By Luana Oliveira-Haas, DDS, MS, PhD
Class IV restorations in the esthetic zone demand precision, skill, and a thoughtful approach to achieve natural-looking results. Simplifying the process without compromising quality is a goal for every clinician. This clinical case illustrates how the universal composite, Tetric Prime (Ivoclar Vivadent), combined with the OptraGloss one-step high-shine polishing system, delivered exceptional results for large Class IV restorations.
A 52-year-old patient presented with large defective class IV restorations on teeth #8 and #9. Patient expressed the desire for seamless, natural-looking restorations to restore her smile. The adjacent teeth displayed minimal translucency or special effects, making this an excellent case for a simplified, efficient technique using universal composite.
- Preparation
The existing class IV restorations were removed, and the enamel margins were beveled to ensure a strong bond and facilitate a smooth transition between the tooth and the restoration.
Figure 1 (below): Initial smile analysis prior to restorations. Visible staining and wear on the maxillary central incisors noted.
2. Shade Selection
Two shades of Tetric Prime were selected:
a. Shade A2 (dentin) to partially cover the scalloped bevel and block the interface between the natural tooth and restoration.
b. Shade A2 to build the final contours and achieve a harmonious blend with the adjacent teeth.
Figure 2 (below): Preparation phase with rubber dam isolation ensuring moisture control and clear visualization of the defective restorations on teeth #8 and 9. Long scalloped bevel placed to ensure enough space for universal composite A2 dentin – Tetric Prime to block line between tooth and restoration.
3. Adhesive Application
Enamel was selectively etched, followed by the application of a universal adhesive (Adhese Universal – VivaPen Ivoclar). After 10 seconds per surface of light curing, the preparation was ready for composite placement.
Figure 3 (below): Final layer of universal composite resin Tetric Prime shade A2 applied to facial surface of teeth #8 and 9 restoring shape and contour. Note the seamless blend between the restorations and the natural teeth.
4. Composite Placement
a. A thin layer of Tetric Prime A2 dentin was placed over the beveled enamel and medium third of dentin, masking the transition zone effectively.
b. Incremental layers of Tetric Prime A2 were then applied to build up the body of the restoration from lingual to facial. Each layer was sculpted to replicate the natural anatomy, including the incisal edge and contours.
c. The excellent handling properties and shade-matching capabilities of Tetric Prime simplified the sculpting process and ensured a seamless blend.
Figure 4 (below): Frontal view of patient smile. Final restorations showing patient smile 3 months after completion of restorations.
5. Polishing
The restoration was finished and polished using the OptraGloss one-step high-shine polishing system. For the final enhancement, the Spiral Wheel HP was used. This efficient polishing system delivers a smooth enamel-like luster and optimal surface smoothness with minimal effort.
Figure 5 (below) : Lateral view of patient smile. Note the appropriate contour of teeth #8 and 9 blending to adjacent teeth.
The restored central incisors exhibited outstanding esthetics, with an imperceptible transition between the restorations and the natural teeth. The combination of A2 dentin and A2 shades, alongside the high-shine polishing system resulted in a smooth, lifelike finish
For large Class IV restorations, when natural teeth lack translucency or special effects, using a universal composite such as Tetric Prime with a two-shade approach can deliver outstanding results without the need for layering multiple opacities or using specialty effects. Paired with the OptraGloss one-step high-shine polishing system and Spiral Wheel HP, you can achieve a polished, natural-looking restoration efficiently and effectively.
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