A clinical case by our Community member Dr. Omar Faez Alani
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Dental traumas are estimated an increasing public health problem that affects permanent dentition among children and teenagers. The majority of dental injuries happen in the anterior region, affecting mainly the maxillary central incisors that can have a significantly negative functional, esthetic and psychological influence. Several techniques can be used for restoring fractured teeth, either by indirect or direct restorations, or in some situations by reattachment of the fragment. Direct composite restorations for non-complex crown fractures with missing fragment represents the most minimally invasive method.
A 17-year-old male patient presented at our clinic with fractures at both maxillary central incisors resulting from a motorcycle accident that happened two days earlier. He asked for an immediate and aesthetic correction to improve his looks and smile. The clinical and radiographic examinations showed the fracture didn’t involve the pulp. Because the fragment was missing, the decision was to restore the fracture immediately by direct composite resin using a freehand technique as a simple approach.
Shade matching was done using a custom-made shade guide.
Adhesive dentistry requires a clean and dry working field. For this reason, isolation of the operative field by rubber dam should is needed obtain long-lasting restorations.
The irregularities of the fracture, and all unsupported enamel were removed by using coarse and medium discs.
A yellow band football diamond bur was used to create a 1.5 – 2 mm bevel.
Selective etching 2 mm beyond the bevel margins, the lateral incisors were protected by using teflon tape to prevent unwanted demineralization.
After etching, universal bonding was laid twice, then palatal shells were constructed using mylar strip and finger support.
The palatal walls were built using an achromatic enamel shade.
Some flowable opaque composite is used in a thin layer where the palatal wall and the tooth margin meet to improve integration.
The opalescent composite was applied between and around the mamelons to create nature-mimicking opalescence.
Before finishing and polishing, the last layer of composite was photopolymerized for 1 additional minute under glycerine air-block; this additional step is important to increase the hardness of the superficial layer as it increases the degree of conversion of composite that prevents the deterioration of the restoration and the interface with the tooth.
A pencil used to mark the transition lines and V-shaped developmental grooves.
Finishing was done using medium-coarse disc and Opti1step polisher, while EVE Dia comp twist was used for pre-polishing and to get initial gloss.
At one-week recall and after complete rehydration, the transition between restorations and fracture lines is invisible.
Final smile after one week.
Direct composite restorations represent the best immediate solution for the patient with fractured teeth in the aesthetic area, especially when the fractured fragment us missing. Restoration of anterior teeth is regarded as a challenge to most dentists, but following the natural layering concept using one shade of enamel and one shade of dentin with the opalescent composite can be considered the simple approach to obtain lifelike mimicking restorations.
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