Today, I want to talk about my step by step technique for repairing broken teeth! 

(Show the Lingual Stent) / (Clips of me Repairing the Teeth) / (Clips of me Talking)

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.  

So this lingual stent is incredibly useful at it allows me to predictably build up the back shell of the filling with ease. Once formed, I can start layering composite, using dentin shade for the body of the tooth & enamel shade for the outermost surface of the tooth. Your decision in layering & characterization ultimately stems from evaluation of the contralateral tooth to establish symmetry. Some teeth are polychromatic, some teeth have unique translucency properties in the incisal edge and others have unique color schemes.  Taking some time to notice these characterizations make a huge difference in the final results of the composite filling. In this video, I layer the tooth as if were monochromatic . I always leave a little room for the final composite layer in order to extend that layer over the entire restoration. One continuous layer makes for a smooth surface that can be polished quite easily. In this video, I use a wheel to blend out the restoration, but today, I would use a medium stiffness brush as it works better in my hands 

Now its time for our refinements. The natural contours of our teeth have an impact on how light reflects off the tooth which can truly transform a filling. This is why it is so important to fine tune the contours. Using a pencil to lightly mark the mesio-facial contours on this tooth helps me see where I need refine the restoration. I always start with a fine diamond for bulk cut back while small refinements are completed with a course red disc. I work this red disc till I have the contours exactly where I need them to be  in this video I use jiffy cups but today I would complete the polish with series of fine discs. To finalize the polish,  I use a series of polishing discs with aluminum oxide for a final glaze. In this video I use 

I hope this gives y’all an idea of what goes on in my head when sequencing anterior fillings. Eventually, I will get to a live video tutorial to show this process in real time. 

If you have any questions please feel free to leave them down in the comment section below. Thanks for your time!