Direct anterior restorations ◼ Class III. ◼ Class IV. ◼ Class V. ◼ Correction of orthodontic anomalies Reading of the colour: natural light ◼ Cervical area: dentin shade (enamel is thin, dentin core can be easily seen) By some authors – choice of dentin shade on canines (big dentine core) Enamel shade ◼ Around the defect, contralateral tooth, age Mammelons and opalescents Characterizations Enamel Dentin Mamelons Opalescebts Characterizations Desaturation Enamel shade Dentin shade Desaturation (loosing of the hue - saturation) Opalescence Preparation ◼ Diamonds – standard, fine, finishing with a soft rubber ◼ Removal of aprismatic enamel – mostly yes, in rare cases is not necesssary (e.g. diastema closure) Adhesive procedures ◼ Acid etching preferable - Large field of enamel! Good connection. Layering of composites ◼ Incremental technique no bulk fill composites! ◼ Flowables for good adaptation in some cases. ◼ Work with dentin, enamel and special cases ◼ Last layer covered with glycerine gel Finishing and polishing ◼ Various concepts ◼ Finishing: Extrafine diamonds (yellow) Rubber rotary instruments (prepolishing) Flexible discs (for „opening“ proximal surfaces – overcome between proximal and vestibular surface, optical width. Finishing and polishing ◼ Polishing with special brushes made of natural materiál in combination with diamond pastes – 3-5µm first, 1µm after. ◼ Polishing with special rotary instrument made of felt Third class Access: From the oral side From the vestibular side bevel Exposure of prismatic structure Good marginal adaptation Layering of composite materials Cleaning of tooth Preparation of cavity Acid etching Matrix – transparent strip, wooden wedge, bonding Layering Layering, polymerization Removal of matrix Finishing Prepolishing Polishing with the brush and diamond paste 3µm Polishing with the brush and diamond paste 1µm Polishing with a rotary instrument (felt) Final result Fourth class ◼ Caries ◼ Trauma Preparation of the margin lroubalikova@gmail.com 51 Making the shape Making the shape ◼ Position of the palatal wall ◼ Placement of the transparent strip ◼ Layering of the composite material Making the shape ◼ Position of the palatal wall lroubalikova@gmail.com 54 Silicone key Wax up lroubalikova@gmail.com 55 Silicone key Mock up Silicone key Creation the oral layer - palatally Location of incisal edge lroubalikova@gmail.com 65 66 68lroubalikova@gmail.com 6 years post op 10 years after the first tteatment lroubalikova@gmail.com 69 Finger method lroubalikova@gmail.com 70 lroubalikova@gmail.com 73 lroubalikova@gmail.com 74 Surface texture Correction of the shape cooperation with the orthodontists Complex approach ◼ Hygiene and cooperation ◼ Intermaxillary relations - Occlusion - Articulation ◼ Soft tissues Gingival hyperplasia lroubalikova@gmail.com 78 Gingival hyperplasia ◼ Improvement of oral hagiene ◼ Tooth brushing (Bass technique) ◼ Gingivoplasty Microdontia lroubalikova@gmail.com 81 lroubalikova@gmail.com 82 lroubalikova@gmail.com 83 lroubalikova@gmail.com 84 lroubalikova@gmail.com 85 lroubalikova@gmail.com 86 lroubalikova@gmail.com 87 lroubalikova@gmail.com 88 lroubalikova@gmail.com 90 Correction of the size and shape lroubalikova@gmail.com 94 lroubalikova@gmail.com 95 lroubalikova@gmail.com 96 Closure of spaces lroubalikova@gmail.com 99 lroubalikova@gmail.com 100 Pre op Mock up lroubalikova@gmail.com 101 Diastema closure ◼ Orthodontic approach ◼ Restorative approach ◼ Combination ◼ Frenectomy can be also performed lroubalikova@gmail.com 107 lroubalikova@gmail.com 108 lroubalikova@gmail.com 109 Periodontology ◼ Frenectomy ◼ Gingivoplasty ◼ Gingivectomy – elongation of the clinical crown ◼ Ostectomy – elongation of clinical crown lroubalikova@gmail.com 111 2 - 3 mm Biological width Epithelium attachement Connective tissue attachement lroubalikova@gmail.com Elongation of clinical crown lroubalikova@gmail.com 113 lroubalikova@gmail.com lroubalikova@gmail.com Elongation of clinical crown lroubalikova@gmail.com lroubalikova@gmail.com lroubalikova@gmail.com 120 Reattachement Reattachement ◼ 1. Check the fragment ◼ 2. Prepare the shallow groove around the defect in the tooth as well ae in the fragment ◼ 3. Use adhesive procedure ◼ 4. Attach using flowable and composite filling material Case report – complex approach ◼ Before the treatment Case report- complex approach ◼ After orthodontic therapy Case report – complex approach lenka.roubalikova@tiscali.cz 127 Final result Ceramic restoratio