Modern dentistry has been, thanks to the clinical requests, going through many important changes for some years now, because of the introduction of new materials and direct techniques to simplify the daily workflow.
Fig.1
16 years old female patient came to the office to change previous inappropriate class IV direct composite restorations on teeth 11 and 21.
Fig.2
The initial situation with teeth in occlusion gives us valuable information about color and opacity as well.
Fig.3
Like a dental technician if you delete color you can concentrate on shape and texture.
Fig.4
In all my class IV complex cases, I like using rigid silicone indexes from a preliminary study on cast models and an accurate wax-up.
Fig.5
This really helps me as a guide in the planning and management of palatal walls, shape and emergency profiles.
Fig.6
Vestibular enamel preparation was limited to clean, well finished margins, using a rounded bevel, highly recommended once using new body materials.
Fig.7
I never bevel the inter-proximal and palatal margins because it would be much more difficult to stratify and finish. All modern composite materials need a solid and not so thin interface.
Fig.8
So I used a diamond bur working only on its tip.
Fig.9
Great care is used to finish the preparation margins using silicone rubber points on a blue ring handpiece, to carefully smoothen the preparation and eliminate the unsupported enamel prisms which would chip during polymerization contraction and lead to discoloration and infiltration of the restorations.
Fig.10
I strongly recommend using this new bonding agent family. Thanks to this technology we can use it as a self etching, as an etch and rinse, but the best option is to perform a selective etching procedure on the enamel.
Fig.11
Brilliant EverGlow represents a new generation of composite material with special fillers. Due to its smart translucency balance, the shades integrate very harmoniously into the existing dental arch.
Fig.12
After bulding palatal walls I like to put a little amount of flowable composite on the cervical edge to secure the palatal walls without risking of breaking them, before removing the silicone matrix.
Fig.13
Palatal view.
Fig.14
Reconstruction step of the dentinal body using a single shade A1/B1 mass leaving a small free space with the incisal ridge for opalescence and internal features.
Fig.15
Blue opalescent effect in between the mamelons and some little white spots.
Fig.16
The final outcome showing a natural integration in shape and color.
Fig.17
With a very high gloss.
Conclusions
New materials are now available on the market that make our work get better and better.
