By Dr. Rafael Beolchi
Longevity is without any doubt a fundamental characteristic of any restoration. However, some dentists might also find this elusive. This article presents a clinical case of diastema closure performed in 2011 and highlights how proper transillumination and polishing techniques contribute to its maintenance over the years.
Fourteen years ago, a 35-year-old female patient presented in my practice, unhappy with her diastema (Fig 1). After the usual steps of the restorative treatment protocol, I applied a layering technique and created the composite restoration for the diastema closure with four different shades. Finally, I performed the curing process with the first generation of the VALO™ LED curing light, which since then has always given me reliable, well-cured restorations. The result looked great and blended in nicely into the natural dentition (Fig. 2).
Fig. 1 & 2: Diastema Closure in 2011
In 2024, after some check-up appointments over the years (fewer than recommended), I felt that the case would require a better clinical revision. Starting the diagnosis with a visual inspection, I noticed some enamel cracks, a normal situation for a 48-year-old patient (Fig. 3). However, I got the feeling that some micro-leakage between the different composite layers might have occurred, especially on the restoration on tooth #11.
Fig. 3: Clinical situation after 13 years
A good method to further explore is to use transillumination techniques, as visual inspection alone can be quite limited in this regard. In my case I relied again on the VALO curing light family: after 13 years, now working with the third generation of my original VALO LED curing light, a new model called VALO X. The new VALO X light not only incorporates light modes for the typical curing protocol, it also offers diagnostic aid light modes with black and white light, plus some helpful diagnostic accessory lenses.
I decided to follow a specific transillumination process for a proper diagnosis. First, I attached the Diffuser Lens to my VALO X light on Black Light Diagnostic Aid Mode for the detection of fluorescent particles in the composite and for an easy differentiation from the natural enamel. It became obvious that tooth 11 showed some black lines on the composite restoration, which backed my initial suspicion that there must be something between the layers of the different composite shades (Fig. 4 & 5).
Fig. 4 & 5: Visualization with the Diagnostic Aid Light Mode
Subsequently, I switched to the TransLume Lens, to facilitate and intensify the visualization of potential enamel cracks, black stains, or defects by the means of orange light (Fig. 6 & 7).
Fig. 6 & 7: Visualization with the TransLume Lens
Finally, I worked with the Interproximal Lens, which allows balanced white light to be placed between the teeth from different angles and which makes the visualization of enamel cracks even more dynamic. This step verified that the black stains were somehow fixed at the same place, regardless of the angle (Fig. 8 & 9). This is an indicative that those should be superficial.
Fig. 8 & 9: Visualization with the Interproximal Lens
The sequence from the black over the orange and the white light from different angles granted me a perfect view, an enhanced prediction and a better feeling of how to read the different signs. With a good clinical indication that the stains and colorations were superficial, I opted to use a sequence of the Jiffy™ Spin shaping and finishing disk, followed by the spiral-shaped Jiffy™ Natural composite polisher to create a great luster (Fig. 10).
Fig. 10: Polishing with the Jiffy System
At the end of the treatment protocol, I used the Ultradent™ Diamond Polish for an unsurpassed esthetic finish (Fig. 11).
Even today, most of the practitioners do not work with a dedicated device for diagnosis and transillumination; in some cases, light from the turbine may be used. However, this case showed impressively that one of the keys for knowing what a good method for maintaining long-lasting restorations – and thus for satisfied, loyal patients – can be a proper diagnosis (Fig. 12). The VALO curing light family not only delivers unmatched cured composites – something evident after years of use – but also offers exceptional diagnostic capabilities as a transillumination device.
Fig. 11 & 12: Final result 2024
In my opinion it is striking how the VALO light evolved over the years from a reliable curing light to today’s VALO X light, offering curing and diagnostic aid modes likewise. It helps me tremendously to provide high-quality and more durable, long-lasting restorations. Thus, my recommendation to every colleague is: if you want your composite restorations to last longer, make sure you’re bringing more light into your diagnostic process!