How to recreate the different layers of the tooth with composite

Reconstructions in the aesthetic dental sector - those involving central incisors, lateral incisors or canines - are laborious and require effort and technique that are sometimes not appreciated by some patients, who may think that to solve a break in a central incisor (i.e. a palette), it is enough to 'glue' some composite in the area, such as a paste of putty. 

Of course, this is by no means that simple, and I will explain why. 

Tooth structure: 

To understand the difficulty of the process involved in an aesthetic reconstruction we must first understand the coronal structure of a tooth. 

The tooth is made up of 3 layers, from the outermost to the innermost: the enamel, the dentine and the pulp or nerve.

In an aesthetic reconstruction, what we try to simulate is enamel and dentine. 

Dentine is the 'inner' layer of the tooth. It is opaque and tends to be yellowish in colour. In addition, it has a characteristic shape in the area of the incisal edge: the dentine mamelons.

Enamel, on the other hand, is the most superficial layer of the tooth and, unlike dentine, is translucent. In the cervical area of the tooth the enamel becomes thinner, reaching a more yellowish shade in the tooth due to the fact that the dentine is more noticeable. The edge of the tooth should be translucent and reflect the dentine mamelons, and in terms of surface anatomy, the enamel shows relief and gloss. 

As you can see, simulating all this in an aesthetic reconstruction is complicated and requires a lot of hard work if we really want the tooth to look as if it has never been damaged. Therefore, in order to reflect all these nuances, we need to use different types of composite. 

Types of composite:

Enamel compositesThey are translucent and are available in different shades. They add 'value' to the restoration. 

Highly translucent opalescent compositesHalo effect: Thanks to their halo effect they are used to mimic the edge of the tooth. 

Dentine compositesThey are opaque and are available in different shades. They provide the 'chroma' of the restoration.

Characterisation dyesThey have brown, blue, orange or white shades. They are used to characterise and imitate tooth stains or staining.

OpaquersThese are very opaque resins used to camouflage black or very dark areas so that they do not show through in the restoration.

Typical aesthetic reconstruction procedure

In order to give you a better understanding of how we use the different compositors and at what point, I will explain the most typical procedure that is carried out during an aesthetic reconstruction. 

First we would select the right shade of the different resins we need using test beads. This is one of the most important parts of the process, as a wrong colour selection will cause the restoration to fail to camouflage and pass as real.

We then condition the tooth to enable bonding and start the actual reconstruction. 

The first layer of composite to be moulded on the tooth is the palatal enamel layer, also called the palatal shell. Next, we add the dentine layer, in which we must recreate the aforementioned mamelons. In the cervical area of the tooth we can use a darker shade if required. Subsequently, a layer of highly translucent opalescent enamel on the edge to simulate the incisal 'halo'.

Finally we add the final layer of enamel and we can move on to finishing and polishing, where we will recreate both the natural relief of the tooth and its surface shine. 

As can be seen, aesthetic reconstructions are a treatment that requires a precise and meticulous technique, as even the slightest error can mean that we do not achieve one hundred percent mimicry of our restoration.

I hope this article has been useful and has clarified your doubts. And you can always contact us through the clinic's social networks