Going Over the Line: Using Characterization Tints to Blend Into Surrounding Dentition

If you do esthetic restorative work in your practice, you likely have some tints in your inventory. Tints are helpful tools to create realistic-looking restorations that blend into the surrounding dentition. However, a slight tint can go a long way. We look at the advantages of using tints, the indications for their use, and some dos and don'ts with this less-is-more material.

Tints have many uses in restorative work. For example, they can help you decrease the value (the lightness) of your restorative work and increase the hue (color) and chroma (saturation) of your chosen dental composite material.

Tints also help you do restorative work that belongs in the patient's mouth with their other teeth. For example, you can mimic surface defects like pit and fissure staining, recreate craze lines to match the patients' other teeth, match unusual colors, or imitate cervical darkening. Tints are also excellent for recreating incisal translucency.

Perhaps most importantly, tints bump up your realism in the appearance of restored dentition. Adding character to the restoration, Todd Snyder, DDS, FAACD, FIADFE, ASDA, ABAD, says, is what makes your restorative work look even more realistic. However, he cautions dentists to use tints minimally.

"If you use too much and you can see them, you've overdone it," Dr Snyder says. "It is a tiny amount. When you look at the tooth, you should never be able to say, 'Oh, yeah. They put a bunch of tints in here.'"

Jeff Lineberry, DDS, FAGD, FICOI, AAACD, says that for anterior cases better served by a direct restoration than an indirect, he likes to have tints around for the finishing touches. For example, he uses them to create the "halo effect" along the incisal edge by recreating the translucency there.

"Tints can be perfect for that and allows you to create a natural appearance," Dr Lineberry says.

Dr Snyder compares using tints for artistic effects in esthetic restorative work to applying women's makeup. When you don't notice all the work that the makeup artist has done with all the different colors and materials on their face, that's when the makeup makes the person look amazing. Dr Snyder has the same philosophy with his restorations. He avoids too much symmetry and adds faint enhancements and characterizations so that his tint work is not noticeable.

"It makes it look more realistic," Dr Snyder says. "When something looks too symmetrical, and everything looks the same across the smile or a tooth, it looks artificial."

Recreating these subtle imperfections is essential to this realism, Dr Snyder says. For example, each of us has a unique fingerprint. However, you don't see how your fingerprint is unique until examining the swirl patterns with a magnifying glass. Likewise, you see teeth characterizations without realizing that you are seeing them and how they create a natural look that is unique to the patient.

To add this subtle effect in dental restorative work, Dr Snyder puts on his loupes and adds tints in tiny amounts to places not detectable by the naked eye—and even difficult to detect with loupes. Dr Snyder finds them by zooming in on a photograph of the tooth blown up on a large monitor. Once they are covered with a layer of enamel composite these embedded details create the illusion of a natural tooth, Dr Snyder explains.

Dr Snyder also likes to use tints on restorative work for younger patients to recreate the incisal edge, matching their natural translucency. He also will use it on older patients to mimic cracks that they might have in surrounding dentition. Some patients will haveimbrication lines in the gingival third of the tooth, and he will add some tints to mimic the lines. These extra details make a significant difference in the finished look of the restoration.

"These are tiny, nuanced detail, things that often clinicians don't do but make the difference between something lifelike instead of something that looks decent or good," Dr Snyder says.

Dr Lineberry cautions clinicians to ensure that when they use tints, they do so on the internal layers of the composite materials. Otherwise, you could lose all that intricate work in the polishing stage. Once Dr Lineberry creates the desired internal effects with tints, he puts an enamel shade over the tint as the outermost layer of the restoration.

"Then, the tint shines through and adds depth to the restoration," Dr Lineberry says. "However, it takes a lot longer to do all of that than a single 1- or 2-color restoration."

The time factor is a significant reason why most clinicians don't bother with tints. Also, Dr Lineberry says, as the dental composite materials improve in esthetic performance and manufacturers make more shades for the various tooth anatomy, stains are not as crucial as before. So, while you may not use them all the time on direct restorations, Dr Lineberry says that having tints in your inventory is a good practice.

"I would also recommend practicing with them. If you are going to use tints, make sure that you do some hands-on courses or even play around with them on your own," Dr Lineberry says.

Troy Schmedding, DDS, AAACD, also thinks practice is essential. Understanding how the materials handle and how a little goes a long way is crucial to your esthetic outcomes.

"Tints are a kind of a lost art, so to speak," Dr Schmedding says. "They're still amazing, and clinicians can use them more, but they aren't used extensively education-wise. So, it's a little bit of a challenge to find people to help you learn."

Dr Schmedding learned about tints and other modifiers with the American Academy of Cosmetic Dentistry (AACD) after dental school. He says continuing education is excellent for more esthetic training with materials and understanding how the materials modify your restoration's appearance.

Dr Schmedding reaches for tints most often when dealing with a highly esthetic case for youthful patients with teeth that have a lot of translucencies or vibrance. He finds tints easier to handle than composites because he can be minimal with them.

"I'm using a very fine edge paintbrush with it, allowing me to be precise in what I am trying to accomplish," Dr Schmedding says. "It's that tough, challenging case that has a lot of esthetic derivatives to it, in relationship to translucencies and hidden little colors or maverick colors within the tooth structure that can be a little more challenging to accomplish."

Like Dr Snyder, Dr Schmedding recommends having a roadmap established by photography before breaking out the tints. In complex cases, Dr Schmedding uses preoperative photos to plot out what he wants to recreate for the tooth before working on it, sometimes even days before the appointment.

"It's difficult to work on that tooth without a roadmap because it could dry out, which changes its translucency and opacities with the dehydration factor," Dr Schmedding explains, adding that he takes that photo right when the patient sits down in the chair. "So have something in front of you that shows you where you want to place things. Keeping your eye on the target and following some route is very important."

Dr Schmedding also says that tints and this level of detail work are not for everybody, which is okay. However, if you want to take your esthetics to a new social-media-worthy level, you should know how to use materials like tints, and that takes practice.

"It's hard to find education on this kind of dentistry for the most part," Dr Schmedding says. "So, do what you can to get practice because this is out-of-the-box dentistry."