When we have a challenge like a central incisor restoration we need the best tools to obtain the best results possible.
Normally when we face a single restoration in anterior sector we immediately think in a polychromatic restoration with several opacities and multi-stratification procedure.
But maybe this is not mandatory always, cause sometimes the characteristics of the teeth allow us to make the procedure simple, thus to this there are new materials that really mimic the effects of the natural teeth with only one opacity.

Fig.1

Young female patient came to office to change the old restoration in her right central incisor.

Fig.2

A photograph with a slightly open bite allow us to decide is the restoration needs multiple colors and opacities or we can go with a simple procedure.

Fig.3

Close up with black background to check the details of the restoration to be done.

Fig.4

Polarized photo with the MDP device allow us to check the real color of the restoration without reflexions.

Fig.5

Prior to do nothing we propose the patient to make a home bleaching procedure with carbamide peroxide at 16% for two weeks. This is the result that we obtain.

Fig.6

Filtek Universal is the system we decide to use cause with only one opacity we can match the color of the natural tooth.

Fig.7

With the help of the MDP we make a color test, we apply three different small balls of universal composite to check which one match better with the natural teeth. As we see in the photo the XW (extra white) color in the one that we are gonna use.

Fig.8

Isolation is mandatory to make an adhesive restoration.

Fig.9

We eliminate the old restoration with high speed and finish with ceramic burs in low speed to eliminate the composite and don’t damage the enamel.

Fig.10

Bevelling the margin.

Fig.11

29 micronsoxide aluminium help us in the preparation.

Fig.12

With the help of the teflon tape we protect adjacent tooth.

Fig.13

We will use a universal system adhesive but we like to use the selective etching approach.

Fig.14

Etching including not only the bevel, going beyond it.

Fig.15

Washing with water is so important to eliminate all rests of etch agent.

Fig.16

Adhesive time.

Fig.17

But first we need to eliminate all the drops…

Fig.18

Adhesive phase is the key for success.

Fig.19

We polymerize from all the parts of the teeth.

Fig.20

Fissura instrument marks the limit of the preparation in a silicon key obtain from a digital model created after a intraoral scan impression.

Fig.21

We are gonna use only one color so we just need to fill all the space of the silicon matrix with the XW color prior selected.

Fig.22

Paintbrush will help us to model the buccal surface…

Fig.23

Polimerization.

Fig.24

This barrier will help us to obtain a better surface in the final polimerization.

Fig.25

For the finishing and polishing we start with the primary anatomy following the Essential Shape rules.

Fig.26

With the Sof-lex disc.

Fig.27

Details in the embrasures.

Fig.28

Then the secondary anatomy with a Perio Set bur.

Fig.29

Now is time for the shine.

Fig.30

With the yellow spiral disc.

Fig.31

And the purple one.

Fig.32

Immediate result before removing rubber dam.

Fig.33

Result after removing immediately the rubber dam.

Fig.34

Immediate smile.

Fig.35

Two weeks review from lateral side

Fig.36

Smile detail, another restoration was made in the lateral to improve the esthetics.

Fig.37

Lateral view, notice the secondary anatomy.

Fig.38

Final result.

The patient is satisfied with the result and we obtain a natural restoration in a easy way and simplifying the class IV procedure that normally is one of the most challenge procedures in dentistry.

BIBLIOGRAPHY

1-Hirata R. Shortscuts em Odontologia estetica:uma nova visao sobre TIPS. Capitulo 3: Restauracaos esteticas e transformacoes anteriores. Quintessence Editora Ltda. 1°Edición. 2016; 236-452
2-Manauta J, Salat A. Layers An atlas of composite resin stratification. Quintessence Editora Ltda. 2013 Fahl N Jr. Ultimate aesthetics with composites: When Art and Science Merge. Dentistry Today, p.56-61, Sep. 1999
3-Romero MF. Esthetic anterior composite resin restorations using a single shade: Step-by-step technique. J Prosthet Dent. 2015 Jul;114(1):9-12.