Class IV using just a single shade: dream or reality?

A clinical case by our Community member Dr Edoardo Yang Fossati

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.

Each time a decision is made to restore a significant anterior fracture with a direct resin composite restoration, numerous issues must be addressed. Initially, attention is focused on the tooth shade selection, followed by the choice of composite brand, often involving the blending of multiple brands. Once the preferred composites are selected, the appropriate quantities of each must be determined. Subsequently, the restoration process begins, with careful consideration given to achieving the ideal shape. Fortunately, it is widely understood that the shape plays a pivotal role in achieving optimal aesthetic results. Hence, the suggestion to utilize a single universal shade, combined with a flowable composite, to achieve a flawless shape seems logical.

style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
style italiano styleitaliano initial situation class IV composite restoration

Fig.1
In the first appointment, the patient came to the office after a traumatic fracture of the element 1.2 and 1.1. The 1.1 was endodontically treated after a trauma and an impression was taken to make a wax-up.

style italiano styleitaliano class IV composite restoration isolation

Fig.2
In the second appointment, the dental dam was placed and the cavities were cleaned with bur and sandblaster. A light bevel was created on the buccal side of the teeth.

style italiano styleitaliano etching and bonding class IV composite restoration

Fig.3
The 37% orthophosphoric acid etching gel was placed just onto enamel for 20 seconds and an universal adhesive (iBond Universal, Kulzer GmbH) was applied to the entire surface of the cavity. For this, the adhesive was gently rubbed in for 20 seconds, carefully air dried with a gentle air flow and light cured for 10 seconds.

style italiano styleitaliano palatal shell class IV composite restoration

Fig.4
The try-in of the silicon guide for the palatal shield.

style italiano styleitaliano palatal walls class IV composite restoration

Fig.5
The palatal shield was made using a high loaded translucent flowable.

style italiano styleitaliano class IV composite restoration dentin placement

Fig.6
For the deep and superficial dentin, the same universal composite (Kulzer Venus Pearl Light) was used.

style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
style italiano styleitaliano class IV composite restoration mamelons creation

Fig.7
With the same composite the mamelons were sculpted.

style italiano styleitaliano class IV composite restoration translucency creation

Fig.8
To increase the incisal translucency between the mamelons, the same initial flowable was injected and cured for 10 seconds before placing the last superficial layer.

style italiano styleitaliano direct anterior class IV single shade composite restoration step by step

Fig.9
From the first step to the last layer, just two composites were used: a translucent flowable plus a universal shade packable composite. The last layer of enamel was accomplished with the same Kulzer Venus Pearl Light.

style italiano styleitaliano direct anterior class IV single shade composite restoration final situation

Fig.10
At the end of the polishing and finishing, it was clear that it was necessary to modify the shape of the teeth and to wait for the rehydration of the tissues. The corrections were planned for the next appointment.

style italiano styleitaliano direct anterior class IV single shade composite restoration final situation follow-up after 1 month

Fig.11
The final result after shape correction and 1 month follow-up.

style italiano styleitaliano direct anterior class IV single shade composite restoration initial situation and final situation (after one month)

Fig.12
The comparison of the initial and final condition.

style italiano styleitaliano Final situation after 6 months

Fig.13
The result after six months. With the correction of the shape, a good matching of the restorations was achieved, even though the value is not perfect but remembering the restorations were made using just one packable composite.

Conclusions

Despite anterior direct restorations posing a continual challenge, technology offers assistance. Presently, single-shade application is common in posterior restorations, yielding excellent outcomes. However, apprehension persists regarding its application in anterior cases. Selecting an appropriate universal composite, such as Kulzer Venus Pure, can yield satisfactory results, albeit potentially not as flawless as traditional layering techniques, yet still meeting patient expectations.

style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering
style italiano styleitaliano kulzer composite venus pure pearl and diamond 4 shades monochromatic layering

Bibliography

  1. Perdigao et Al. Adhesive dentistry: Current concepts and clinical considerations Journal of Esthetic and Restorative Dentistry 2020;1-18.
  2. Marchesi G, Frassetto A, Breschi L et al. Adhesive performance of a multi-mode adhesive system: 1-Year in vitro study. J of Dentistry. 2014.
  3. Demarco F F et al. Anterior composite restorations: A systematic review on long-term survival and reasons for failure. Dent Mater. 2015 Oct;31(10).
  4. Zulekha et al. Clinical performance of one shade universal composite resin and nanohybrid composite resin as full coronal esthetic restorations in primary maxillary incisors: A randomized controlled trial. J Indian Soc Pedod Prev Dent. 2022 Apr-Jun;40(2):159-164.
  5. De Abreu JLb et alAnalysis of the color matching of universal resin composites in anterior restorations. J Esthet Restor Dent. 2021 Mar;33(2):269-276.

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