Step by step for class IV restorations
The use of composite resins for class IV restorations is a procedure that demands the clinician to commit, from planning to execution, combining art and science using a minimal invasive approach that allows more tissue preservation with optimal aesthetic and functional outcome.
The polychromatic complexity and color selection of the restoration is one of the most challenging stages, the optical features of the dentin, enamel and their simultaneous coexistence are the ones that determine the final color of the tooth. Stratification techniques have as an objective to reach the color from the inside to the outside through the combination of dentin and enamel composites, chromatic and achromatic, effects, using small increments in each layer of the restoration.
Dental color has as well a direct relation with the surface texture, a tooth with a whiter appearance is strongly linked with a richer surface detail which makes light reflect more and in different direction, compared with a tooth that has a smoother surface, which will make it of a darker appearance.
A source of even lighting (5500ºK) and a photographic evaluation of the teeth to be restored will provide more information regarding color and will allow to detect important details as the limit between enamel and dentin, and the different color characteristics of the natural teeth.
A simple way of selecting color for a restoration is the following: observe the cervical third to obtain the color of the dentin, the middle third to obtain the color of the chromatic enamel and observation of the distal, mesial and incisal margins for choosing the achromatic enamel.
Upper central incisors are the most prone to coronary fractures and constitute one of the most frequent dento-alveolar trauma in the permanent dentition. The type IV lesions can be seen by loosing the incisal edge, the middle third, involving or not the incisal angles, after the pulp and periodontal evaluation, we should decide the restorative therapy to follow.
In the following pictures a Class IV fractures case on 11 and 21 restored with composite resins will be presented with a simple protocol at the reach of everyone.
The selected resin shades were A3,5 Dentin, A2 Enamel and Trans 20 (Empress Direct Ivoclar Vivadent)
The main goal of performing direct restorations with composite resins is to handle an easy workflow that allows the clinician to have a predictable, natural, functional and long lasting result. Composite resin is a tooth-friendly material, and it allows a minimally invasive approach; color selection is always a challenge for the clinician, in the present article, a simple method is proposed and on top of that, a digital method to enhance the present characterizations of the natural teeth. Combining science and art and the thorough observation of the natural details must concern the clinician from the beginning to the very end. Said that, a constant quest for natural aesthetics together with a continuous evolution of the adhesive systems and dental materials allow the professional to achieve aesthetic results for long term restorations.
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