Simplified Esthetics With Fewer Shades

Dentists want to simplify treatments in their offices and reduce costs by downsizing inventory. Universal composites are effective in many types of restorations, and their qualities only improve as they continue developing. In recent years, the trend has moved toward formulating composites in which fewer shades are necessary to satisfy the esthetic demands of patients.

One of the most challenging aspects of reducing the number of shades is developing composites that have the proper balance of translucency and opacity. Translucency allows the underlying tooth structure to influence the final shade of the composite. Popular single-shade composites are more translucent and can be effective in smaller restorations. Opacity helps to block light transmission through the restoration when there is not underlying tooth structure to avoid a gray cast. Composites with optimized opacity can be used in restorations large and small and are more universal in their applications.

GC America has introduced a composite that addresses these challenges: G-ænial™ A’CHORD. This universal composite features a good balance of simplicity, excellent color-blending capability, and physical properties for use in most situations, including Class I, II, III, IV, and V restorations. It offers a versatile universal solution for anterior and posterior restorations, and its simplified shade system achieves the esthetics of all 16 Classic Vita® shades with just 5 core shades. It achieves invisible restorations with a reduced inventory and quick polishing, which makes it not only efficient but also cost effective.

Fifteen Catapult evaluators were invited to use G-ænial A’CHORD in their practices. They were asked to compare the handling and esthetic characteristics of the new composite with the composites they were currently using. Among the handling properties surveyed were viscosity, adaptation, packability, sculptability, polishability, and overall handling. In the esthetic evaluation, shade difference before and after light curing, chameleon effect, match with shade tabs, gloss retention, and overall esthetics were evaluated. Most evaluators found their experience with the material to be very good and liked its ability to match several different shades with 1 material. They found the translucency to be just right, and the majority rated its polishability as excellent.

Comments included, “It fits in areas where I need more chroma,” and, “It was easy to use and condensed nicely in Class I and II preps.” Several evaluators preferred that the material be warmed, as they do with other composites they use, to give their accustomed handling characteristics. Although not required, this is a procedure that I always incorporate. Because of the overwhelming positive reviews of the material, G-ænial A’CHORD received the Catapult Vote of Confidence, and most evaluators said they will add this material to their repertoire.

Figure 1

A patient presented to my office who did not feel comfortable smiling due to extensive deep staining of the anterior teeth (Figure 1).

Figure 2

She was visiting from out of town and her friend set up an appointment with our office to treat her during her stay. She wanted to improve her smile in the most conservative way possible while still achieving a nice smile that looked natural and blended in with the rest of her mouth. She did not want veneers, crowns, or for the teeth to look too perfect. I recommended direct bonding but said that I would need to remove part of the outer enamel to remove the darkest areas and to allow for enough thickness to block the underlying stain.

I started with the maxillary left central incisor to see how it would look and if the patient wanted to go forward with the remaining incisors. The outer stain was present throughout most of the enamel layer and was removed. I wanted the simplest, most efficient way to mask the stain without using multiple types of composites, shades, and opaquers, so G-ænial A’CHORD shade A2 was selected for the procedure. I etched and bonded the surface and placed the composite. It was shaped, finished, and polished to completion so that I could preview what the resulting color would look like. I showed the patient the result and she was thrilled. I prepared and restored the remaining maxillary incisors and the results were amazing. The color was quite believable and matched the rest of her teeth (Figure 2). She was brought to tears when she saw her new smile in the mirror.

Figure 3

Another patient presented to my office with multiple Class V lesions (Figure 3).

Figure 4

The patient was anesthetized, and the areas were thoroughly excavated. The enamel was selectively etched, washed, and dried. A dentin bonding agent was placed and cured. The composite was placed at the cervical in 1 increment, spreading the material from the center of the restoration toward the outer margins. A brush was used to smooth the surface. The composite was thoroughly cured for 20 seconds. A fine diamond bur was used to contour the composite and an instrument was placed into the sulcus and pulled apically to allow the margins to shape flush with the surface of the tooth. It was subsequently shaped with a very fine carbide and then polished with mounted polishing instruments. Again, excellent results were achieved (Figure 4).

Figure 5

A new patient presented with posterior decay that was detected by radiographs and visually (Figure 5).

Figure 6

The patient was anesthetized, and the decay was removed. (Figure 6)

Figure 7

A resin-modified glass ionomer was placed in the deepest areas to decrease sensitivity. The second molar was restored, followed by the first molar. I prefer to always restore the mesial margined tooth first so that I have better vision to shape the interproximal area to ideal contour. (Figure 7)

Figure 8

Finally, the second premolar was restored. The occlusion was carefully adjusted, and the restorations were finished and polished. All restorations were post cured to ensure adequate polymerization and improve surface hardness. A radiograph was taken to ensure interproximal seal and to demonstrate the radio-opacity of the material (Figure 8). I showed the patient the before and after pictures on the computer screen and she was quite pleased.

G-ænial A’CHORD has demonstrated excellent results in most common situations. It blends in well in the anterior region in Class V restorations, as well as in Class I and II restorations. It certainly qualifies as a simplified universal composite, and I recommend that you try this material with your patients.

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