How to: Use direct veneers for a class IV repair

Since their introduction in the late 1960s composite resins have continually evolved in terms of convenience, durability and esthetics. The evolution in esthetics has been particularly important to increasingly demanding patients and is largely because of enhanced optical properties and improvements in the ability to achieve a high surface luster. Esthet-X® HD High Definition Micro Matrix Restorative is the next generation of Esthet-X® Micro Matrix Restorative, a universal composite and a pioneer in nano technology with a clinical track record of more than 10 years.

Esthet-X HD restorative shares the same chemistry with the original Esthet-X
and provides the same physical properties, clinical performance, handling characteristics and life-like esthetics. The difference is Esthet-X HD’s enhanced filler technology that results in a material that takes polish to a new level. This was accomplished by removing the proportion of larger filler particles and shifting the particle size distribution to smaller size particles including nano particles.

The case

The patient was a young female pedodontist who wished to enhance the appearance of her smile by having her maxillary central incisors restored with composite resin. Previous composite resin restorations had been placed a number of years earlier after trauma resulted in a Class IV fracture of her right central incisor and incisal fracture of her left central (Fig. 1)

No pulpal damage had occurred and the teeth were caries free and periodontally sound. Esthet-X HD was chosen as the restorative material because of its high strength, excellent polish, easy handling and shade selections.

Clinical protocol

01. Use a football-shaped diamond bur to prepare the lingual surface of the left central incisor. Next, a small chamfer diamond is use

d to prepare the facial surfaces. 

02. Fig. 2 shows the final preparations for direct composite facial veneers and Class IV repair.

03. Etching gel is applied to the right central incisor and then Dentsply International’s Prime & Bond NT is applied to the etched surface (Fig. 3). 

04. Esthet-X HD body shade is applied to the Class IV area of the right central incisor (Fig. 4). Fig. 5 shows the incisal build-up with body shade. 

05. The enamel shade is applied to the entire facial surface of the right central incisor, and the incisal shade is applied to the facial surface of the right central incisor. 

06. Use a football-shaped carbide finishing bur to refine the contour of the lingual area. A small carbide bur is used to finish the marginal areas.  

07. A plastic instrument is used to “torque” the teeth and separate the composite from the adjacent tooth (Fig. 6). A Dentsply Int’l PoGo Polisher is used to achieve a high gloss (Fig. 7).

08. After the restoration was completed, Fig. 8 shows the right central incisor completed and Fig. 9 shows the tissue healing at two weeks’ post-op.

Closing thought
The procedure was accomplished in a single appointment and a post-operative evaluation was performed two weeks later (Fig.10). The patient was extremely pleased with the end result and commented that her friends and family immediately noticed the improvement in her smile and could not differentiate between her natural teeth and the composite resin restorations. Fig. 11 shows the completed case with the patient’s new smile with Esthet-X HD direct composite restorations.