Restoring class IV cavities is one of the biggest challenges for a dentist, because of the diﬃculties in color matching, in emulating natural internal structure of the tooth, and in hiding the fracture line.
This young boy broke his teeth playing hockey on a Saturday. Luckily none of the fractures was complicated by pulp exposure, and, because the fragments weren’t retrieved, a dentist sealed the dentin.
An impression was taken to do a wax-up based on which a silicone index was fabricated.
Also, early color matching was done, using a standard VITA Shade Guide.
I always do a direct mock-up with the exact composite shades and shapes that I want to use, so that the actual outcome of the ﬁnal restoration is visible.
A black and white picture is useful to analyze the value.
Rubber dam isolation is mandatory to perform adhesive procedures.
For a more eﬀective isolation, the rubber dam should be tucked into the sulcus. Floss ligatures provide extra retraction.
The surface should be thoroughly cleaned. Creating a bevel is advantageous when trying to hide the fracture line. All edges were rounded.
I always etch a wider surface than the one I’m going to bond the restoration to, to avoid the risk of leaving part of the restoration unbonded, hence early staining and inﬁltration.
A single-bottle universal adhesive was used.
It’s useful to mark were the fracture line is in the silicone key, in order not to have a big excess in the palatal area.
A small amount of A1 dentin (Filtek Supreme XTE, 3M) was applied, because of its opacity. A layer of A1 body shade (Filtek Supreme XTE, 3M) was used to reproduce the mamelons, and calibrated with Misura instrument (LM Arte kit powered by Styleitaliano), to ensure proper spacing for the enamel mass.
A correction can be done with a diamond bur at low speed to achieve a very precise incisal shape.
For the incisal halo, I used the same dentin selected for the rest of the layering.
We can apply a clear translucent mass in between the mamelons and also on top of them for the contra-opalescence.
Proximal walls are made with the same enamel shade by using posterior matrices in a vertical position.
Some white spots were added for a more natural look.
The ﬁnal aspect of the restorations.
The restorations at the end of the session, before rehydration.
The correct polish is extremely important for the long-term success of the restoration. First correct the light reﬂecting angle lines.
Surface texture was created using a diamond bur at low speed and no irrigation.
A felt with aluminium oxide paste was used to achieve highly glossy surfaces.
At check-up, one month later.
After rehydration, the fracture lines are invisible and the restorations look natural.
Before and after, 6 months later.
Direct composite restorations can be a great solution to restore aesthetics and function in case of fracture of the anterior teeth. To achieve these goals, it is mandatory to follow a precise protocol. This protocol should include a good diagnosis, a complete planning with a restorative trial and a silicone key. Isolation and a good adhesive technique, together with a simpliﬁed restorative technique and heavy-duty ﬁnishing and polishing complete a successful session.
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3. 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.