Class IV Restorations in StyleItaliano Philosophy

A clinical case by our Community member Dr. Mohammed Shaga

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

The goal of esthetic and restorative dentistry is the replacement of lost or damaged tooth structure with synthetic materials that possess biological, physical, and functional propertied that are similar to those of natural teeth.
Contemporary composite systems offer a multitude of shade, translucencies, opacities and effects that together with placement technique make it possible to create restorations that faithfully mimic the polychromatic and optical variations that exist in natural teeth. This evolution of materials, techniques and concepts allows clinicians to treat a wide range of problem in everyday practice by utilizing direct composite resin restorations in a reliable, predictable and conservative way.

styleitaliano style italiano smile with broken tooth

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.

styleitaliano style italiano broken upper incisor

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

styleitaliano style italiano composite button try

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

styleitaliano style italiano isolated field with dental dam

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

styleitaliano style italiano prepared cavity for class IV restoration

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

styleitaliano style italiano enamel etching with teflon tape protection

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

styleitaliano style italiano etched enamel

Fig.7
After

styleitaliano style italiano bonding microbrush on tooth

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

styleitaliano style italiano palatal composite shell and sectional matrix

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.

styleitaliano style italiano composite buildup for class IV restoration

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

styleitaliano style italiano composite layering steps

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.

styleitaliano style italiano translucent composite layering

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

styleitaliano style italiano raw composite class IV restoration

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

styleitaliano style italiano white stains on restoration surface

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

styleitaliano style italiano complete composite anterior restoration before polishing

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

styleitaliano style italiano enhancement of surface texture with articulating paper

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

styleitaliano style italiano spiral wheel and polishing paste for composite polishing

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

styleitaliano style italiano silicone brush polishing composite

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

styleitaliano style italiano polished composite class IV restoration

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

styleitaliano style italiano textured composite class IV restoration

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.

seamless class IV composite restoration style italiano styleitaliano

Fig.21
Intraoral postoperative immediate view.

styleitaliano style italiano smile after restoration of broken tooth

Fig.22
Extraoral postoperative immediate view.

styleitaliano style italiano surface texture of composite restoration

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.

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