Stratification of composite material on Class IV restorations

The higher aesthetic demands as well as the approach of a minimally invasive therapeutic attitude increases the difficulty level of the treatment of anterior tooth fracture. Unfortunately, it is not always possible to realize indirect restorations and so we have to do direct restorations in the dentist’s office (emergency situations, very young patients, etc.). This fact sometimes imposes a complex stratification of the composite material.
The present article proposes to illustrate the steps that should be followed to realize a direct aesthetic restoration.

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Fig.1

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Fig.2
The preparation on 21 (mini-chamfer). On 11 there is a little Class III lesion that will be restored after the reconstruction on 21.

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Fig.3
The etching of the preparation.

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Fig.4
The reconstruction of the palatal and proximal walls with composite enamel (medium value).

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Fig.5
The first layer of dentin, the most saturate (equivalent of A4) and a little amount of dentin for the incisal halo (equivalent of A2 – basic chroma for this case).

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Fig.6
The second layer of dentin (equivalent of A3).

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Fig.7
The last layer of dentin (equivalent of A2 – basic chroma).

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Fig.8
The translucent material for the incisal opalescence.

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Fig.9
The vestibular enamel layer (the same enamel used for the reconstruction of palatal and proximal walls).

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Fig.10
The situation after the first appointment.

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Fig.11

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Fig.12
The final aspect after finishing and polishing. The little cavity on 11 was also restored.

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Fig.13

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