July Clinician's Choice Onsert - 10

SOLUTIONS FOR
CLINICAL EXCELLENCE
The Starburst Bevel: A Simple Solution
for Enhanced Esthetics and Retention
D
Susan McMahon
DMD, AAACD, FAGD
Dr. McMahon owns the
largest cosmetic dental
practice in Western
Pennsylvania. She is
accredited by the American
Academy of Cosmetic
Dentistry, and a Fellow of
the prestigious American
Society for Dental
Aesthetics and a Fellow in
the Academy of General
Dentistry. An author and
lecturer, Dr. McMahon has
devoted her professional
career to the pursuit of
advanced technologies in
cosmetic and minimally
invasive dentistry. She
frequently lectures
across the United States
on minimally invasive
dentistry, technology and
conservative cosmetics.
She has been voted by her
peers as a Top Pittsburgh
Dentist every year for over
20 years.
eveloping a protocol for your Class
IV technique is essential for attaining
predictable
and long-lasting
esthetic
restorations. Depending on the size of
the Class IV and the presence of incisal translucency
and surface characteristics of the adjacent teeth, for
instance, your anterior composite protocol should also
be both flexible and versatile. Layering of composite
materials available in multiple shades and opacities
and finishing and polishing techniques to allow you to
better adapt your technique is critical to an excellent
restorative result. However, it is equally important
that you establish a consistent approach to your bevel
design. In addition to esthetics, hiding the fracture
line and bonding failures are significant challenges
in these cases. This makes bevel design a significant
consideration in seamlessly blending your restoration
into the surrounding tooth structure while providing
the highest degree of retention for long term service.
The starburst design
allows light to diffuse and
refract in a way that hides
the junction between tooth
and restoration better than
a flat, traditional bevel.
The term retention has taken on an increasing significance
in the dental world. Retention of the restoration has
always been a cornerstone of the successful longevity
of direct and indirect restorative dentistry. Retention
also refers to the ability to retain a patient of record.
Failure of a restoration in the esthetic zone is often not
tolerated well by the patient due to its social, economic,
and degree of inconvenience, and may undermine the
confidence a patient has in their dental team. Thanks
to a higher dental IQ, the dental public holds higher
expectations of restorative quality in both esthetics and
life span. The source from which a patient obtains dental
information and its esthetic and functional potential is
no longer limited to the dental office. Social media and
the internet have become popular media through which
our patients gain insight into their existing or desired
dental treatment possibilities. It is not uncommon for an
unhappy patient or one seeking a new dentist to choose a
dentist based on positive internet reviews.
10 SUMMER 2023 | CLINICAL LIFE | clinicianschoice.com
FIG. 1
A young woman presented with a mesio-incisal
fracture on tooth #8, previously restored one year
earlier.
The following case illustrates how the fracture of
a recently placed Class IV restoration created the
scenario where a patient began her internet search for
a new dentist. Positive online reviews of our dental
office were responsible for bringing a young woman to
our office. She presented with a mesial-incisal fracture
of tooth #8 that had been restored one year earlier.
(FIG. 1) In addition to the obvious disappointment
of losing the restoration, she admitted to disliking the
esthetics of the previous " bonding " in the first place.
FIG. 2
A starburst bevel provides a larger surface area to
increase the strength and longevity of the bond. In
addition, the junction between the restoration and
tooth was disguised through enhanced diffusion and
refraction of light.
This relatively small incisal fracture was best suited for a
direct composite and no local anesthetic was necessary.
After shade selection, the anterior teeth were isolated
using a Comfort View Lip and Cheek retractor (Premier).
This provided both the isolation essential for ideal bonding
conditions as well as the visibility necessary to mimic
the shape, profile, contour and surface characteristics
of the adjacent dentition. A starburst bevel was placed
using a coarse, flame-shaped diamond bur. (FIG. 2) The
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July Clinician's Choice Onsert

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