Lec 13 Direct Anterior Restorations-1

Direct Anterior
restorations
Dr. Farah Naz

Assistant Professor, AIDM
This lecture includes
 Class III composite restorations
 Class IV composite restorations
 Composite veneers
 Composite splints
Class III composite
restorations
 Etiology
 Location
 Detection (explorer,
radiograph,
transillumination)
Class III restorations
 Treatment Rationale
 Incipient enamel caries: can be
remineralized
 Cavitated enamel caries: shallow
cavitation restricted to enamel, saucer
shaped prep. composite restoration
 Dentin caries with peripheral enamel
margins: remove carious dentin, fragile
enamel, bevel the enamel margins, restore
 Preparation should not extend on labial
surface unless it is involved
Dentin caries with margins extending
onto the root surface:
 No enamel at gingival side for bonding
 Two possible solutions:
1. Open sandwich technique (RMGIC +

LCC)
2. Retentive groove at gingival surface
Conventional class III
Preparation
Class IV restorations
 Etiology
 Location
 Treatment rationale
 Caries:
 same prep. as class III + incisal edge
 Wider bevel (1-1.5mm) at incisal edge
 Tooth fracture:
 bevel only and restore with composite
 Fragment reattachment
Material Options
 Composite restoration
 Micro-filled (Class III)
 Hybrid composite (class III and IV)
 Hybrid base and micro-filled surface
layer
 Glass ionomer restoration
 Lingual preparations
 High caries risk patients
 No beveling required
Direct composite veneers
 Indications
 Intrinsic stains (Mild to Moderate)
 Developmental defects of enamel and
dentin
 Congenitally abnormal shaped teeth
 Diastema closure
 If diastema more than 2.5mm then augment
with orthodontic treatment
Compared to ceramic veneers
Advantages
 Can be completed in one visit
 Less costly
Disadvantages
 More chair side time
 Appearance declines with time

Shade Selection
 Very important in anterior esthetic restorations
 Depends on:
 Proper lighting (metamerism: capability of humans to
recognize any color under different light sources i. e sun,
bulb etc)
 Colour acuity and eye fatigue (rested on blue shades)
 Confirmation
 Trial-Place and cure without etching
 Ask opinion of Patient and dental Assistant
 Should be done on wet teeth before preparation
 Tinting and Opaquing (Opaque shades and intense
colors e.g. cervical, incisal translucent, Brown and
white tints)
Matrices
 Most commonly used- clear plastic matrix
strip
 Clear plastic crown form can be used-
extend 1mm past the prepared margins
 Wedges can be placed b/w tooth and
plastic strip to prevent material flash in
the gingival margin
 Pre-wedging- in class IV restorations to
create space for contact placement
Material placement
 Incremental layering of 2mm each.
 Crown form – filled and placed, cured
 Crown form cut from labial surface to
allow incremental layering
 Overlay technique- microfilled veneer
over hybrid composite to achieve
strength as well as smooth surface
Finishing and polishing
Can be done by using:
 Fine diamond burs or 12-30 fluted carbide
burs
 No. 12 scalpel blade for reducing
interproximal flash
 Abrasive disks
 Impregnated rubber points and cups
 Finishing abrasive strips
 Aluminum oxide or diamond polishing
paste
 REBONDING: glazing by etching and bond
placement
 Contouring:12 fluted
carbide burs, disks or
fine diamond burs
 Finishing: finer
versions of all the
above
 Polish: Aluminium
oxide or diamond
paste.
Clinical steps- Class III & IV
 Select shade
 Place rubber dam
 Cavity prep. Guided by caries extent, avoid damaging
adjacent tooth
 Remove carious dentin by slow speed round bur
 Remove unsupported enamel/ place bevels
 Etch enamel (15-30 sec.), rinse: 15 sec. , dry: 10 sec
 Prime, bond
 Light cure 10 sec.
 Place resin composite, cure
 Place clear strip/ matrix and wedge
 Add composite, cure 20 – 40 sec as recommended by
manufacturer
 Remove wedge and strip, inspect
 Remove flash with finishing bur or scalpel blade
 Contour the restoration
 Remove rubber dam
 Check occlusion and adjust if required
 Finish and polish with rubber points and disks
 Apply etchant, rinse, apply bond and then cure
Class III
Class IV
 Multiple layerin
 Opaque: dentin
shade
 Transparent:
Enamel shade
 Color tints
Clinical steps- Direct resin
composite veneers
 Select shade
 Place rubber dam
 Very small or NO tooth prep. (if stains or caries)
 Etch with 37% phosphoric acid, rinse, dry
 Place clear plastic strip and wedge
 Apply opaque resin when required, cure
 Add composite, in layers, contour and light cure
 Proper length and width of teeth prepared
 Contour gingival margin
 Remove flash
 Contour with finishing bur
 Remove rubber dam
 Check occlusion
 Finish and polish with disks, polishing points
 Etch and apply bond
Composite splints
 Periodontally weak teeth
 Post dental trauma stabilization of
teeth
Periodontal splinting
Post trauma composite and
wire splinting
Thank You!

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Direct Anterior

Dr. Farah Naz

 Two possible solutions:

1. Open sandwich technique (RMGIC +

 Appearance declines with time

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