Basic rules for class IV restorations

Class IV restoration of the anterior teeth is always one of the most difficult challenges for doctors, since there is always a risk not to get the color right, and this can lead to the future mistrust of the patient. Following the basic rules of color matching and the layering of composites we can turn our daily routine work into excellent aesthetic results.

styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.1

Before restoration.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.2

We started with color check for dentin and enamel with the button try technique.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.3

To make sure that we choose the right color we always check with VITA shade guide and following the Styleitaliano recipe we can easily restore this defect with 2 shades.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.4

Checking color with cross polarization filter. For this we can use the camera with filters or a mobile phone with the help of Smilelite.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.5

Isolation of the treatment area provides the ability to create an aseptic and dry environment and improves manual control together with efficiency. We use photodam for this case and it gives a good contrast. Note the sclerotic dentin in the tooth which had to be removed in order to obtain a better adhesion.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.6

All sharp edges were rounded up and 2 mm bevel was placed. For creating bevel we use a diamond bur with a yellow marker.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.7

Or Soflex coarse discs too.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.8

For better adhesion and for removing aprismatic enamel we can use sandblaster (Aquacut or Rondoflex) with 27 micron aliminum oxide particles.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.9

After isolation of adjacent teeth with mylar matrix strips (or teflon tape), selective etching technique is used on the enamel for 30 seconds.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.10

Right after rinsing of the etching gel.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.11

We start to apply the new generation of adhesive (multilayer) by brushing actively, much on the the dentin and less on the enamel. We must wait minimum 20 seconds for the exposition of the adhesive followed by 5-10 second air drying for removing the solvent. Light cure for 60 seconds.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.12

First, palatal shell restored with the silicone key technique. We used the same enamel shade that will be the last layer of vestibular enamel. The thickness of the palatal shell can be 0.3 to 0.5 mm.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.13

Second phase: mamelon base was created using the dentin composite. The same dentin shade we used for the incisal edge. The dentin mass is calibrated with the “Misura” instrument from LM Arte set; the composite excess is removed and the incisal edge is modeled in order to leave space for translucent masses and for the final enamel layer
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.14

Layering of the final enamel layer with LM Arte Modella instrument, followed by smoothening with brushes.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.15

The final stage of our layering must always be air isolated with glycerine. Curing for 1 minute.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.16

We need 3 main phases to obtain a good polishing: contouring, finishing and polishing. With Soflex discs we start the contouring phase of our restoration.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.17

Second phase is finishing. In order to get smooth margins we use carbide bur from StyleItaliano Finishing Kit.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.18

To create the illusion of perykimata we always use diamond Perio bur from the StyleItaliano Finishing Kit at a very low speed without water irrigation.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.19

Third phase is polishing. With a rubber abrasive point we start the final procedure.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.20

Polishing is finished with a silicone abrasive wheel.
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.21

Final view of restoration
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.22

Final view after rehydration
styleitaliano style italiano class IV restoration composite incisor broken tooth LM arte compobrush color rules tutorial protocol rubber dam how to

Fig.23

Before and after restoration.

Conclusions

With simple techniques and protocols we can easily overcome the challenges this kind of hard cases always present.

Bibliography

1. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent 2010;5(1):102-24.

2. Manauta J. Paolone G. Devoto W. IN ‘n’ OUT – A New Concept in Composite Stratification. Labline Magazine, 2013;3(2):110-127.

3. Manauta J. Controlled Body thickness Part 1 – www.styleitaliano.org

4. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012. Print.

5. Akhundov M. Composite meets ceramics. www.styleitaliano.org