrix, and proprietary post-processing ensures the matrix does not bond to the composite. In fact, light cure testing found that the depth of cure of the composite was greater than 2mm regardless of the matrix thickness (up to 5mm) or the distance of the curing light from the composite (up to 2.5mm) – see the results below.

        To cure, place the curing light as close to the composite as possible, and cure through the matrix. It is recommended to cure for 20 seconds from both the facial and lingual surfaces to ensure complete polymerization. Additional light curing can be performed after matrix removal, if necessary, but isn’t required. After curing, the doors can be opened, the clamps released, and the matrix removed from the composite. At this point, remaining excess composite is removed during the finishing process. Properly developed proximal contacts are easy to separate via gentle wedging or with several different types of contact separation instruments or strips. Final finishing and polishing can then be completed to create a lifelike restoration.

     

Case selection and indications

The Filtek Matrix is an excellent solution for creating composite veneers, closing diastemas, and reshaping anterior teeth (e.g., post-orthodontic treatment, wear cases, etc.), especially when the case includes multiple teeth. It is available for first bicuspid to first bicuspid treatment on the maxillary, and canine to canine on the mandibular.

It’s also an excellent choice for:

• Teeth with wear
• Undersized or poorly contoured teeth
• Correction of slight misalignments
• Situations where conserving natural tooth structure is a priority
• When porcelain veneers or orthodontics are cost-prohibitive or too time-intensive

As with any new technique, certain procedures will be more challenging than others and require practice to perfect. If you are not already used to doing composite veneers, you may want to start with a simple peg lateral or a diastema. As you increase the number of teeth and diastemas, the complexity and time required will increase.

Seeing is believing: a clinical example

A 65-year-old man wanted a better smile while preserving as much healthy tooth structure as possible. He considered orthodontic treatment and porcelain veneers both too time-consuming and too expensive and requested a minimally invasive treatment option. The Filtek Matrix was selected.

close up of teeth smiling

Pre-operative situation

After a trial fit, the matrix was removed so the teeth could be cleaned and acid etched. After placing and curing 3M™ Scotchbond™ Universal Plus Adhesive, the veneer matrix is secured and clamped in place. Its rigid form maintains shape throughout the procedure.

The gingival margin was lined with 3M™ Filtek™ Supreme Flowable Restorative (shade A1), the doors were closed, and the composite was light cured. Warmed 3M™ Filtek™ Supreme Ultra Universal Restorative (shade A1B), was then injected to fill the “windows” of the matrix. The window “doors” are closed, exerting enough pressure to create precise contours. Excess composite will be extruded through the facial vents. The precise gingival trim prevents excess flash from forming. The composite was then cured from both the facial and lingual surfaces to ensure complete polymerization.

a. The matrix is placed on the conditioned teeth b. The gingival margin lined with 3M™ Filtek™ Supreme Flowable Restorative (shade A1) c. Warmed 3M™ Filtek™ Supreme Ultra Universal Restorative (shade A1B) injected into the matrix. d. Light curing from both facial and lingual.

After the matrix is removed from the mouth the composites are finished and polished to a high gloss.

3M™ Filtek™ Matrix provided a template to deliver ideal contours and tooth shape in less time – and without porcelain laboratory fees. The matrix is inherently predictable because it is designed to fit each patient, so you can be confident in achieving the desired shape and contours when placing composite. At the same time, it allows freedom for creative design during the finishing and polishing procedure. The procedure is both efficient and affordable (and even reversible, if desired), delivering natural-looking esthetic results with minimal preparation. Best of all, the patient loved his new smile!

To see this case in more detail, check out Clinical Case: Conservative Smile Rejuvenation.

With all of this in mind, the Filtek Matrix system provides a bevy of benefits for clinicians, including:

• Increased control, predictability, productivity, and profitability
• The ability to achieve precise anatomy confidently and consistently
• A simplified procedure, streamlined workflow and reduced chair time
• Reduced technique sensitivity barrier-to-entry for direct restorations
• A lower-cost, esthetic, conservative option for treatment planning and patient acceptance

For patients, this new matrix system provides a treatment option that is:

Conservative: No tooth preparation or anesthetic in many cases
Predictable: You can preview the outcome in advance of procedure
Esthetic: A true “smile makeover,” where the patient can preview the results
Fast: Treatment typically requires just 2 appointments – one to take photos and the scan/impression, and one for the restoration itself, with shorter appointments
Affordable: Lower cost option than porcelain veneers or orthodontics, with long-lasting and highly esthetic results
Reversible: The ability to replace the restoration may reassure patients

Conclusion

Freehand restorations are not the only way to take advantage of composite to “make over” patients’ smiles. The Filtek Matrix system is an easy and efficient way for dentists to integrate the streamlined nature of digital dentistry with the consistency and control allowed by a matrix. The result: a straightforward method to custom-design patients’ smiles and achieve predictably esthetic restorations.

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