Fig.1
A young patient came with esthetic problem and displacement of the old restoration on his upper right central incisor, asking to restore this tooth.

Fig.2
Intraoral preoperative image shows details of tooth fracture and the old restoration.

Fig.3
Body and enamel shade selection was done using the button try technique, the body shade more cervically and enamel shade incisally.

Fig.4
Isolation with rubber dam inversion to achieve a clean, dry working field and minimal interference with restorative procedures.

Fig.5
The entire old restoration was removed, sharp edges were rounded up by finishing discs and a 2 mm bevel was created.

Fig.6
After protection of the adjacent teeth with teflon tape, enamel etching for 25 seconds with 37% phosphoric acid was carried out.

Fig.7
After

Fig.8
Multiple coats of universal bonding agent were rubbed for 20 seconds, then carefully thinned with air before curing for 40 seconds.

Fig.9
The silicone key technique was used to restore a 0.3-0.5 mm thick enamel shade palatal shell. A metallic sectional matrix was used to restore the proximal walls using the same enamel shade, 0.5-1mm thick.

Fig.10
Once the outer framework was built the body shade could be layered.

Fig.11
The body shade was placed leaving a 0.5 mm spacing for the final enamel shade. The mamelons were modeled using a sharp instrument as a probe leaving an incisal empty space to recreate a natural halo effect.

Fig.12
A small amount of transparent enamel was placed between the mamelons and at the incisal edge.

Fig.13
After complete layering of body and transparent shade, and before adding the final layer of enamel.

Fig.14
Some white stain was added to copy the perikymata of the adjacent incisor.

Fig.15
The final enamel shade was adapted and smoothed with a dental brush.

Fig.16
To better see the surface anatomy of the adjacent tooth, articulating paper was rubbed on the surface.

Fig.17
For the polishing and gloss a spiral wheel with polishing paste were used.

Fig.18
A silicone brush was used to thoroughly polish the areas that are harder to reach.

Fig.19
After finishing and polishing, this view shows the horizontal anatomical features on the upper left incisor.

Fig.20
The restoration matching the texture of the natural tooth. A fine needle bur was used to scratch the restoration surface horizontally in same area and then a flame-shape rubber was used to polish.

Fig.21
Intraoral postoperative immediate view.

Fig.22
Extraoral postoperative immediate view.

Fig.23
Surface texture.

Conclusions

With the Controlled Body Thickness technique and protocol we can use a minimal amount of layers to easily overcome the challenges this kind of hard cases and make it easy to get a natural, aesthetic and functional outcome.

Bibliography

1. Manauta J. Controlled Body thickness Part 1. Styleitaliano.org
2. Angelo P. Recipe for Class IV Restorations. Styleitaliano.org
3. 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.
4. Manauta J. Paolone G. Devoto W. IN ‘n’ OUT – A New Concept in Composite Stratification. Labline Magazine, 2013;3(2):110-127.