C HAPTER 10

A NTERIOR R ESTORATIONS
Choose a job you love and you will never have to work a day in your life.
Confucius

This chapter discusses the restorative treatment of • Safe-ended 40-µm straight-sided diamonds (eg,
Class III, Class IV, and Class V lesions with light- Brasseler Finishing Safe-Ended Flame 8859
cured composite. For each class, it outlines prepa- GKEF [fine]; Safe-Ended Flame 859 GKEF
ration design, restoration placement, and finishing. [extra fine], Brasseler Inc., Savannah, Georgia)
The procedures described minimize the problems
• Wood, plastic, or Cure-Thru wedge (Premier,
of voids and open margins often associated with
King of Prussia, Pennsylvania)
polymerization shrinkage.
• Small ball-ended applicator
The following armamentarium applies to all
three classes of lesion. Additional materials are • Interproximal carver and condenser
identified in the restorative treatment for each class
• Finishing discs (eg, Sof-Lex, 3M Dental Prod-
of lesion. The standard setup includes operator
ucts, St. Paul, Minnesota)
items, such as a gown, gloves, mask, and face
shield. Isolation materials include retraction cord, • Finishing cups (eg, One Gloss, Shofu Dental
rubber dam, interproximal wedges, and Mylar Corp., Menlo Park, California)
strips with a Mylar retention clip. Standard sup-
• Diamond metal strips (eg, GC Metal Strips 300
plies include anesthetic, a caries indicator, and
and 600 grit (GC America Inc., Chicago, Illi-
placement supplies, such as cotton forceps and
nois) or Premier Compo-strips)
placement brush. Instruments that are standard
include an explorer, mouth mirror, periodontal • Bard Parker No. 12 blade and handle
probe, small spoon excavator, and handpiece with
assorted cutting instruments. Standard equipment CLASS III RESTORATIONS
includes a curing light, radiometer, tooth dryer, air
When Class III preparations are surrounded by
and water syringes, suction mechanism, and color-
enamel, they are usually restored with a composite
corrected light source.
resin. In deeper restorations, a resin–ionomer liner
Anterior restoration materials include: can be used to replace the dentin portions of the
tooth. In shallower restorations, a dentin–resin
• Suitable liner
bonding agent is generally preferred to replace the
• Appropriate conditioning or etching liquids or gels dentin.
• Appropriate enamel and dentin primers with The rationale for using an internally placed
bonding agents glass ionomer is long-term sealing for reduced inci-
dence of caries or pulp death. With larger direct
• Pulp-capping material
resin restorations, a perfect seal is difficult to
Anterior restoration equipment includes: achieve and often impossible to maintain, provid-
ing access for caries development.
• Quarter- and half-round burs
In restorations involving dentin margins, which
• Round-ended preparation diamonds
are frequent in mature patients, a glass ionomer is
• Regular tapered and pointed 40-µm straight- often recommended for the entire restoration.
sided diamonds Some clinicians coat this restoration with a com-
184 Tooth-Colored Restoratives

posite resin immediately after placement to • No. 1 and No. 2 round-end diamonds (medium to
improve its durability. fine grit)
Restoring enamel-only lesions
Class III restorative treatment
The goal of composite resin dentistry is the con-
Class III restoration requires the following materi- servation of tooth structure. Since bonding allows
als in addition to the armamentarium prescribed at composite restorative retention without mechan-
the beginning of the chapter: ical undercuts, more conservative restorations are
• A radiopaque, agglomerated microfilled, submi- possible. If caries in a tooth can be removed with-
cron, or small-particle composite in compules, or out entering the dentin, no additional tooth
a material that can be loaded into a syringe. In reduction is necessary. This type of preparation
some clinical situations, an autoset composite or and restoration is illustrated in Figure 10–1.
resin-modified glass-ionomer restorative is best. Preparation of dentin-involved lesions
It would be ideal to place these materials with a Prior to rubber dam placement, clean the tooth
syringe. and select the appropriate shade of composite.

A B

C D

Figure 10–1. Typical Class III carious lesions treated with intra-enamel preparations: A, proximal view; B, lingual view; C, pre-
operative view; D, immediate postoperative view.
 Anterior Restorations 185

Outline. Make the initial entry with a small dia- bonding, use a trough undercut, usually at a depth
mond or new round bur. If the lesion is equidistant of a quarter-round bur, 0.5 mm inside the cemento-
between the facial and the lingual surfaces, using a enamel junction. The undercut should not be
lingual approach conserves labial tooth structure placed at the expense of the axial wall. Retention
and is generally more esthetic (Figure 10–2). If the is evaluated by seeing the tip of the explorer dis-
caries is mainly on the facial, a facial entry con- appear into these retention areas. If a trough devel-
serves tooth structure. ops during excavation of caries, the resulting
undercut may provide sufficient retention.
The outline form is dictated by the extent of
caries and is roughly defined with a rotary instru- Enamel etching. Clean the preparation of all
ment. If possible, maintain all or part of the prox- debris, making sure the enamel cavosurfaces are free
imal contact point. Since there is no “extension for of debris and base or liner. Place Mylar strips and
prevention” in composite preparations, caries in wedges to protect adjacent teeth from the etching
dentin is removed with a spoon excavator or a solutions. Isolate teeth and etch the enamel.
slow-speed bur. Using a caries indicator is highly
recommended. Placement of composite
Place a Mylar matrix and wedge. The Mylar strip
Use a flame-shaped finishing diamond (or fine contains the material, restores the proximal contact,
flame bur) to smooth the enamel walls and to and reduces flash. The wedge seals the gingival
round any unsupported enamel rods. Wherever margin, separates teeth to ensure proximal contact,
possible, bevel the cavosurface margins to a 45 pushes the proximal dam and tissue gingivally, and
degree angle and a width of 0.5 mm or more on the opens the gingival embrasure.
lingual surface (Figure 10–3).
Etch, rinse, and dry the enamel in the usual
Retention. Acid-etching the enamel provides ade-
fashion. Place a bonding agent. Wet the cavo-
quate retention for most restorations. In areas
surface margins by brushing on a bonding agent
where there is little or no exposed enamel for
as thinly and evenly as possible. Apply a stream
of air to spread the bonding agent in a thin layer,
and remove the excess. Polymerize.
Step 1. Place the composite with a composite
syringe and wedge it between the preparation and a
piece of Mylar (Figure 10–4).
Step 2. Pack the composite into the prepara-
tion with a condenser; score the edges with a
carver.
Step 3. Pull the Mylar strip slowly through the
contact to adapt the composite to the facial wall of
the preparation.
Step 4. Remove the Mylar swiftly, with a quick
snap. If the composite comes out with the Mylar,
the composite either was too soft or had more sur-
face area on the Mylar than on the tooth.
Step 5. Using an interproximal carver, remove
Figure 10–2. Schematic representation of the correct angled any excess composite, and cure (40 seconds at
approach of the cutting instrument when making a Class III 400 mW/cm2 if EOP = 16 joules).
preparation. Angling preserves lingual tooth structure. The
straight approach weakens the tooth and places more com- Step 6. Place another Mylar strip and inject
posite in function. composite from a syringe tip to fill the remaining
186 Tooth-Colored Restoratives

A B

C D

Figure 10–3. Typical Class III carious lesions treated with dentin–enamel preparations: A, proximal view; B, lingual view; C,
preoperative view; D, immediate postoperative view.

area of the preparation. (Preparations with dentin such as interproximal spaces. The contact area can
involvement should be filled in at least two light- be tightened by pressing the composite from buc-
cured layers, as described here.) cal and lingual.
Step 7. Pack the composite into the prepara- Large preparations involving dentin require
tion with an interproximal carver. multiple (more than two) layers of composite to
control polymerization shrinkage (Figure 10–5).
Step 8. Pull the Mylar strip slowly through the
contact to adapt the composite to the facial wall of Finishing and polishing
the preparation.
Step 1. Remove proximal flash with a sharp
Step 9. Remove the Mylar swiftly, with a quick hand instrument or a No. 12 or No. 15 Bard
snap. Parker blade.
Step 10. Remove any excess composite and Step 2. Use fine diamonds for gross reduction.
completely contour the composite. Care should be Also use a lubricant to reduce heat and friction.
taken to remove excess in difficult-to-reach areas, Overzealous gross reduction of composite can result
 Anterior Restorations 187
1: Inject Composite and Pack 6: Replace Mylar, Inject More Composite and Pack

7: Shape and Remove Excess Composite

2: Shape Composite

Pack

8: Pull Mylar Slowly to Adapt

3: Pull Mylar Slowly to Adapt

Slowly

Peel
from mylar
Peel
from mylar

9: Remove Mylar Quickly

and Then Establish Contact

4: Remove Mylar Fast

Fast

10: Carefully Contour and then Cure

5: Remove Excess, Cure

Cure

Cure

Figure 10–4. The procedure for treatment of a medium-size Class III preparation involving dentin. Two increments of light-
cured composite are layered and contoured to create the restoration.
188 Tooth-Colored Restoratives

Yes

3
2
1

Figure 10–5. Treatment of a large Class III lesion requires at least No

three layers of composite to minimize polymerization shrinkage.

in interfacial composite fractures and white line mar-

gins. These can weaken the restoration.
Step 3. When approaching the margins, use
only micron diamonds, white stones, or flexible
discs, with copious water spray. Finishing strips Figure 10–6. Correct use of a proximal strip to finish a Class
may be used at the proximal margins. III restoration involves pulling the strip through in an S-
shaped pattern to maintain the contact point (top). Pulling
Step 4. Finish with a proximal strip (Figure 10–6). the strip from the same side tends to open the proximal con-
tact point (bottom).
It is common practice to remove all unsupported
enamel in dental preparations. By bonding com-
posite, however, unsupported enamel can be two composite resins: a stiff internal material for
retained (Figure 10–7). The procedure involves support (such as a heavily filled hybrid) to increase
bonding a stiff composite to the lingual surface of stiffness and reduce fracture from cyclic fatigue,
the enamel to support it as the dentin once did. The and a small-particle material (such as a microfilled
incisal edge is minimally affected. Once the restora- or submicron composite) to provide the outer con-
tion is completed, care must be taken to avoid tour and finish.
occlusal contact over the composite supporting the
enamel, since composite flexure can cause cracks in
the enamel. A great amount of enamel can be pre-
served with this technique, which also results in
better esthetics and longevity (Figure 10–8).

CLASS IV RESTORATIONS
When Class IV preparations are surrounded by
enamel, they are usually restored with a composite
resin. In deeper restorations, a resin–ionomer liner
can be used to protect the dentin portions of the
tooth. In shallower restorations, a dentin–resin
bonding agent is generally preferred to replace the
dentin.
When treating larger Class IV restorations with Figure 10–7. A completed Class III preparation with exten-
direct resin restoratives, it is often preferrable to use sive caries removal and intact facial enamel.
 Anterior Restorations 189

Figure 10–8. A, Preoperative view of multiple large Class III lesions with extensive dentin involvement. B, Immediate postoper-
ative view. Note the high esthetics possible by retaining facial enamel.

A bonded porcelain restoration should be con- increase the color-match and esthetic outcome
sidered for restorations that are large and have no (Figure 10–10).
remaining enamel in the incisal edge or contact
Chamfer design. Prepare a chamfer 1-mm long
areas.
(or half the length of the fracture) to half the
Class IV restorative treatment depth of the enamel on the labial and lingual sur-
face. This type of preparation results in the most
The standard setup and supplies required are
durable restorative margins (Figures 10–9, B, and
listed at the beginning of the chapter. Specific
10–11). It is important that the chamfer is cut only
additional materials needed for Class IV restora-
halfway through the enamel surface (Figure
tions include:
10–12). Horizontal and vertical lines are easily
• A light-cured submicron or small-particle com- hidden in anatomy, whereas oblique lines conflict
posite in a tube, or a material that can be shaped with natural anatomy and surface texture and are,
without slumping. In some clinical situations, a therefore, more visible. Stair-stepping the labial
heavily filled composite is used as a core. Some enamel with a good chamfer cavosurface margin
operators prefer to use a microfilled composite as into the tooth anatomy helps achieve a good
the final surface material for these restorations. esthetic result (Figure 10–13).
• A bullet-shaped chamfer diamond Beveled margins. An alternative to a stair-step
chamfer design is to prepare a 2- to 3-mm bevel
Preparations
in place of a chamfer (Figures 10–9, C, 10–14,
Decide on the tooth shade prior to rubber dam
and 10–15). This bevel creates a gradual change of
placement. Anesthesia is often unnecessary for
color from the tooth to the restoration. Although
small fractures where the preparation is limited to
the beveled margin is not as durable as a chamfer,
enamel. Larger fractures with exposed dentin may
beveled preparations usually provide more consis-
be sensitive to air, cold water, and bur vibration
tent esthetic results. Scalloping the labial enamel
and often require anesthesia. Determine the tooth
with a beveled cavosurface margin is less impor-
shade, then place a rubber dam and clean the
tant in achieving an esthetic result. It is best to fin-
tooth with pumice and water.
ish these bevels in a curve, going from horizontal
Outline. These preparations are appropriate for to facial (Figure 10–16). The major problem
fractures that run one-third to two-thirds of the encountered at recall with beveled margins is
incisal edge, which often expose dentin. Typical chipping.
Class IV fractures are illustrated in Figure 10–9, A.
Enamel conditioning. Clean the preparation of all
Most anterior teeth have horizontal and vertical debris. Make sure the enamel cavosurfaces are clean
grooves that can be used to hide the margins and of any dentin lining materials. After protecting the
190 Tooth-Colored Restoratives

Typical Class IV fractures Chamfer preparations Beveled preparations

A B C

Figure 10–9. Facial views of A, typical Class IV fractures, B, typical outline forms used in chamfer Class IV preparations, and
C, typical outline forms used in beveled Class IV preparations.

adjacent teeth with a Mylar strip, etch with acid

using an enamel–resin bonding technique. This
technique usually involves a 20-second etch of the
enamel and a 10-second (or less) etch of the dentin,
rinsing for a minimum of 5 seconds, then drying
according to the manufacturer’s recommendation
for the specific bonding agent.

Composite placement
Prepare, etch, and dry the tooth; add bonding
Oblique Bevel Stair
agent, and cure. Place a Mylar strip. Place and form
the composite in a minimum of three increments, Figure 10–10. A facial view of the horizontal and vertical
each 1- to 2-mm thick (Figure 10–17). For the first grooves that can be used to hide Class IV preparation mar-
layer, the composite core, use a heavily filled ma- gins and increase color-match and esthetic outcome.
 Anterior Restorations 191

A B

C D

Figure 10–11. Four views of the typical chamfered Class IV preparation in which the margins are kept in the horizontal, and
the vertical anatomic forms of the tooth are used to help hide the margins.

terial. Form it to the proper contour with Mylar, Step 2. Shape the composite core by slowly
an interproximal carver, and an explorer. Remove pulling the Mylar through to wrap the composite
the excess material from the gingival and proximal to the lingual, which draws the composite around
areas with an explorer. Polymerize for a minimum the tooth.
of 40 seconds on each side. For darker shades,
Step 3. Polymerize the composite core.
polymerize for 60 seconds on each side (for ma-
terials with an EOP of 16 joules.) Step 4. Place the contouring layer, using a sub-
micron material.
Step 1. Place the composite core, using a heav-
ily fill material. Wedge the composite between the Step 5. Slowly pull the Mylar strip through to
Mylar strip and tooth fracture. wrap composite to the lingual.
192 Tooth-Colored Restoratives

than 2 mm thick, and cure after each addition.

The final layer should be contoured and shaped
until it closely resembles the desired shape of the
tooth, and then polymerized.

Figure 10–12. A facial-lingual cross-sectional view of a com-

pleted chamfered Class IV restoration.

Step 6. Separate the composite from the Mylar

strip, and contour. Remove the strip quickly.
Step 7. Polymerize for a minimum of 40
seconds on each side (60 seconds for darker
shades). A
Step 8. Replace the Mylar strip. Add a final
layer of composite, and contour. Slowly pull the
Mylar strip through to wrap composite to the
lingual. Pull the Mylar strip through rapidly to sep-
arate the strip from the composite. Remove the
strip.
Step 9. Remove excess composite and carefully
contour.
Step 10. Polymerize for a minimum of 40
seconds on each side (60 seconds for darker
shades).
Step 11. When set, check for voids and excess B
material. Repair any voids.
Step 12. Wait 10 minutes after the last addition
of composite before contouring the restoration.
Most composites do not cure thoroughly if
built to a thickness greater than 2 mm. If the
thickness of the fracture is in excess of 4 mm
across the center of the restoration (from labial to
lingual), the central area will be more than 2 mm
from the surface. In this situation, multiple place-
ment steps are necessary. Without the crown form
in place, add and cure a central core of composite
within 2 mm of the final surface of the restoration. C
After this addition, a crown form can be used for
composite final placement. If a crown form is not Figure 10–13. Chamfer design: A, Preoperative view; B,
being used, add the composite in layers with a completed preparation; note stair-stepping; and C, immedi-
plastic instrument. Make sure each layer is less ate postoperative view.
 Anterior Restorations 193

Finishing
Step 1. Remove flash with a sharp hand
instrument or a No. 15 Bard Parker blade.
Step 2. Use fine diamonds for gross reduction.
Also use a lubricant to reduce heat and friction.
Step 3. When approaching the margins, use
only micron diamonds or flexible discs. A fin-
Figure 10–14. A facial-lingual cross-sectional view of a com- ishing strip is a good alternative at the proximal
pleted beveled Class IV restoration. margins.

A B

C D

Figure 10–15. Four facial views of typical beveled Class IV preparations that can be used to hide the margins by gradually blend-
ing into the tooth surface.
194 Tooth-Colored Restoratives

A B

C D

Figure 10–16. Bevel design: A, preoperative view; B, com-

pleted preparation; C, immediate postoperative view; D, six-
month postoperative view; and E, fracture at 21/2 years post-
operative, owing to fatigue and occlusal trauma.

surface with a microfilled resin. If a full veneer is

required, finish the resin away from tissue. In any
case, finish it proximally just short of the contact
(Figure 10–18).
E
CLASS V RESTORATIONS
As with Class IV restorations, when Class V prepa-
rations are surrounded by enamel, they are usually
Step 4. When using a microfill or submicron restored with a composite resin. In deeper restora-
particle composite, rubber composite finishing tions, a resin–ionomer liner is recommended to
cups and aluminum oxide pastes may be used to replace the dentin portion of the tooth. In shal-
place the final finish. Occlusion plays an impor- lower restorations, a dentin–resin bonding agent is
tant role in the longevity of a restoration. The generally preferred to replace the dentin.
restoration should be in light occlusion (espe-
cially protrusive), since composites expand slightly Again, a glass ionomer is recommended with
over time. larger restorations because an adequate seal is dif-
ficult to achieve and often impossible to maintain,
Microfilled veneer thereby providing access for caries development.
When it proves difficult to match a composite to The glass ionomer provides long-term sealing and
the tooth, one solution is to veneer the restoration reduction in caries or pulp death. In restorations
 Anterior Restorations 195

Remove any excess

Figure 10–17. The procedure for treatment of a Class IV preparation involving dentin. Three increments of light-cured com-
posite are layered and contoured to create the restoration.
196 Tooth-Colored Restoratives

A B

C D

E F
 Anterior Restorations 197

G H

Figure 10–18. Large Class IV with discoloration owing to previous restoration with a metal pin. A, Preoperative facial view. B, Pre-
operative incisal view. C, Facial portion of restoration, prepared. Note severe discoloration from metal pin. D, Radiograph show-
ing pin position. E, Postoperative facial view. F, Postoperative incisal view. G, Preoperative facial view. H, Postoperative facial view.

involving dentin margins, common with Class V retention without mechanical undercuts. If it is
lesions, a glass ionomer is often recommended for possible to totally remove caries without entering
the entire restoration. Some clinicians coat the the dentin, no additional tooth reduction is nec-
restoration with a resin glaze to improve the seal. essary; the composite is bonded to the remaining
enamel. This type of preparation is illustrated in
Class V restorative treatment Figure 10–19.
Specific materials needed for Class V restorations,
Preparation for dentin-involved caries
in addition to the standard setup and materials
Prior to rubber dam placement, pumice the tooth
identified at the beginning of the chapter, include:
and select the appropriate shade of composite.
• A restorative, such as a light-cured glass ionomer Anesthetize for sensitive or deep lesions.
or a composite with dentin bonding
Outline. Make the initial entry with a medium-
• No. 1 and No. 2 round-end diamonds (medium grit, small, round diamond. Keep the diamond
to fine grit) perpendicular to the enamel surface. The ideal
depth is the minimum depth to remove caries. The
• Cure-Thru cervical matrix
outline is determined by the caries present. Remove
Caries in enamel only only carious tooth structure. The ideal preparation,
The goal of composite resin dentistry is conserva- viewed from the facial, should have rounded line
tion of tooth structure. Bonding composite allows angles (Figure 10–20).
198 Tooth-Colored Restoratives

A B

C D Figure 10–20. Typical Class V preparation.

Figure 10–19. A typical Class V carious lesion in enamel
only: A, frontal view, B, cross-section, C, close-up view and
D, a typical intra-enamel preparation for this lesion.

In the event of pulp exposure, dry and apply a

Use a flame-shaped finishing bur or diamond calcium hydroxide liner over the exposed pulp.
to bevel the enamel cavosurface margins to Cover this with a glass-ionomer liner.
achieve a 45-degree exit angle for the composite Dentin bonding agents. If dentin bonding agents
in the final restoration. A width of 0.5 mm is usu- are to be used, limit the base to the deep areas of
ally adequate. If the gingival margin is in dentin, the exposed dentin. A base is unneccessary for
leave a 90-degree exit. maximum dentin bonding in shallow preparations.
Retention. Figure 10–21 illustrates a typical Enamel conditioning. Acid etch the enamel with
dentin–enamel preparation in the cervical area of a gel etchant. Rinse with water and dry thoroughly
an incisor. The portion of the preparation that is in with air.
dentin needs additional retention. Make a 0.5-mm
groove inside the cementodentin junction with a Polymerization shrinkage considerations
quarter-round bur (Figure 10–22); place it 0.5 mm Composite shrinkage upon polymerization is a
deep (or to 100% of the cutting flutes of the bur). problem in larger preparations, especially when a
It should not be placed at the expense of the axial preparation has both enamel and dentin margins.
wall. Figure 10–23 shows a typical clinical applica- One-phase addition. In small preparations that
tion of a Class V restoration with a gingival groove. have margins entirely in enamel, the restorative con-
Pulpal protection. In deeper restorations, a glass- tracts away from the axial wall (Figure 10–24). This
ionomer liner is usually placed on the axial wall is called a contraction gap. Larger restorations may
over the dentin that leads to the pulp. In deep show white lines (or open margins) and should be
preparations that extend within 0.5 mm of the filled in two steps to minimize the contraction gap.
pulp, place a thin liner of calcium hydroxide (eg, When dentin margins are involved, the one-step
Life, Kerr, Romulus, Michigan or Dycal, LD placement technique often results in an open dentin
Caulk/Dentsply, Milford, Delaware) just over the margin (Figure 10–25). The opening of the dentin
exposure or near the exposure and then cover it margin is reduced but not eliminated with the use
with a glass-ionomer liner. of dentin bonding agents. Because the enamel–resin
 Anterior Restorations 199

A Retention groove
placed here

Retention
Groove Enamel
Bevel

Facial View

Figure 10–22. A, Cross-sectional and close-up views and, B,

facial view of placement of a retention groove just inside the
C cavosurface margin of a Class V preparation for dentin bond-
ing of composite.

layers is recommended to minimize opening of the

dentin margin. The multilayer technique for a
moderate size Class V preparation is illustrated in
Figure 10–26.
Step 1. Place composite in the upper half of the
Retention preparation and contour with an interproximal
D groove carver. Cure.
Figure 10–21. A typical carious lesion, A, front view, B, cross- Step 2. Add a second layer of composite to
section, C, close-up view; and D, the preparation outline for cover from the first layer to just short of the reten-
a Class V restoration involving enamel and dentin. tion groove. Cure.
Step 3. Add a third layer of composite to fill in
bond is usually greater than the dentin–resin bond, the retention groove and add the surface layer.
the dentin margin fails first as the composite shrinks. Cure.
Multiphase additions. Because composite resins Step 4. Finish the margins with a safe-end
shrink, filling preparations in multiple steps or diamond.
200 Tooth-Colored Restoratives

Contraction
gap space

C
Figure 10–24. A facial-lingual cross-sectional view showing the
contraction gap resulting from one-phase technique in a Class
V restoration with all-enamel margins: A, finished preparation;
B, single layer pre-cure; and C, single layer post-cure. This type
of contraction gap is not desirable but is acceptable.
C
addition. This change of color is natural in the
gingival third of many teeth.
Figure 10–23. A, Preoperative view. B, Completed prepara-
tion of a Class V restoration with a gingival groove. C, Com- Composite placement
posite buildup, done in three layers. The following technique is for preparations com-
pletely surrounded by etched enamel.
Step 5. Smooth and polish the surface with Step 1. Control moisture with retraction cord,
rubber cups. suction, or a rubber dam.
Note how the multiphase placement technique Step 2. Wet the etched enamel margins with a
effectively reduces the impact of polymerization bonding agent as thinly and evenly as possible.
shrinkage (contraction gap) on the dentin margin. With an air syringe, apply a stream of air to the
To improve esthetics, use a darker shade for the preparation to spread the bonding agent in a thin
dentin addition and a lighter shade for the enamel layer; remove excess, and polymerize.
 Anterior Restorations 201

Retention
groove

Cu
re
1 Be
eveled
E
Enamel

A Retention
Groove

A Dentin Gingiva

Cu
re
B
B

Cu
re
Contraction 1
gap space

C
C

Figure 10–25. A facial-lingual cross-sectional view showing

the contraction gap resulting from one-phase technique in a
Class V restoration with dentin–enamel margins: A, fin-
ished preparation; B, single layer pre-cure; and C, single layer
post-cure. This type of contraction gap is not acceptable.
Safe
End

Figure 10–26. The recommended multiphase procedure for

treatment of a Class V lesion with enamel and dentin mar-
gins: A, first layer cured; B, second layer cured; C, third layer
cured; D, finishing; and E, polishing. A contraction gap is less
likely to occur with multilayer placement of composite.
Composite is always placed and cured on the enamel first.
Rubber
Cup
E
202 Tooth-Colored Restoratives

Step 3. Place the composite, using a plastic Step 2. Use fine diamonds for gross reduction.
instrument or a composite syringe. For restorations Special straight-sided diamonds with safe-cut tips
more than 1-mm thick, add composite in 1-mm help avoid ditching the dentin. Use water as a
increments and cure each increment for the appro- lubricant to reduce heat and friction when gross
priate time. reduction is needed.
Pre-polymerization contouring Step 3. When approaching the margins, use
Pre-polymerization contouring is an alternative to only micron diamonds (ideally with safe-cut tips)
the Class V matrix. To use this option, shape and or flexible discs. Finishing strips may be used at the
sculpt the composite with a fine explorer. Com- proximal margins.
pletely remove the excess on the margins and shape
Step 4. When using a microfill or submicron
to ideal contour and smoothness prior to curing.
particle composite, rubber composite finishing
Finishing and Polishing cups and aluminum oxide pastes may be used to
Step 1. Remove flash with a sharp hand instru- place the final finish.
ment or a No. 12 or No. 15 Bard Parker blade.