The difference a material makes – Dr Shahram Mirtorabi

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  Posted by: Dental Design      18th December 2018

Dr Shahram Mirtorabi is the Principal Dentist at Hindley Dental Practice in Lancashire. He qualified from the University of Manchester Dental Hospital in 1996, and is now a full member of the British Academy of Cosmetic Dentistry.

In modern practice, clinicians are under increased pressure to prove their skills, professionalism and empathy. There are similar expectations from dental materials, which have to be practical and reliable with more emphasis on aesthetics. Gone are the days where only one shade of restorative material was available and sufficed.

With patients’ demands increasing and more aesthetic restorations being required we need, as clinicians, to rely on our skills and materials to be able to deliver on all fronts. For me, COLTENE’s BRILLIANT EverGlow®composite ticks all the boxes and answers all the most frequently asked questions. It is also ideal for both anterior and posterior restorations, is available in many shades and can be used in layering techniques.

Case study

For all of these reasons BRILLIANT EverGlow® proved to be invaluable in a recent case. The patient was a 34-year-old male who presented to the surgery for an emergency appointment complaining of excruciating pain. He was in agony and even asked if all his teeth could be extracted! On clinical and radiographic examination, a diagnosis of irreversible pulpitis of his upper right canine was made and the tooth was extirpated and dressed with Odontopaste and Coltosol® F temporary filling material (COLTENE) to relieve the pain.

At the review appointment one week later, the patient had suffered no pain or discomfort since his appointment the previous week and was given the time and space to voice all of his dental concerns. Once the rapport and trust was established, a thorough examination was carried out with radiographs and clinical photos taken (Figs 1 and 2).

Fig 1

Fig 2

The cause of the patient’s neglected dentition was identified as being due to his long working hours, during which he would regularly snack on foods and carbonated energy drinks with high sugar content. He was well aware of the deterioration of his teeth and had almost given up hope of ever restoring them, to the point he was genuinely considering having them all removed. He was always self-conscious of his visible fillings on his anterior teeth and concerned about their aesthetics.

To formulate a treatment plan whereby the patient would be completely compliant and committed post-surgery, he was fully involved in the decision-making process. This was achieved by exploring all the possible treatment modalities together and discussing the advantages and limitations of each. In this case due to financial constraints, we agreed to do the root canal treatment of the upper right canine and carry out direct restorations to address the patient’s concerns. He was happy to retain his diastema.

Once the root canal treatment was successfully completed, all anterior teeth were isolated using a rubber dam (Fig 3). Caries was then removed and special attention was paid to preparing the enamel margins using ultrasonics and fine diamond burs (Fig 4). Firstly, the upper right canine was etched with 30% phosphoric acid for 30 seconds (Fig 5) then rinsed for a further 30 seconds and air dried with oil-free air. The adhesive ONE COAT 7 UNIVERSAL (COLTENE) was used as a bonding agent and applied for 20 seconds and light-cured for 20 seconds with >1000 mW/cm2.

Fig 3

Fig 4

Fig 5

Due to the dark and discoloured layer of dentine, an opaque shade ofBRILLIANT EverGlow®was used to hide this and allowed for a much more natural and uniform aesthetic appearance (Fig 6). A layer of opaque bleach was then applied to build up the bulk of the missing tooth and to emphasise the colour stability of the restoration (Fig 7). The other layers comprised of shade A3 to blend in with the remaining dentition (Fig 8).

Fig 6

Fig 7

Fig 8

Once the upper right canine had been restored, I continued with the upper right lateral. To help achieve better contact points and therefore a more natural aesthetic restoration, I used PTFE tape to isolate the adjacent teeth (Fig 9). The same procedure was repeated on the left side (Fig 10). Thinner opaque layers were needed here as there was not as much tooth missing (Fig 11). Once the canine was restored with BRILLIANT EverGlow®in shade A3, the left lateral was isolated (Fig 12) and then restored with BRILLIANT EverGlow® in shade A2.

Fig 9

Fig 10

Fig 11

Fig 12

To finish, the teeth were polished to emphasise the natural shape and anatomy of the teeth. For this I used DIATECH fine diamond burs (COLTENE) for the transitional lines and primary anatomy (Fig 13) followed by diamond impregnated rubber polishers and wheels for high polishing and to incorporate secondary and tertiary anatomy (Fig 14).

Fig 13

Fig 14

All in all I am very happy with the end result, as is the patient who can’t believe how seamless and natural the restorations look – and that it was all achieved in one two-hour appointment. His smile has been transformed. That is why I would highly recommend the BRILLIANT EverGlow® along with other COLTENE products. Without it, I would not have been able to achieve the outcome that I did.


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