Step by step Class IV restoration - composite layering with brush technique

In this video, we will show how to restore a Class IV restoration following a two-shade approach with Essentia universal composite resin from GC, making use of a silicone index. In the initial situation, the incisal third of tooth 11 is fractured. In a complex case, an initial study model can used for the planning; a wax-up is a good way to picture the end result; this can also be used to make a silicone index to transfer the desired shape to the mouth. Another option is to create the mock-up directly in the mouth. A mockup is an excellent way to picture the end result; the patient will also get a better image of the end result. The diagnostic wax-up can also be transferred to the mouth to make a mockup.
To create the index, a silicone putty can be used to copy the wax-up/mockup; in simple cases, where no wax-up/mockup has been made, it can be made in the mouth to copy the initial situation; the silicone can then be cut away to create the space for the composite restoration. After proper bonding with e.g. G-Premio Bond (note that Composite Primer is used on the model, but to bond to tooth substrate, an adhesive should be used), the palatal shell is created with a thin layer approximately 0.5 mm of enamel Essentia composite (shade LE was used in this case), using the silicone index as a mould. A flat, wetted GC Gradia brush is well suited to perfectly shape and adapt the composite layers. Note that for use in the mouth, it is recommended to use GC Modeling Liquid. After light-curing of the palatal shell, the index can be removed. Next, a matrix and wedges are placed to continue with the build-up of the proximal wall. Note that a posterior metal matrix was used here, because its curvature renders a nice and more natural result here. This will reduce the amount and time for finishing needed. Shade LE (light enamel) was used and adapted to the matrix with the composite brush to create the contact point. Observe the cervical half of the tooth to select the enamel shade. Next, the dentin was built up. In this case, Shade MD (medium dentin) was used; to select the dentin shade, observe the cervical portion of the teeth; also look at the naked dentin at the site of the fracture. A brush was used to smoothen and shape the body and with the probe, the mamelon effect was created at the incisal edge. Next, shade LE is again used to create the buccal enamel. With the brush technique, shaping and modeling is made easier, so little time is needed for the contouring and prepolishing procedures. In young teeth, secondary anatomy details and surface texture can be added with diamond burs, highlighting the lobes and depressions of the vestibular surface. The incisal edge of the contralateral tooth can be copied using fine-grit diamond pointed burs. Texture can be smoothed with coarse polishing disks and high gloss is obtained with fine silicone rubbers, felt disks and/or bristles. Epitex strips in different grit sizes can be used for proximal finishing. With Essentia universal composite resins from GC, a natural, high-end aesthetic result can be obtained in a predictable way. Using these tips and tricks, minimally invasive, aesthetic restorations are within the reach of every dentist.