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.

style italiano styleitaliano dentistry

Fig.1
Before restoration.

style italiano styleitaliano dentistry

Fig.2
We started with color check for dentin and enamel with the button try technique.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

Fig.7
Or Soflex coarse discs too.

style italiano styleitaliano dentistry

Fig.8
For better adhesion and for removing aprismatic enamel we can use sandblaster (Aquacut or Rondoflex) with 27 micron aliminum oxide particles.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

Fig.10
Right after rinsing of the etching gel.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

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

style italiano styleitaliano dentistry

Fig.14
Layering of the final enamel layer with LM Arte Modella instrument, followed by smoothening with brushes.

style italiano styleitaliano dentistry

Fig.15
The final stage of our layering must always be air isolated with glycerine. Curing for 1 minute.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

Fig.17
Second phase is finishing. In order to get smooth margins we use carbide bur from StyleItaliano Finishing Kit.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

Fig.19
Third phase is polishing. With a rubber abrasive point we start the final procedure.

style italiano styleitaliano dentistry

Fig.20
Polishing is finished with a silicone abrasive wheel.

style italiano styleitaliano dentistry

Fig.21
Final view of restoration

style italiano styleitaliano dentistry

Fig.22
Final view after rehydration

style italiano styleitaliano dentistry

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

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