Operative Dentistry · Self-Learning
Reviewed: 07/22/2021 · Valid until 07/22/2024
This video will clearly show the step by step technique when performing Class IV composite restoration. Dr. Sami Shahhal reviews how to use a putty matrix system to fabricate the lingual shelf for this Class 4 composite filling. His high quality videography is meant to help dentists and dental students visualize the procedure. Dental fillings to repair broken anterior teeth can be difficult to perform in the office. Good Luck!
Sami Shahhal graduated from the UCLA School of Dentistry. He currently practices as a general and cosmetic dentist in San Diego, California. Today, I want to talk about my step by step technique for repairing broken teeth!
Restoring broken teeth with composite resin is by far one of my favorite procedure to perform in office but can also be one of the most technically challenging to do right. (Photos of before/after images). Last year, I made a video giving a visual of this procedure but failed to describe the reason behind the technique. In this video, I want to go into more detail about the sequence of repairing anterior teeth & share a few tips/tricks I use to achieve an awesome result.
So let’s break it down
The first concept we need to talk about involves bonding. Bond strength of composite resin to the patients natural teeth is critical for the long - lasting prognosis of these teeth. Unfortunately, fractured teeth doesn’t give the the dentist much retentive features to lock the filling in place. So we need to do everything in our power to increase the bond strength with our physical & chemical preparation design.
To start off, I roughen the enamel surface of the tooth up with a medium grit diamond bur in a star shaped pattern. This 2-3 mm patterned bevel microscopically increases surface area of the tooth which allows for greater adhesion. I gradually fade out the preparation to the periphery because it helps establish a seamless transition from natural tooth to the filling. If this bevel is too short or doesn’t fade out appropriately then you will be able to distinguish where the filling begins and ends.
Next, we need to chemically prepare the tooth. A 35% phosphoric acid etchant helps with adhesion by creating a porous retentive surface on the tooth. I extend the etchant beyond the margins to once again facilitate the seamless transition from tooth to composite resin. The white teflon tape protects the adjacent teeth from this potent chemical. If you don’t have a teflon tape or mylar strip to protect the adjacent tooth, this chemical can extend to the surface and create post operative sensitivity. After a firm wash & dry, you will notice that the etched enamel appears frosty. This is a good way to tell if the surface was etched for a long enough time. Next, I paint on my bonding agent with a brush. I apply multiple layers to ensure that the porous enamel saturated with bond. However, it is important to thin this agent out because it can interfere with the adhesion of the composite resin to the tooth. After curing the bonding agent we can move on to the artistry of composite layering. I begin every class IV restoration with the formation of a palatal shelf. In this case, I have a prefabricated putty to help form the lingual shelf. & I know many of you are probably thinking how would you have the available if the patient came in with a fracture. Well, it simply involves a semi rigid putty matrix and using a bur to cut back to the desired incised length. & I will def make a video showing how to create a lingual index if anyone is interested. in fact, leave a comment down below if thats something you would want to see.
San Diego Dentistry is a YouTube Channel dedicated to dental education. The purpose of this channel is to educate dental patients on dental instruments, materials, & how to maintain healthy teeth for the rest of their lifetime. Dr. Sami I. Shahhal, graduated from UCLA & practices in the Greater San Diego Community. Please feel free to give us comments on what topics interest you regarding all aspects of dentistry. We hope you use this channel to make educated decisions regarding your dental health
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