Isolating, Bonding, and Creating Composite Artistry

Fig 1. Photograph sent to the author displaying the overcontoured resin on the mesial of tooth No. 9, long contact, and inflamed papilla between the two central incisors.

Fig 2. Preoperative full smile of the patient after the resin in Fig 1 was replaced and periodontal treatment was completed to repair the damaged tissue between the central incisors.

Fig 3. Preoperative close-up, 1:1.5 magnification ratio, retracted view with black contraster.

Fig 4. Absolute isolation was achieved with a heavy-gauge 6-in x 6-in rubber dam (Nic Tone, nictone.ro) from teeth Nos. 6 through 11 with primary W2 clamps (Hu-Friedy, hu friedy.com) placed over the rubber dam and on the first bicuspids.

Fig 5. All existing resin was removed under a microscope (PromiseVision 3D™, Seiler, seilermicro.com). A “starburst” bevel was placed in enamel. The surfaces to be restored were air-abraded with 50-μm aluminum oxide via an air-abrasion system.

Fig 6. The lingual matrix, used to build-up the lingual shelf in achromatic enamel, was tried in after rubber dam placement to ensure proper seating before starting the final restorations.

Fig 7. Tooth No. 8 is shown after the etching and bonding protocol. Because this case was entirely in enamel, a total-etch technique was used. After being washed with water spray, the enamel was etched with Select HV Etch w/BAC (BISCO) for 15 seconds and then rinsed thoroughly. Excess water was removed by blotting the surface with an absorbent pellet for 1 to 2 seconds, leaving the preparation visibly moist. One to two drops of All-Bond Universal dental adhesive was dispensed into a clean well, and the cap on the bottle was replaced promptly to avoid evaporation of solvent. Two separate coats of All-Bond Universal were applied, with the preparation being scrubbed with a microbrush for 10 to 15 seconds per coat. The adhesive was not light-cured between coats. Excess solvent was evaporated by thoroughly air-drying with an air syringe for at least 10 seconds; there should be no visible movement of the adhesive. The second coat of All-Bond Universal was applied in the same manner as the first, followed by a 10-second light-cure.

Fig 8. The completed resin on tooth No. 8 prior to final polish. The tooth was shaped and contoured with flexible discs (FlexiDiscs , Cosmedent, cosmedent.com).

Fig 9. Tooth No. 9 was prepared for its final restoration with the bonding technique utilized for tooth No. 8 described in Fig 7.

Fig 10. The lingual shelf shown here was created using a putty matrix built off of the original teeth. The resin used for this was an achromatic enamel in Milky White shade (Estelite Omega, Tokuyama, tokuyama-us.com).

Fig 11. Final layer of resin (Estelite Omega) was placed. For this, EB1 shade was chosen. This photograph was taken prior to any finishing or shaping

Fig 12. Completed Class IV resin restoration prior to removal of rubber dam, final polish, and occlusal adjustments. Shaping was completed in the same manner as described in Fig 8.

Fig 13. Final postoperative smile.

Fig 14. Final close-up, 1:1.5 magnification ratio, retracted view with black contraster.