Dentaltown December 2019 - 28

show your work
case study

Restoring Large
Class III Cavities with a
One-Shade Composite
by James H. Peyton, DDS, FAACD
James H. Peyton, DDS, FAACD,
maintains a private practice
in Bakersfield, California. He
graduated in 1982 from the UCLA
School of Dentistry, where he is
a part-time clinical instructor.
Peyton is also a lecturer at
Esthetic Professionals in Tarzana,
California, and a part-time
instructor for the Fahl Institute
in Curitiba, Brazil. He has lectured and given workshops
for several American Academy of Cosmetic Dentistry
(AACD) annual meetings. Peyton has published articles in
Practical Procedures & Aesthetic Dentistry and the Journal of
Cosmetic Dentistry, where he is a contributing editor. He is an
accredited member, fellow and examiner for the AACD.

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DECEMBER 2019 // dentaltown.com

atching shades of composite to seamlessly blend into the natural color
of a tooth can be very difficult, because teeth are polychromatic. It is
necessary to match the higher chroma at the gingival one-third as well
as the translucent properties of the incisal one-third and still match the
middle area of the tooth.
A small or conservative Class III composite usually blends into the tooth and color
matching is not an issue. However, with a large Class III composite that has wide-open
interproximal decay, shade matching can be very difficult.1 In the following clinical
case, I used Omnichroma, a composite material from Tokuyama Dental, that takes
on the shade of the surrounding tooth structure.

Clinical case
The 39-year-old patient had recently been placed on blood pressure medication,
some of which can cause a decrease in saliva, leading to "dry mouth," in which the
important enzymes in saliva that buffer acids are not available to stop the decay process.2
One unfortunate result in this patient was a rapid rate of tooth decay interproximally
on teeth #6-11. At first glance, the teeth didn't look so bad; however, after looking at
the X-rays and viewing the teeth from a side view, the decay was clearly seen. Once the
surface enamel was removed, the true extent of the decay was revealed.
Caries control and restoring the teeth to function was accomplished with this
one-shade universal composite. Permanent restorations, such as veneers and crowns, can
always be done in the future, but the decay must be removed as soon as possible. The
restoration of the teeth with a direct composite can be viewed as an aesthetic buildup,
and these restorations may last a long time. What the dentist needs to avoid is placing
a large number of indirect restorations, then having to redo them six months or a year
later. The decay needs to be treated, but most importantly, the reason for the decay
must be diagnosed and treated.3

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Dentaltown December 2019

Table of Contents for the Digital Edition of Dentaltown December 2019