One color for everything?

Direct aesthetic anterior restorations with composite have become the established standard over the past decades [1, 2, 10, 16, 17]. Taking into account a few essential preparation guidelines such as beveling the margins [15] and a sufficient adhesive technique [5], aesthetic, functional and durable minimally invasive restorations are obtained that can often withstand comparisons with veneer restorations [3, 6, 8].

The range of composite materials is almost unmanageable; systems are rapidly replacing each other or simply changing their names. One trend, however, is currently in evidence: The slimming down of the shade range, which makes it easier to stock up and also clearly results in cost savings in terms of reducing the waste of expired materials due to a lack of indication for use. Examples such as Enamel Plus HRi (Micerium), Amaris (VOCO), Ceram.X (Dentsply) or currently Filtek Universal (3M) show that the dental industry wants to satisfy the user's desire for a reduced but still sufficient range of shades. Numerous published case studies [4, 7, 9, 11 - 14] prove that this works.

But instead of a reduced range of colours only one colour? TOKUYAMA DENTAL took up this challenge at the beginning of the year 2019 with the market launch of an innovative aesthetic composite which, after a trademark dispute at IDS 2019, has since been given the interim name "Colour through Light" and is now available again under the original name OMNICHROMA. The range of colours consists of: A rotary syringe (or pack of compules). To cover discoloured structures or an undesired translucency of the oral cavity, an additional "blocker" is offered - that's it; more reduction is really no longer possible. In the first own experiments in cavities in the plastic teeth of the Vita shade guide, the material disappears impressively in all shade bars from B1 to C4. This encouraged us to try out the material in vivo. In the following case studies, extremely dark basic shades are still missing, but the application is still pending as soon as corresponding cases with the shade indication can be imagined.

Case 1

Closing the gap in a 37-year-old female patient

The 37-year-old patient presented with the wish to close the remaining gap between teeth 12 and 11 after completion of orthodontic treatment (Figs. 1 and 2). After discrete grinding of the adhesive surface with a Soflex disc (3M), the boarding was carried out using a vertically inserted partial matrix fixed to the adjacent tooth with Clip (Voco) (Fig. 3) [6, 7, 9]. The chalky etching pattern on tooth 11 shows the situation after phosphoric acid conditioning. After the proximal build-up of tooth 11 with OMNICHROMA (Tokuyama Dental), tooth 12 was shuttered for its mesial build-up (Fig. 4).

Figure 5 shows the phosphoric acid conditioning of tooth 12; Figures 6 and 7 show the finished gap closure made of OMNICHROMA. The "blocker" was not used here. The result shows a convincing result for the simplicity of the material, which can certainly compete with layer concepts.

Case 2

Distortion of enamel formation on tooth 13 in an 18-year-old patient

Figure 8 illustrates the initial situation of an aesthetically impaired enamel formation disorder on tooth 13 after previous milk tooth trauma in childhood in an 18-year-old boy. The strongly brown discoloured areas were carefully removed with a spherical Rotring diamond; partial areas of the white-opaque discolouration were left as an aesthetic compromise in consultation with the patient for reasons of tooth substance protection (Fig. 9). A thin layer of the opaque "blocker" was applied to the depth of the defect to mask the remaining opaque areas. Figure 10 shows the restoration with OMNICHROMA: Despite leaving the white opaque areas, the material was able to mask the enamel defect well and give the patient the courage to laugh.

Figure 10 shows the same situation at a followup visit after one year. The motivation for oral hygiene has unfortunately decreased considerably: However, the mirror image shows that there are fewer plaque islands on the composite restoration than on the adjacent tooth structures.

Case 3

Incisal edge eruption on tooth 13 in a 17-year-old patient

The 17-year-old patient was presented with his mother with the wish to construct tooth 12 distally incisal and to repair the incisal eruption at tooth 13. There was no anamnestic evidence of a possible cause for incisal chipping on tooth 13. Both teeth were also restored with the new OMNICHROMA composite in the one available colour. Here, too, the "blocker" was not used. Figure 13 illustrates the restoration with a very good shade adaptation of the edge build-up and the incisal defect.

Conclusion

The simplicity of the material is impressive and convincing. It is certainly still a little too far-reaching to claim that all direct anterior indications can be covered with this one shade; for this, considerably more cases need to be evaluated - above all with shades that are not to be treated every day. When the material is adapted to the tooth, one is initially afraid of hardening it because it appears whiteopaque. In the mind, another 15 min. treatment time is already planned for the removal of the restoration that does not match the shade and for the new restoration with a "correct" anterior aesthetic composite. The "aha effect" then occurs after polymerization: The filling material OMNICHROMA is suddenly no longer visible on or in the tooth! An exciting story that inspires the imagination for many treatment indications.

The purchase, initially as a supplement to the currently used layer system consisting of several shades, is surprisingly inexpensive due to the low use of materials and the purchase of only two rotary syringes (filling material and blocker) required for a new composite system, thus considerably reducing the risk of a bad investment. Therefore, my advice would be to try out the new material in parallel with the existing, proven multi-colour system. In my opinion, neck fillings in particular are an ideal testing area. The courage for further indications and larger restorations will then probably come automatically.

Author:

Prof. Dr. Claus-Peter Ernst
Professor, Polyclinic for dental conservation, University Medicine of the Johannes Gutenberg-University Mainz

Dental clinic medi+
Haifa-Allee 20
DE-55128 Mainz
Germany

Phone: +49 6131 4908080
ernst@mediplusmainz.de
https://mediplusmainz.de

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