Cavities found on the proximal surfaces of the anterior teeth involving the incisal angle

Types of ClassIV
True Class IV caries involving the incisal angle (mesioincisal or distoinicsal)

Non Classical Class IV fractured angle or abraded angle

Characteristics:
1. No definite outline form 2. 45 degrees bevel from CSM Purpose of bevel: - increase area of retention - to have room for material - to dissolve interprismatic substance and create microporosities - for good enamel-restoration interface

Areas not beveled:

1. Gingival floor enamel is thin and access is difficult, beveling may result in loss of retention form and difficulty in maintaining proximal contour during restoration. 2. Incisal area will result in a thin resin extension covering the bevel on an incisal edge where masticatory stress is often the highest and fracture is likely to occur. 3. Lingual area

Procedures:

1. Shade Selection

Shade Selection
Use natural lighting. Avoid staring at the tooth and shade guide for long periods of time ( May cause colors to blend resulting to loss of color acuity).

2. Cavity Preparation

3. Polishing and Cavity Debridement

Use of prophy paste WITHOUT fluoride

4. Application of Calcium Hydroxide (if necessary) or Type III GIC

Class A and Class B no need for base

Function of Liners and Bases: Serve as barrier to an irritating chemical in the restorative material applied during procedure Aid in the attainment of a healthy pulpal response * Prior to the next procedure, you are required to fit the preformed crown

5. Acid etching

Objectives:

All debris and pellicle remnants are removed from the surface to enhance adaptation of the resin Surface energy of the freshly etched enamel is altered, making the surface more reactive and improving the wettability of the polymer on enamel Acid solutions of suitable concentration cause dissolution of the exposed ends of enamel rods This dissolution creates surface irregularities that increase the roughness and provide a greater surface area upon which the polymer can attach.

6. Washing off acid etchant

Blot Drying with the use of cotton pellet

Remove etchant using air & water syringe.

7. Application of bonding agent


Gentle stream of air is used to remove excess bonding agent that pools in restricted areas of the preparation and to insure uniform thin layer on the entire surface

8. Incremental placement of composite

9. Curing

20 seconds per increment Factors of polymerization: Thickness of the increment Intensity of the light beam Translucency of the resin Number, size and distribution of filler particles

10. Trimming and polishing

11. Check Occlusion

Failure and replacement of Class IV restoration is most often associated with:

Color change or shade mismatch Excessive wear Loss of contour

Before

After

Before

After

Before

After