Received: 15 November 2020 Accepted: 23 November 2020

DOI: 10.1111/jerd.12698

CLINICAL ARTICLE

A systematic approach to contouring and polishing anterior

resin composite restorations: A checklist manifesto

Marcos A. Vargas DDS, MS1 | Robert Margeas DDS2

1
Department of Family Dentistry, The
University of Iowa, Iowa City, Iowa, USA
2
Private Practice, Des Moines, Iowa, USA
Correspondence
Marcos A. Vargas DDS, MS, Department of
Family Dentistry, The University of Iowa,
801 Newton Rd, Iowa City, IA 52242.
Email: marcos-vargas@uiowa.edu
Abstract
Purpose: This article presents a systematic, step-by-step checklist approach to be
used for contouring and polishing anterior resin composite restorations to achieve
maximum esthetics efficiently.
Clinical considerations: This checklist is intended to be used to take the guesswork
out and streamline the process to predictably, practically, and repeatedly contour and
polish anterior resin composite restorations. The practitioner's knowledge of basic
dental anatomy combined with this step-by-step checklist facilitates identifying and
modifying the final restoration to an anatomically correct form, thus satisfying the
most esthetically demanding patients. This approach is demonstrated with case pre-
sentation of direct resin veneers in a young female, which resulted in an improved
smile that satisfied her esthetic desires.
Conclusions: The use of standardized protocols facilitates and expedites daily proce-
dures in dentistry. Specifically, this checklist protocol, which is geared towards con-
touring and polishing anterior direct resin composite restorations.
Clinical significance: The clinical technique presented in this article shows the advan-
tages of using a step-by-step checklist approach to predictably and efficiently obtain
ideal esthetics when performing anterior resin composite restorations.

KEYWORDS
checklist, clinical article, contouring, dental anatomy, polishing, resin composite

1 | I N T RO DU CT I O N facilitated by composites that demonstrate exceptional handling,

The placement of anterior composite resin restorations has become
more systematic and simplified during recent decades, largely due to
the introduction of more esthetic and natural tooth structure replicat-
ing materials. By acknowledging the interdependence of dentin and
enamel, light and color, and morphological elements, manufacturers
have produced materials, which resemble dentin and enamel optical
properties like, shades, opacities, opalescence and fluorescence, which
has enabled dentists to more predictably mimic adjacent natural teeth
when direct composite restorations are required in the esthetic
1,2
zone.
The ability of today's composites to disappear into the surround-
ing tooth structure contributes to natural-looking esthetics. This is
strength, and polishabilty. (e.g., Evanesce Nano-Enhanced Universal
Restorative, Clinician's Choice Dental Products, Filtek Supreme Ultra,
3 M Dental, Estelite Omega, Tokuyama and others), ensuring the den-
tist's ability to blend, sculpt, and adapt the material to the preparation
is greatly enhanced.3
However, despite material advancements and the variety of
multi- and single-layer techniques it remains quite common for the
novice esthetic restorative dentist to produce restorations that do not
seamlessly blend with the anatomy, gloss, and contour of adjacent
teeth or restorations. Often contributing to this problem is the clini-
cian's inexperience or difficulty to identify what is specifically wrong
with form and shape of the restoration and, most importantly, know-
ing how to correct it.4

20 © 2020 Wiley Periodicals LLC wileyonlinelibrary.com/journal/jerd J Esthet Restor Dent. 2021;33:20–26.


VARGAS AND MARGEAS
Micro- and macro-morphology of natural teeth and restorations
are as significant as—if not more so than—composite shade selection
in determining the esthetics and lifelike nature of direct composite
restorations. In particular, several morphological characteristics of
individual teeth—as well as the interaction of these traits across all
teeth in the arch—influence light reflection, color perception, and
5
observed proportional harmony in the smile as a whole. For this rea-
son, an understanding of these details and how to incorporate them
into anterior direct composite restorations is necessary when con-
touring, finishing, and polishing in order to deliver the most lifelike
6
and esthetic restorations.
The purpose of this article is to describe a systematic, step-by-
step checklist approach for predictably, practically, and repeatedly
contouring and polishing these cases. Rather than emphasize material
placement and layering, the case presented incorporates the use of a
single shade, single opacity composite placement technique to create
the ideal esthetic restorations.
As previously mentioned, due to the clinician's inexperience or
difficulty to identify what is specifically wrong with form and shape of
the restoration and, most importantly, knowing how to correct it, it is
quite important that the practitioner has: (a) the basic knowledge of
the basic anatomical features that are present in the teeth to be
restored (Diagram 1) and (b) follow a systematic approach to end up
with a natural looking restoration (Table 1).
This 10-step checklist deliberately and systematically undertakes
a “divide and conquer” approach to focus the dentist's attention on
T A B L E 1 Ten anatomical features and checks for systematic
contouring and polishing
1 Length of the restoration
2 Incisal-facial line angle
3 Facial profile/crest of contour
4 Line angles
5 Embrasures
6 Point angles
7 Axial inclination
8 Depressions and elevations
9 Surface texture
10 Gloss
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21
each individual anatomical component of the restoration. By
approaching contouring and polishing in this manner, each section can
be compartmentalized and isolated for better understanding, evalua-
tion, visualization, correction, and ultimately, completion of an “imper-
ceptible” restoration.7,8 The dentist should become accustomed to
observe the anatomical features on the adjacent teeth and reproduce
them on the restoration. It is also the prerogative of the dentist to
modify this protocol as his/her experience increases, thus visualizing
and foreseeing their desired final surface characterization, luster, and
anatomical contour.
The clinical technique presented in this article shows the advan-
tages of using a step-by-step checklist approach to predictably and
efficiently obtain ideal esthetics when performing anterior resin com-
posite restorations.
2 | CASE PRESENTATION
A female patient presented with a chief complaint about the appear-
ance of her existing anterior composite resin veneers (Figures 1 and 2),
and she was ready to undergo treatment to have them corrected. After
a thorough examination and planning, the patient was presented with
two treatment options: porcelain veneers or direct composite resin
veneers. Due to financial constraints, the patient accepted treatment
with direct composite resin veneers. Digital smile design (DSD) was
then used to plan function, ideal tooth esthetics, shape, and anatomy.9
3 | PREPARATION
Rubber dam isolation was established (Figure 3). The existing restora-
tions were removed, the teeth conservatively prepared mostly in
enamel, and the preparations were air-abraded with 50 micron alumi-
num oxide particles. A total-etch, three-step adhesive protocol
(OptiBond™ FL, Kerr Corporation, Brea, CA) was then performed.
F I G U R E 1 Preoperative smile view of a patient who was unhappy
with the appearance of her anterior resin composite veneers and
ready to undergo treatment to have it corrected

22
FIGURE 2 Retracted intraoral view of the patient's preoperative
condition
F I G U R E 4 The direct veneer buildup was completed using a
single shade of nano-enhanced universal composite material
F I G U R E 5 Fine grit aluminum oxide abrasive coated discs at
10,000 RPM were used to level the incisal edge
4 | C OM P OS I TE BU I LD U P
A single shade of a nano-enhanced universal restorative material
(Evanesce™ Nano-Enhanced Universal Restorative Composite Enamel
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VARGAS AND MARGEAS
F I G U R E 3 Rubber dam isolation was established, after which the
existing restorations were removed and the teeth conservatively
prepared
White, Clinician's Choice Dental Products, Inc Dental Products, Inc,
Brookfield, CT) was selected for this case (Figure 4). Several other
materials also demonstrate beneficial handling characteristics
(e.g., sculptability without slumping, non-sticky without pullback, high
polishability), any selected composite should contribute to an efficient
placement and seamless blending with the adjacent natural dentition.
Additionally, it would facilitate adherence to a systematic protocol for
contouring and polishing the proposed direct composite restorations.
4.1 | Check #1: Length of the restorations
Following buildup of the veneer restorations, the incisal edge position of
each single restoration was determined by analyzing the adjacent teeth
according to the planned treatment based on esthetic and functional
parameters. The central incisors were matched to each other, and lengths
of contralateral pairs of teeth (e.g., laterals, canines, etc.) were also matched.
During this step, the dentist's focus should only be on tooth length and
should not de distracted or pay attention to other features. In this case, the
vertical position of the incisal edge was adjusted and matched using
medium grit aluminum oxide abrasive coated discs (e.g., Sof-Lex XT, 3 M)
at 10,000 RPM. When performing this step attention should be paid to the
inciso-facial line angle and the inciso-palatal line angle, the inciso-facial line
angle is usually longer than the inciso-palatal line angle (Figure 5).
4.2 | Check #2: Antero-posterior incisal edge
position
A pencil was used to mark the inciso-facial line angle, after which an occlu-
sal view was used to determine the facio-lingual position of the incisal edge
(Figure 6). The incisal-facial line angle should follow the natural arch form. In
this case, a fine diamond or disc was used to impart these contours. Note
that for single restorations, clinicians must ensure that the inciso-facial line
angles match the position of adjacent teeth or contralateral teeth. When

VARGAS AND MARGEAS
F I G U R E 6 A pencil was used to mark the inciso-facial line angle;
the occlusal view to determine the facio-lingual position of the incisal
edge; and a fine diamond or disc to adjust these contours
F I G U R E 8 It is preferable to use two colors to pencil the
transitional line angles; one color for the actual crest of contour or
line angle position, and the other for the line angle desired position
multiple restorations are placed, the antero-posterior incisal edge position
should follow the natural arch curve. It is also recommended to finish from
the restorative material to tooth structure to improve marginal adaptation.10
4.3 | Check #3: Facial profile/crest of contour/
cervical-third contour
A line was traced between the middle and gingival third on the
adjacent teeth and restorations, which indicated where the height of
contour should be, positioned (Figure 7). An occlusal view facilitates
evaluation to ensure replication and harmony of facial contours across
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23
F I G U R E 7 To check the contour of the emergence profile and
cervical third, a line was traced between the middle and gingival thirds
on adjacent teeth; this line should indicate where the height of
contour should be positioned
F I G U R E 9 The four embrasure surfaces (i.e., incisal, facial,
gingival, lingual) must be contoured to achieve the proper shape,
respect contact point position, and ensure natural differences of
embrasure sizes among the restorations
natural teeth and the restorations. A fine diamond or a disc can be used
to remove restorative material to define and align the facial contours.
Note that the following checks—#4, #5, and #6—are closely
related because they each and collectively contribute to embrasure
contouring, creating the restoration(s) framework.
4.4 | Check #4: Transitional line angles
Transitional line angles were checked by penciling with two colors;
one color for the actual crest of contour position; the other color to
establish the desired line angle position (Figure 8). Line angles should
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24 VARGAS AND MARGEAS

F I G U R E 1 1 Every tooth in the arch is mesially inclined to varying

degrees, and this axial inclination must be respected when multiple
F I G U R E 1 0 Discs are used to contour the point angle at the restorations are placed
junction of the line angle, embrasure, and incisal edge

mimic the contralateral tooth in shape and direction, and the distance
from the line angles to the contact points should also match. Place-
ment of the lines angles closer to each other on the same tooth will
create the illusion of a narrower tooth, on the contrary placement the
lines angles farther apart will crete the illusion of a wider tooth. A disc
or diamond is used to contour the restoration(s) so that the line angles
imitate those of a natural tooth.

4.5 | Check #5: Embrasures

The four embrasures (i.e., incisal, facial, gingival, lingual) surrounding the
contact point were contoured with discs to achieve the proper shape and
size (Figure 9). Also described as the “valleys” between teeth, these areas
deflect light when viewed from the facial aspect and demonstrate different
sizes. The incisal embrasures between the central incisors is smallest; F I G U R E 1 2 To ensure harmony, the naturally occurring
embrasures between central and lateral incisors is larger; embrasures depressions and elevations of adjacent natural teeth should be
between laterals and canines is even larger. Dentists must exercise caution replicated in restorations by penciling over the facial surface to
visualize their position
when observing contact point position, since it influences embrasure size.

4.6 | Check #6: Point angles

Point angles—the intersection of the line angle, embrasure, and incisal
edge—should be a single point. In this case, it was modified and
properly positioned using discs (Figure 10).
4.7 | Check #7: Axial inclination
Every tooth in the arch is mesially inclined to varying degrees and
must be respected for multiple anterior restorations (Figure 11). This
is not as significant when contouring smaller restorations.
4.8 | Check #8: Depressions and elevations
The facial surfaces were penciled over to visualize the position of
the depressions and elevations observed in the adjacent natural
teeth and across the restorations (Figure 12). These attributes
were imparted using a flame finishing diamond at about 10,000
RPM. Note that most anterior teeth have three main elevations
and two main depressions. The mesial depression is generally lon-
ger, deeper, and narrower than the distal depression, which is
wider and more curved. Combined, these characteristics form the
elevation.
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VARGAS AND MARGEAS 25

F I G U R E 1 3 Imparting texture—which is comprised of several F I G U R E 1 4 Final luster and gloss are achieved using sequentially
lines across the enamel surface—can be imparted by running a fine decreasing grits of wheels, discs, or cups
grit flame diamond from mesial to distal

F I G U R E 1 5 Close-up retracted post-operative view of the

completed restorations demonstrating anatomical harmony with the
adjacent natural dentition FIGURE 16 Close-up post-operative view of the patient's natural
smile

4.9 | Check #9: Surface texture

Teeth are not smooth; perikymata and imbrication lines are most often
present in young teeth and tend to become less defined and prominent
with age or complete disappear with wear. Perikymata refers to several
lines that cross the enamel surface from mesial to distal, they run paral-
lel to each other and break light reflection (Figure 13). Imbrication lines
refer to deeper and much fewer lines in the cervical third. This texturing
was accomplished by running a fine grit flame diamond in one single
direction from mesial to distal at 3000 RPM.

4.10 | Check #10: Gloss

Final luster and gloss are achieved using sequentially decreasing grits of
FIGURE 17 Post-operative full facial smile view of the patient wheels, discs, or cups. In this case, a two-step diamond polishing system

26
(A.S.A.P. All Surface Access Polishers, Clinician's Choice Dental Products,
Inc) was used to impart a high gloss to the enamel surface (Figure 14).
Interproximal finishing and polishing was initiated by using a #12
scalpel blade to remove excess adhesive remnants. In some cases, if
larger excess exists, it should be removed using a medium grit dia-
mond strip (VisionFlex, Brasseler USA). Final polish was performed
using decreasing grits of polishing strips (Epitex Strip, GC America).
Dental floss was then used to ensure no overhangs and rough areas
were present and proper interproximal polishing was obtained.
Final restorations after weeks of placement can be appreciated in
Figures 15 to 17.
5 | C O N CL U S I O N
This clinical article described a systematic checklist which expedites
and facilitates contouring and polishing of patient's anterior direct com-
posite resin restorations. Because it is deliberate and structured—with
each step building upon the previous step—its systematic nature
promotes predictability and efficiency. Although not all steps will be
required for all restorations, reviewing them sequentially will contribute
to esthetic restorative success in the anterior region.
DIS CLOSURE
The authors do not have any financial interest in the companies
whose materials are included in this article.
ORCID
Marcos A. Vargas https://orcid.org/0000-0002-2030-3792
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VARGAS AND MARGEAS
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How to cite this article: Vargas MA, Margeas R. A systematic
approach to contouring and polishing anterior resin composite
restorations: A checklist manifesto. J Esthet Restor Dent. 2021;
33:20–26. https://doi.org/10.1111/jerd.12698