Class IV Composite Filling Tutorial | Front Tooth Filling

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!
Dental Materials (As Seen in Video) -
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Ivoclar Vivadent Virtual Putty - ebay.to/2TY5oUG
Strident USA Typodont - ebay.to/2FDJp2g
3M Filtek Supreme Ultra - ebay.to/2RD9YLf
Teflon Tape - amzn.to/2FMXhXh
Videography (How I Shoot My Videos) -
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Nikon D7100 - amzn.to/2CB1pGz
Macro Lens - amzn.to/2CAYJsD
Rode Microphone - amzn.to/2MkcYX6
Yeti Microphone - amzn.to/2sFt2cQ
Please make sure to adequately research any product if purchasing online. I personally go directly through the company when purchasing any dental product.
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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.

[@SmileInfluencers]

Rubberdam Course (Affiliate)- bit.ly/2BJ31kQ Exclusive Content for Dentists & Students - www.patreon.com/smileinfluencers

[@davidci5529]

Călin Pop!

[@denthf9408]

@@davidci5529 What is the name of the piece you used for the blue tooth measurement at 2.39 minutes in the video? kzbin.info/www/bejne/p32ufpt-bcp2rZo

[@usmale47374]

I'm neither a dentist nor a dental student, but this presentation is fascinating. I've never broken a tooth, but would consider this video to be both enlightening and helpful if I ever did.

[@SmileInfluencers]

That’s so kind of you! I never know whether to address patient or doctors but I’m so happy that you enjoyed it!!

[@selenakylie111]

Thanks for the educational videos. I’ve been looking all day for professional videos and came upon yours. Great job on explaining the dental process.

[@SmileInfluencers]

thank you!

[@MrDentist]

Great job 👏🏻

[@josephinequinosa4754]

i love you dr sammy!

[@SandeepKumar-hk5sr]

Thanks for this information 👍

[@stacicumming6461]

I'm a newly qualified dental therapist and I really struggle with anterior composite build ups for fractured teeth - mainly because I don't have access to any sort of putty matrix to build the palatal wall from. At university, we were very briefly taught on anterior composite and were always taught to do them free hand. I'd love to see a video on how to build a palatal wall free handed! This video was great, very intricate and informative!

[@SmileInfluencers]

Absolutely! In all honesty, I do half of my composite resin fillings building the lingual wall freehand ... the trick is to take an appropriately sized Mylar, place in between the teeth, take your non-dominant finger and wrap the Mylar towards the lingual of the tooth and hold your finger just below the preparation site as to not cause an unwanted indentation in the filling. After preparing the tooth chemically with enchant and bonding, you would shoot the composite resin into the “fractured site” while still holding the Mylar with the non dominant hand and then use a plastic instrument to form the lingual wall while the composite is still pliable. Get it as close to accurate as possible and cure!

[@SmileInfluencers]

Staci Cumming my explanation may be super confusing & I will try to make a video showing how I do this in the next couple weeks! Please let me know if you have any other video 💡 ideas

[@SmileInfluencers]

kzbin.info/www/bejne/ponSgWpqh8x3eLs this video is dedicated to you

[@yuniaaliaga5176]

Interesting, Thank you.

[@keerthithambu5140]

Great explanation sir

[@vanessagram4419]

Really informative video!! I’d love to see how you make a lingual index for fractured teeth as this is something I really struggle with , I’d love to see how you do it!

[@SmileInfluencers]

Absolutely! Second person who asked for that so I have to do it. 😁

[@SmileInfluencers]

This lingual index video - kzbin.info/www/bejne/ponSgWpqh8x3eLs

[@vanessagram4419]

Thank you so so much for making this! Will watch ASAP!🙏🏽

[@eranovillanueva7968]

What would you recommend to an incissors chipped up to the gum line? Mine had undergone root canal and became brittle overtime causing it to fracture up to the gum line. Thanks in advance!

[@alexmartian3972]

I had my crushed front tooth "side angle" restored with filling and it lasted for like 15 years. During restoration emphasis was made for enabling me to bite apples not looking most naturally - the horizontal edge was restored not parallel to remaining line but at slight angle so that during biting pressure was almost all on natural remaining part. Do many patient except such tradeoff?

[@iTzCorey]

So is this a filling or dental bonding? i was booked in to see a specialist who does composite bonding to fix a groove/dent on my incisor but she sent me back to my dentist so i'm assuming he will use a filling as he doesn't do bonding.

[@vritantsharma1295]

Nice tech sir i will also apply in my clinic.

[@jaysonugat9598]

Hello sir! Do you fill up the tooth without grinding it.

[@faribashafaei6420]

Fine 👍

[@sherafati]

Ia the bevel fully covered with the dentin shade composite or just partially?

[@faribashafaei6420]

Thanks

[@DrGregAsatrian]

Still got to do that collab on lateral build-ups!

[@SmileInfluencers]

Braces Explained yes sir

[@LucidTactics]

The main issue with anterior fillings is that they tend to not last long. You mention the bonding procedures but many dentists if have spoken with have indicated that even with good bonding, anterior fillings dont tend to last. As an engineer, one thought that I have is that if the composite material is very stiff the load will likely propagate through the filling until it reaches a specific point on the tooth, that small point will end up taking very high loads. If there could be a smaller less stiff layer between the tooth and the filling (it could still be rather stiff just a good bit less stiff than the resin), then the load would compress the material where the load path from the filling first propagates down, then as that compresses, the load would travel through other parts of the filling to other parts of the tooth surface. (basically allowing the entire bond of the tooth to take the load from a hard bite rather than a a tiny area. Not sure if there are good candidate resins for a two part bonding system systems though with a less stiff initial coat)

[@SmileInfluencers]

Well said. There are other things to consider like “c-factor” which represents the amount of layering we do when we fabricate these fillings. Each time we cure the composite resin a certain level of shrinkage occurs; accordingly, it’s important to incrementally fill and cure the resin to establish a stronger longer lasting bonding to the tooth. Another thing to consider is parafunctional habits ( grinding forward side to side ) and making sure that there is an even distribution of forces so that you don’t apply all that force to the filling and break it! Thanks for watching

[@BatMan-wm1in]

شكرا جزيلا

[@rics009]

What did you use for polishing?

[@radheyshyam8721]

can i ask a question?...pls sir yesterday i got my cavity filled it was similar to this ..b/w the front 2 incisors a small cavity was there and behind tooth also a small cavity was there..my doctor filled both the cavities.The thing is front filling feels very smooth no problem at all but the filling behind is quite rough..when i touch it with finget i cannot feel any roughness but with tongue i can feel it a rough a lot.what should i do? the filling was composite filling.

[@yanoevy1634]

Sir what is the name of the instrument used to blend composite in 3:40 ?

[@stevenlu8570]

Good info

[@SmileInfluencers]

Steven Lu thanks bruh

[@Indra_Prince]

How long composite filling last ? For Front teeth lower ?

[@yanniskettane5052]

Keep going men ! i am a french student and you videos are really helpfull, everytime i have trouble visualizing a theorical lesson

[@SmileInfluencers]

I’m glad you enjoy the content! Please let me know if there is anything you would like to see next! Enjoy!

[@SmileInfluencers]

Yannis! Check out the lingual stent vid kzbin.info/www/bejne/ponSgWpqh8x3eLs

[@landofmilkchillies5832]

So when you beveling you also roughen the surface and you have jagged like spaced pattern to increase retention.

[@bogdandjukic3193]

Do you use matrices or only teflon tape? Great video, by the way!

[@SmileInfluencers]

That is brother. I use both depending on the situation. Sometimes I use Teflon if I need to establish a strong contact and the matrix isn’t able to be secured properly. Other times I use the matrixes. I need to make a video on different scenarios and how to select the proper tool for the job

[@inhtinhoangnguyen2551]

Thank you for your great video! It's very easy to understand and you're thoughtful, too. Can you write the materials that you've used in description, please?

[@SmileInfluencers]

That’s incredibly kind of you! Let me make sure I have accurately accounted for all material in the video & I will let you know once I’ve updated my description! Thanks!

[@inhtinhoangnguyen2551]

@@SmileInfluencers Thank you very much! You're doing a awesome work. Hope to see another great videos soon.

[@inhtinhoangnguyen2551]

Which's brand of instrument that you use to polish?

[@SmileInfluencers]

Đình Tín Hoàng Nguyễn so you can use the Flexi discs or jiffy cups for final polishing. I personally prefer the Flexi discs for polishing starting with the most course and moving your way down to the finest iterations aluminum oxide mixed with water helps me with the final polish; hope that helps

[@inhtinhoangnguyen2551]

@@SmileInfluencers thank u very much!

[@christopherbebeau3357]

noice!!!

[@Ahuromazda]

Plz make a video about the lingual Index!!!

[@positivevibes7425]

Aren't u gonna bevel the palatal surface of tooth? And do u etch a d put bond on Palatal surface of tooth?

[@drolisvlog7591]

How to get prefabricated putty index Dr?

[@legsday.5611]

Sr ,is composite filling a permanent soln...?

[@gerald9992]

Hope I'm able to get a reply from you. I have an anterior tooth that's chopped in half (diagonally), similar to the one you used for your explanation. I'm done with root canal treatment and I'm lost between getting a composite filling or a crown. Please which is better??.

[@SmileInfluencers]

A root canal treated tooth tends to discolor over time so I personally would place a crown on it depending on the amount of healthy structure and the extent of the fracture. It is also possible to do a filling which is more conservative and transitioning to a crown at a later time. Once again I don’t know you’re case but things to consider when reviewing your options with your dentist

[@user-ou3nh5hb7w]

I would like to make another video about lingual index

[@SmileInfluencers]

Najwa Bashammakh for you - kzbin.info/www/bejne/ponSgWpqh8x3eLs

[@thetoothfixer8509]

same!

[@lpg5350]

What do I do if my composite resin sticks to my instrument whilst I am placing a filling?

[@SmileInfluencers]

Wetting resin will help with that

[@mikaelamendoza8374]

So I have a chipped front tooth same type of chip and the example teeth but mine is even smaller (Slimmer) I’ve always wanted this done because I didn’t want veneers but my dentist said he could only do this but in a temporary way because of the way my tooth was chipped🤔, so should I go a cosmetic dentistry for this

[@SmileInfluencers]

Have an open & honest conversation with your dentist about what she/he means by temporary procedure. They may mean to do this exact procedure (composite resin filling) as a means of restoring the broken tooth & if the restoration fails then move on to a more permanent solution like a porcelain veneer. Class IV Composite Resin Bonding has been proven to be long lasting but it depends on a variety of factors including bond strength, occlusion, patient habits . . . etc. I feel as though you should communicate with your dentist to be clear on what are all the treatment options & then weigh some of the risks, benefits, etc. . . Hope that helps!

[@katefoucart1033]

@@SmileInfluencers Hi I was wondering, what is the difference between (Composite Resin Filling) & (Composite Resin Bonding) ? thank you so much! :)

[@sumankhan229]

How you have taken impression with putty?

[@ewoiasio2784]

they ptu some kind of electronic gun stick in my mouth after they put in filling or before, what is this. it had a orange light and it was a wide device. i had a white filling done

[@alibongois]

I wish you were my dentist. They just keep taking teeth out cos my enamel has almost totally eroded due to acid from chronic vomiting..... Anything you wud recommend?

[@gulshangulshan6550]

Sir how much composite filling can lasts. Is it better than Crown cap if we eat proper food

[@SmileInfluencers]

It honestly depends on the type of composite resin filling being performed. Some fillings are large & encompass a large proportion of the tooth; thus, they may have a guarded prognosis while other small fillings can last the entire lifetime of the patient. The success of a crown also dependent on a variety of factors including material choice, occlusion patterns & functional/parafunctional habits( grinding / clenching )

[@vanessacampbell7882]

Hello where is your office located? I see

[@shraddha8026]

How to make lingual index with putty Plz explain as I am new to it

[@phasupsubba5295]

How long to light cure it

[@Arthandmishka]

When the tooth is already broken how do u prefabricate putty. Pls guide.

[@quitasellers9548]

Wow

[@alonzina999]

I got my front teeth filling done but food gets stuck in between my teeth especially crunchy food, it's so annoying, should I go back to the dentist to get it fixed, I had a filling before 2 times and I never had this problem,

[@nourana1517]

Where are you located?!

[@SmileInfluencers]

I’m located in North County San Diego

[@olayinkakingsley3130]

I have a son I want to his teeth like this How do I go about it please

[@Saakshikhare]

Is teeth reduced before composite bonding ?? Plz reply

[@filmshare.5144]

Yes

[@chiranjoydas6327]

Composite filling how long to do ???

[@savannalaguna7060]

When you tooth cracks & is even witt gum then what orthodotis

[@mohamedshuaau632]

How long does this last? And can this fill in gaps?

[@SmileInfluencers]

It can fill gaps and it can last a long time but it depends on how well you clean the tooth and take care of it

[@mohammed333fahad]

What is the composite brand ??

[@SmileInfluencers]

u the redband good morning! There are a variety of composite resin brands on the market! I believe the one I used in the video was a standard 3m product. I personally believe a good bevel and layering technique with lingual wall, body shade composite followed enamel shade finished properly with a series of finishing discs is more important then type of resin! However, some resins on the market provide for better translucency... Which one are you using!

[@mohammed333fahad]

San Diego Dentistry thanks a lot for the response The composite that i wes is 3M nano hybrid

[@rinorshala945]

Does it fall

[@jaybesra3910]

Is this filling permanent...?? Plz reply....sir

[@vinaykrishna747]

How luch long this composite exist ?

[@SmileInfluencers]

These composites can last a long time but they tend to wear over time and also discolor!

[@Skittlesskittles-om6hp]

You have pretty teeth. I wish mine look like that....🥺🥺🥺🥺😢

[@khrystylbahala1937]

It is permanent already?

[@buckerooney2247]

I've got a hole in my front tooth in the root. It doesn't hurt but with covid I've not had chance to get fixed. End of September it will be.

[@faribashafaei6420]

Like 🙏

[@bhrajithhybhrajith5868]

It is permanent or temporary

[@fovos7359]

ofc its permanent. can last to 20 yrs.

[@nuriyagetachew8566]

How long does it last

[@tutandas3440]

i have chipped enamel in same front tooth like this video due to trauma. my dentist told me i cant eat any hard food.. that meas cant i cut burger or sandwich or chicken ?

[@o0Avalon0o]

I cut up my food just to be on the safe side, but normally they just stay away from crunchy hard foods like raw carrots, uncut apples, sticky/taffy/hard candy.

[@SpoonieSensei]

will you fix my teeth for me, please???? too bad i'm on the other side of the country!!!

[@faribashafaei6420]

Like

[@thinkbox3494]

He looks like the good looking version of Yousef Erakat.

[@HeyoBuster]

I wonder if there are more females with dental issues then there are men...?

[@SmileInfluencers]

Interesting question! Not sure!

[@magdacad1099]

Thanks

[@SmileInfluencers]

No problem!