Class IV restoration Incisor 11
Treatment protocol and work flow.
A 9 years old female patient came to the office with an uncomplicated traumatically fractured anterior tooth after falling down from stairs. It was the preliminary therapy plan to perform a temporary Class IV restoration in order to restore the lost dentin and enamel substance and thus the chewing function.
Four (4) years after the injury – the meanwhile 14-year-old patient appeared once more for replacement of the temporary by a final restoration. (Picture 1)
It was the desire of the patient rather to have a direct restoration done with composite, instead of an indirect prosthetic treatment with a crown or a partial crown. For this ambitious anterior case, I used a new composite by Harvard Dental, the UltraFill. For preserving the shape of the tooth and incisal edge, a palatal silicone index was taken (Harvard PremiumSil Putty Soft) The precise index obtained by this provided a good overview over the shape, position and angle of the tooth to be restored. (Picture 2)
By Rubber dam isolation a complete drain was ensured. Then the provisionally treated tooth was cleaned and polished, old composite removed from it and the enamel edges rounded for obtaining larger bonding surfaces. By applying the tooth into the silicone index, the outline of the missing dentin and enamel substance became obvious. The neighboring teeth were covered by a teflon layer and isolated. Enamel etching was performed by a thixotropic etching gel which could be applied precisely without effort. A Palatal shell was modelled as the basis of the restoration, with Harvard UltraFill INC, (70% opacity). (Picture 3)
By the application of a transparent plastic matrix, the approximal restoration contacts could be defined, however they were not finally elaborated, yet. On the palatal incisal shell, the mamelons were restored with composite in dentin opacity (90%). As A1 was the natural shade of the patient, this shade was also chosen for the mamelon restoration (Harvard UltraFill A1D). (Picture 4)
The final layer above the mamelons was applied with enamel opacity (80%) composite (Harvard UltraFill A1 E), while the incisal edge was again modelled with the incisal composite (UltraFill INC) (Picture 5)
In order to obtain life-like perfect esthetics, some secondary anatomy corrections were done, including the final shaping of the approximal contact areas. After finishing and polishing, the labial surface of the restored tooth 11 showed some deviating details in comparison to the neighbor tooth 21. So, a few 3rd anatomy corrections had to be done.
After the 3rd anatomy corrections, the restorative margins were absolutely invisible. This was due to the opalescence of UltraFill, and to the fact that the light refractive index of the composite is similar to the typical refraction of light by the enamel. Furthermore, the cameleon effect of UltraFill ensured the perfect matching of the shades. (Picture 6)