Learning and Applying Natural Layering Concept

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The advances in composite allow us the ability to expand our ability to treat decayed or missing tissues with a greater ability than before. Often times, minimal to no preps, are needed to restore function. This fits right in with the biomimetic protocols of preserving tooth structure. Additive procedures, bleaching, micro-abrasion, enamel re-contouring, direct composite resins, bonded bridges and implants are basically the scope and procedures that are limited to biomimetic dentistry. These procedures offer the practitioner and patient improved practicality, efficiency, and predictability. This ideology leads to a comprehensive and conservative smile design type approach towards restorative dentistry.

The Natural Layering Concept (NLC), as explained by, Didier Dietschi, is a simple and effective method for the creation of highly aesthetic direct restorations. The method isn't exactly new, but stands to be reviewed due to its relativity. There are a variety of indications where the technique can be applied. Congenital aesthetic deficiencies, post orthodontic conditions, and acquire aesthetic deficiencies are just a few of the main groups where a simple direct composite is indicated.

The use of the natural tooth led to the simplified shading and layering concept of NLC. The idea behind it is that you can identify the true dentin and enamel optical characteristics. Optical characteristics of dentin are best matched with a single hue, opacity and a large chroma scale. This allows color matching for some specific color matching like sclerotic dentin.

Replacing enamel tends to be more complicated than dentin. Differences in lightness, translucency, and age of the tooth all need to be considered. There are three different tissue types that general exist:

-Young enamel: white tint, high opalescence and lower translucency.

-Adult enamel: neutral tint, lower opalescence, intermediate translucency

-Old enamel: yellow tint, higher translucency

The success of the final restoration depends on the correct shade evaluation. According to the NLC principles, there are only two basic steps that are needed to be followed. The selection of dentine chroma in the cervical area, where the enamel is the thinnest, and the selection of the enamel tint, preforming by visual observation is normally okay. However, a third option of photographic mapping of the tooth’s special optical effects, such as hypocalcifications, opalescence, or translucencies, etc. This step has become increasing popular and due to being able to do so much with a digital image.

Two techniques have been traditionally used in the Natural Layering Concept. The classic approach, the centrifugal technique, is normally limited to Class III, small Class IV, and limited corrections. Two placements of dentine composite is placed then followed by the enamel covering.

Another common technique is the bunco-lingual technique which is aided by a silicone putty that has been prefabricated. Often a simple free handed mockup can be adequate for simpler cases. In this method a thin enamel layer is placed on the putty guide, forming the lingual surface. This helps to form the width, profile, and position of incisal edge of the restoration in one step. Thereafter, dentine and effect materials (when needed) can be applied in a precise 3-D configuration. This provides the conditions for an optimal aesthetic result, as well as translucency, opalescence and halo effects.

Attention should be given to the natural aging process as the morphology and changes along with the incisal edge structures. Actually, in addition to the increase in dentine chroma and enamel translucency, the progressive thinning of the enamel layer and exposure of dentine at the incisal edge necessitates an adaptation of the layering technique to allow for consistency.

Composite resins, which require a strictly conservative approach, have thus become the materials of choice. The contemporary practitioner is ultimately challenged to replace the missing tissues or eventually modify their configuration, by applying an artificial material to the patient’s teeth, which has to simulate the appearance of natural tissues.

The NLC has enabled this objective to be achieved in a predictable way, by incorporating knowledge about natural tissue optical properties into contemporary composite systems. This advance can be regarded as a milestone in operative dentistry, as it will contribute tremendously to direct composite application, helping a larger number of our patients to receive aesthetic restorations that are more conservative.

More details are given in the full article which can be found here, which is suggested to read.

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