LM ARTE Solo instrument for anterior composite modelling

Making class IV restorations predictable

One of the challenges many dentists face when working on anterior teeth is the lack of predictability. This happens both in class IV restoration cases and in multiple veneering cases. The main challenges are the final restorations shade, shape, and the entire process. So how can we make our results predictable and repeatable in our daily practice? Well, since Styleitaliano introduced their simplified protocols, the workflow had become easier, just as getting the desired outcome. The new techniques, instruments, and materials facilitate the entire restorative workflow and make it easy and simple. In this article I will show you how we can be predictable and repeatable with a magic combination, when dealing class IV restoration or any anterior composite restoration by using the simplified two-shade system (WDB), the specifically designed UNICA matrix, and the all-in-one LM ARTE Solo instrument by LM dental. That’s not all, also polishing has been simplified, thanks to the Lucida™ star-shaped felt and the one-step polishing paste.

broken upper left central incisor

Fig.1

A young patient came to the clinic with a three-year-old fracture, asking to restore this tooth.

class IV cavity before preparation

Fig.2

Retracted view. The initial situation with a left central fracture at the incisal 1/3, it extends more palatally making very thin enamel edge labially. and the tooth responds well to thermal stimuli. Before the treatment, we did scaling for lower incisors and removed the calculus.

button try for composite shade selection

Fig.3

Color matching and analysis must be performed before rubber dam isolation when the teeth are fully hydrated, otherwise, there is a high risk of mismatching color by choosing one that’s whiter than appropriate.

class IV cavity on central incisor with rubber dam isolation

Fig.4

Rubber dam isolation is mandatory to work a clean, contaminant-free environment.

bevel preparation for class IV restoration

Fig.5

In this specific case, a 1.5 -2 mm bevel was created using a yellow-band flame diamond bur. If the tooth were bright and opaque and small fractures there would be less or no need to hide the cavity margin, so no bevel would be required.

color scheme for simplified class IV restoration

Fig.6

The White Dental Beauty CompoSite system only features one enamel shade, which has been designed to blend flawlessly with all the Si universal shades. Thanks to its calibrated translucency and opalescence properties, it is ideal for a two-layer technique or to simply characterize the incisal edge.

palatal composite shell on tooth 21

Fig.7

The palatal shell is modelled freehand, supporting a mylar strip with the finger. The Enamel shade (White Dental Beauty) was layered as thin as possible (about 0.5 mm).

unica matrix for proximal and distal composite layering on incisors

Fig.8

Using the Unica matrix (by Polydentia) to restore the proximal wall. The matrix can be stabilized with a wedge if necessary. In this case, My Custom Resin (Polydentia) was injected and cured to keep the matrix in the desired position.

close-up of unica matrix during composite modelling

Fig.9

Building the proximal wall using the same Enamel shade (E , WDB) using the new Solo instrument (LM, powered by Styleitaliano).

LM ARTE solo instrument for anterior composite restorations by styleitaliano

Fig.10

The new all-in-one, multipurpose instrument Solo (LM, powered by Styleialiano) was specifically designed for composite veneers and anterior composite restorations.

dentin layering in class IV cavity

Fig.11

After building the proximal wall the frame to layer the dentin shade SI3 (WDB) is ready.

LM ARTE Solo spatula for anterior composite modelling

Fig.12

Application of dentin SI3. As you can see, the Solo instrument was used for the entire procedure, except when checking the thickness of the outer enamel layer.

LM ARTE misura instrument for controlled enamel mass layering thickness

Fig.13

For this purpose, the Misura instrument (LM Arte kit, powered by Styleitaliano) was used, as it allows to easily control the 0.5 controlled thickness for the final enamel layer.

composite restoration before finishing

Fig.14

After application of the final enamel layer, before finishing.

diamond bur for composite finishing

Fig.15

The perio diamond bur from the Styleitaliano Finishing kit is ideal to even the surface at low speed, and to correct shape and contour.

polishing wheel for composite restorations

Fig.16

The spiral wheel (3M) polisher is ideal for pre-polishing, thanks to its flexible shape which adapts to all tooth surfaces.

LUCIDA Star felt and Paste for composite polishing

Fig.17

The Lucida™ Star Felt is a disposable polishing device. Latch mandrels for the Lucida Star Felt may be autoclaved and reused. The DiaShine Lucida™ Paste is completely water soluble. These two allow for a single-step polishing of composite restorations.

finished class IV composite restoration

Fig.18

The final situation, with correct shape, shade and contour, and a glossy surface.

smile of patient with restored central incisor

Fig.19

The smile of a happy patient.

Conclusions

By the introduction of new simple techniques, materials, and tools, we can simplify our daily work and make it predictable and repeatable. Following the Styleitaliano philosophy can decrease chairside time for the dentist and the patient, making such procedures affordable and minimally invasive for the patients.

Bibliography

1. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
2. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37(47): 5-13
3. Mangani F, Cerutti A, Putignano A, Bollero R, Madini L. Clinical approach to anterior adhesive restorations using resin composite veneers. Eur J Esthet Dent Off J Eur Acad Esthet Dent. 2007;2:188–209.
4. Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr. Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 2011;23(2):73-87.