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GAETANO PAOLONE
DIRECT ANTERIORS - CASES - SHADEGUIDES

IV CLASS RESTORATIONS. SPECULAR SYMMETRY

TRICKS

GUIDE THE ENAMEL WITH

DENTIN

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Although IV class direct restoration procedures are well known and codified, it is always quite
challenging when we have to reproduce specular characteristics. In this clinical case a simple trick to
reproduce specular surface chromatic characteristics is described.
An Article by

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Initial situation. Patient refers cold sensitivity and complains about esthetic aspect on his #1.1

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AESTHETIC ZONE: YES, WE
CAN
TESTIMONIALS

Initial radiograph.

ANNIKA KORVO
Styleitaliano has easy recipes that
we can follow. I find it a great
course for the general practitioner
and for the expert.

After initial preparation.

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Highly aesthetic restorations

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by Rodrigo Cavaco
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Using software (Photoshop), it is possible to better understand chromatic characteristics of #2.1 in

order to plan layering procedures and materials for #1.1.
We can notice a wave-shaped path composed by high-value bands mixed with low-value bands.

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FOUNDERS

Sometimes I use inverted photos (as well as black and white photos) to check volumes, form, shapes.

Walter Devoto
Dr. Walter Devoto Born in
Chiavari on 29/03/1965
graduated in Dentistry in 1991
at Genova University.

Angelo Putignano
M.D. degree and D.D.S. post
graduate certificate from
University of Ancona-Italy.

FOUNDERS ENDO

Pio Bertani
Pio Bertani is a full member of
the prestigious association...

If the wax-up is accurate, palatal and interproximal walls will need few finishing procedures. (Wax-up
by Paolo Santi Laurini, Grosseto, Italy)

Fabio Gorni
Fabio Gorni is an active
member of the Italian Society
of Endodontics and the Italian
Academy...

MEMBERS
Rubber dam isolation

Monaldo Saracinelli
Ive been a student of prof.
Fabio Toffenetti and
Riccardo Garberoglio.

Jordi Manauta
Was born in Mexico City,
where he graduated cum
laude. in dentistry from
UNITEC.

Gaetano Paolone
My passion is aesthetic
direct and indirect
adhesive dentistry in
anterior and posterior
teeth.

Daniele Rondoni
Born in Savona in 1961
where he lives and has

worked in his own

laboratory since...

Vincenzo Musella
Vincenzo Musella
graduated in dental
technician. Proud friend
and student of...

Giuseppe Marchetti
Giuseppe Marchetti was
born in Parma (Italy) in
October of 1972 and
graduated from...

Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Giovanna Orsini
Giovanna Orsini is a well
known researcher in Italy
and internationally.

Remarkable dehydration occurs. A color chart has to be filled out before rubber dam isolation
otherwise we could be diverted.

Paulo Monteiro
My passion for esthetic
dentistry began when I
attended the last year...

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Patrizia Lucchi
Patrizia Lucchi Graduated
in Dentistry cum Laude in
1995 at the University of
Verona

Anna Salat
Dr Anna Salat graduated
with a degree in dentistry
from the International
University of Catalonia

Giulio Pavolucci

Dental preparation. Cervical area is difficult to treat

After graduation magna

cum laude in Dentistry, I
started focusing my daily
work on...

Marcos Vargas
Dr. Marcos Vargas
attended Cayetano
Heredia University School
of Dentistry in Lima...

Stefan Koubi
Dr. Koubi graduated from
University of Marseille
where he...

Engin Taviloglu
Dr. Taviloglu graduated
from ?stanbul University
School of Dentistry in...

Dimitar Filtchev
Co-founder of the Laser
Dental Center and the
Implant...

Angie Segatto
My commitment to arts has
determined my
specialisation.

Kilian Molina
Kilian is required as a
regular lecturer in indirect
restorative...

Gregory Camaleonte
I was born in 1980 in
Marseille-France and i have
graduated in 2006 from...

Caroline Werkhoven
Caroline Werkhoven
graduated in 2002 at
ACTA, the dental faculty in
Amsterdam..

Ajay Juneja
Ajay Juneja finished his
BDS in the year 1995...

Applying a modified 212 clamp makes it easier to treat cervical area

Carlos Fernndez
Villares
Member of SEPES Spanish
Soc...

Sulivan Leite
Sulivan Leite graduated
from the Ribeirao...

Maciej Zarow
Author of book edited by
Quintessence: EndoProsthodontics: guidelines
for clinical practice ...

Dan Lazar
Dan Lazar, graduated from
the Faculty of Dentistry in
2005 in Cluj-Napoca...

Murad Akhundov

After adhesive procedures, chromatic dentin and high value enamel are layered in cervical area.

Dr. Murad Akhundov

graduated from the
Faculty of Dentistry in
Baku...

Janos Grosz
Graduated summa cum
laude in 2006 from the
University of Szeged,
Faculty of Dentistry,
Hungary...

MEMBERS ENDO
Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Louis Hardan

Now 212 clamp can be removed while we need space for our silicon index

Head of Restorative and

Esthetic department in
Saint-Joseph University
in...

Filippo Cardinali
Graduate in Dentistry and
Dental Prostheses at the
University of Ancona in
1992. Active Member of...

Riccardo Tonini
He is active member of the
Italian Academy of
microscopic Dentistry and
Active member of...

Paolo Generali
Doctor Generali was
graduated from Pavia
University in the year...

Calogero Bugea
Graduate in Dentistry,
Certificate in Oral Surgery.
Active Member of the
International
Piezosurgery...

On the silicon index, based on the wax-up, incisions are made to place sectional trasparent matrixes.
The silicon index is then checked in the mouth with matrixes and wedges in order to estabilsh
interferences which could prevent passive fit.

Clifford Ruddle
Internationally recognized
as a leading expert in all
aspects of clinical
endodontics, Dr. Ruddle is
acclaimed for...

Pierre Machtou
Pierre Machtou was the
first scientific director and
general secretary of the
French Endodontic
society...

Marga Ree
Primary author of several
articles published in
national and international
journals and has ...

Marco Martignoni
Marco Martignoni leads a
private clinic in Rome Italy
and dedicates his practice
mainly to endodontics,
pre-prosthetic...

Massimo Giovarruscio
Massimo Giovarruscio
works in Rome, Bristol and
London, specialising in
Endodontic Treatment
and...

Composite is then layered directly on the silicon index and on the matrix bands.

IV class is transformed in a first class

The frame has to be filled with dentin.

A sagittal silicon index is useful to understand the correct amount of dentin and enamel

During finishing procedures

Polishing is then performed. Restoration could be considered finished at this step. But I was thinking
on how to reproduce the above-mentioned chromatic characteristics.
For the wave-shaped bands I needed something that could reproduce simmetry, which is always
quite challenging and quite difficult to do freehand.
I made an incisal silicon stent. I made an incision in it parallel to teeth and right in front of them. I
have put a trasparent matrix band in the incision so that it could lay right in front of the buccal face
of the incisors.
I used a green felt pen to mark on the matrix middle line and distal boundaries of the two incisors.

I used a black felt pen to mark the wave-shaped bands path.

I extracted the trasparent matrix and I reinserted it once twisted using middle line and distal
contours as a reference. Now the wave-shaped bands are placed symmetrically on the incisor we
need to characterize.

A little 8-micron articulating paper is placed between the matrix and the tooth. An explorer is used to
trace the wave-shaped paths

The path transferred

Space for high-value and low-value stains is created

Right after dental dam removal

A month after treatment

palatal view

16 months after. As we can notice from sound tissues, patient is motivated to oral hygiene despite of
the beginning situation

volume and shape check with inverted image

In the following video, it is possible to see the patient after 14 months. First part of video is in the
dental office (neon light), second part is with sun light.

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