Class 4 composite restoration

Over the years, one of the most challenging restorations to place has been on a tooth presenting with a Class IV fracture. Dentists have universally experienced difficulty in providing a long-lasting restoration that exhibits all of the color properties necessary for a successful shade match, as well as harmonious texture and polish. Due to their past experiences, many clinicians have regarded a direct-bonded Class IV restoration as a temporary solution. They will often advise their patients that the affected tooth will require a porcelain restoration as the definitive treatment.
However, there has been a flurry of progress in the research and development of composite resins during the first decade of this millennium. New techniques have been introduced, and an improved protocol has been developed in the clinical environment to maximize these advances. Because of this, there should no longer be a reason to regard composite resin restorations as temporary or substandard. It is, however, important to update your knowledge on the properties of the composite resin material that you are utilizing in order to consistently create beautiful restorations. In order to realize long-lasting results, adhering to protocol is even more importantPreparation and Composite Resin Placement Protocol
Local anesthetic (3% Isocaine plain [Septodont]) was administered and the fractured teeth were prepared with a long star-burst shaped bevel (48L bur [Brasseler USA]) ).3-5 Teflon tape would have been necessary to cover the enamel of the adjacent tooth if an interproximal contact had been present. In this case, the adolescent had diastemas present, which were left open in anticipation that future orthodontic treatment would be able to properly position the teeth.
Beginning with the right central incisor, the teeth were restored. Tooth No. 8 was etched (UltraEtch [Ultradent Products]) and bonding agent applied (PQ-1 [Ultradent Products]). To ensure an invisible margin, both the etchant and the bonding agent were applied well beyond the fracture line in a gingival direction. Longevity of the restoration depends upon utilizing a maximum amount of the remaining facial enamel. The increase in surface area improves the bonding anchorage value of the restoration to such an extent that this restoration should rival the cosmetic life of any all-ceramic counterpart. Since the fracture in tooth No. 8 only involved the enamel, and occurred at the line of translucency, no dentin shade or lingual opaque shade was needed. Therefore, only Pearl Neutral was used, thus preserving the translucent zone as well as continuing the incisal halo of the natural tooth.
After preliminary shaping of No. 8, the enamel and dentin surfaces of No. 9 were prepared with UltraEtch and PQ1 bonding agent, again extending in a gingival direction well beyond the fracture line. The lingual enamel layer was placed using a universal lingual opaque shade (Opaque Snow). It is important to note that it was left short of the final distal and incisal edges of the tooth, allowing for the creation of a thin band of translucency that was required for optimal aesthetics in this case (Following the simplified layering technique protocol, the dentin-enamel junction (DEJ) was used as a guide for the placement of the dentin layer. Dentin shade A1 was placed to restore the portion that was missing from the fracture. This was placed directly over the lingual enamel layer (The final facial enamel layer was then placed using Pearl Neutral.