Restoring a Class IV Fracture Using a Compactable, Universal Nanohybrid Composite

Robert Marus, DDS


It’s not uncommon for dentists to encounter patients who show up with Class IV fractures. Although some patients may opt to correct such defects with adhesively cemented indirect veneers, in many instances, a more minimally invasive yet functional, long-lasting, and natural-looking approach is warranted.
However, anterior direct restorations for Class IV fractures traditionally have presented placement challenges due to the handling and adaptability characteristics of the composites used. Additionally, based on their physical and optical properties, some direct composites with the strength and wear properties required for incisal edges may be more appropriate for placement in the posterior, since they may lack the aesthetic qualities that enable their use in the anterior. Likewise, composites with the desired level of polishability and chameleon effect for use in the anterior may fall short in terms of durability and functional strength.
Fortunately, a compactable, universal nano-hybrid composite is available that enables dentists to enhance clinical outcomes for their patients while simultaneously increasing their return on investment through more efficient clinical procedures. Easy to place, shape, sculpt, and polish, G-ænial Sculpt (GC America) incorporates high-density, uniform dispersion nano-filler technology to create a resin that produces strong, highly wear-resistant, self-polishing, and radiopaque finished restorations.
Contributing to procedural efficiency and a re-duction in chair time when using G-ænial Sculpt are the material’s delivery systems—either a syringe or a convenient single-dose capsule unitip—which enhance ease of placement. Additionally, the material’s nonsticky and packable viscosity facilitates easy shaping and adaptation of the material to preparations, as well as sculpting anatomy, since it maintains its shape prior to polymerization.
Further efficiencies are realized as a result of the material’s barium glass fillers, which make it easy to achieve a superior polish and high gloss. Rough finishing with a bur is all that is required to bring G-ænial Sculpt restorations to an aesthetic luster that continues to increase polish in the mouth with daily tooth brushing (ie, a self-shining/polishing effect).
Contributing to easily achieved aesthetics are G-ænial Sculpt’s optical properties, which produce an excellent chameleon-like shade matching and blending effect with surrounding tooth structure. The wide range of available shades for both anterior and posterior restorations (17 shades, including opaque and enamel) also helps dentists realize ideal aesthetics in everyday treatments.
G-ænial Sculpt compactable, universal nano-hybrid composite is indicated for direct Class I, II, III, IV, and V cavities; wedge-shaped defects and root surface cavities; and direct veneers and diastema closures. It can be used in combination with an 8th-generation universal adhesive bonding agent (ie, G-Premio BOND [GC America]), which is compatible with all etching techniques (eg, total-etch, self-etch, and selective-etch).

Clinical Technique
A 17-year-old female patient presented for treatment of a Class IV fracture of her left maxillary central incisor (tooth No. 9) that she sustained during a previous accident 4 years earlier (Figure 1). Physical and radiographic examinations revealed no root fracture or pulpal exposure. Photographs were taken.
Given the patient’s age and the need for a minimally invasive and conservative treatment approach, she was immediately scheduled for operative treatment with G-ænial Sculpt compactible, universal nanohybrid composite. This direct composite was selected based on its strength; unique sculptability; and its handling, aesthetics, and polish retention.
After administering local anesthetic, tooth No. 9 was prepared using a diamond bur to create a lingual and facial bevel, which would support the fracture resistance and durability of the restoration. The preparation was then cleaned, mechanically etched with 50-µm of aluminum oxide particles, and air dried.
A total-etch technique was performed to ensure the highest bond strength. A one bottle, 8th-generation universal adhesive bonding agent (G-Premio BOND) was then precisely applied to the preparation and allowed to soak for 10 seconds; no scrubbing was required (Figure 2). The adhesive was air dried for 5 seconds to quickly dissipate the solvent, after which it was light cured for 10 seconds.

Figure 1. Close-up preoperative view of a fractured central incisor requiring restoration. Figure 2. G-Premio BOND (GC America) 8th-generation universal adhesive was applied to the preparation in a total-etch technique.
Figure 3. Shade OA1 of G-ænial Sculpt (GC America) was placed and sculpted to create the lingual enamel layer. Figure 4. Postoperative view of the final and completed G-ænial Sculpt Class IV restoration on tooth No. 9.

To create the lingual enamel layer and block any show-through, an increment of G-ænial Sculpt in shade OA1 was placed, with a previously fabricated palatal matrix in position, and sculpted using a composite placement instrument (Figure 3), and then light cured. Care was taken to ensure the curing light remained as close to the composite surface as possible. To replicate the aesthetics of the middle third and incisal one third of the adjacent tooth No. 8, an increment of G-ænial Sculpt in shade B1 was placed, sculpted, and light cured. Anatomical details were finalized, finishing and polishing were completed using a finishing and polishing kit (The Ultimate F&P Kit [GC America]), and the occlusion was checked.

When dentists are faced with providing patients with direct anterior Class IV restorations, the use of composite materials that demonstrate optimal handling, sculptability, aesthetics, and polishability can help them experience success rather than challenges. G-ænial Sculpt compactable, universal nano-hybrid composite demonstrates an ideal viscosity, optimal sculptability, and excellent polishability, enabling dentists to provide faster, more efficient, and highly aesthetic direct anterior composite treatments, including for Class IV fractures (Figure 4).
For more information, call GC America toll-free at (800) 323-7063 or visit