As conservative as possible

A clinical case by our Community member Dr. Muhammed Bahadeen

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

A 25 year old female patient came to the clinic with fractured central incisors and a discolored left central incisor. Upon clinical examination we found out that tooth 21 was necrotic, so root canal treatment was planned first.

styleitaliano style italiano isolation for RCT

Fig.1
Isolation was performed to obtain an optimum clean field for the endodontic therapy.

styleitaliano style italiano necrotic pulp out of pulp chamber

Fig.2
As shown in the photo, the pulp was necrotic.

styleitaliano style italiano xray of finished rct

Fig.3
Root canal was finished final x ray was taken. As it appears in the x-ray, the chamber is not clean enough and we still have sealer left.

styleitaliano style italiano clean and isolated root canal before internal bleaching

Fig.4
After thorough cleaning, 2mm of flowable composite is applied over the gutta percha at the level of CEJ, to avoid leakage into the radicular part and periodontal tissues and causing unwanted adverse effects. The composite should be at the level of the CEJ to ensure adequate bleaching of the entire clinical crown.

styleitaliano style italiano hydrogen peroxyde for internal bleaching

Fig.5
35% hydrogen peroxide was used for the purpose of internal bleaching.

styleitaliano style italiano incisor after internal bleaching, before restoration

Fig.6
This result was obtained within two days.

styleitaliano style italiano palatal composite shell build up

Fig.7
After waiting long enough for optimum adhesion (about 3 weeks), we proceeded with the restoration of both incisors. First, the palatal shell was built to proceed to restore the tooth.

styleitaliano style italiano building palatal shell for class IV restoration

Fig.8
Finishing tooth 21, and starting with 11.

styleitaliano style italiano restored central incisors

Fig.9
Final result.

Conclusions

The combination of well-established techniques and minimal invasiveness can lead to optimum results for the dentist and the patient.

Bibliography

– Managing Discoloured Non-Vital Teeth: The Inside/Outside Bleaching Technique NEIL J. POYSER, MARTIN G.D. KELLEHER AND PETER F.A. BRIGGS
– Manauta, Jordi, and Anna Salat. Layers: An atlas of composite resin stratification. Quintessenza Edizionei, 2012.
– Poyser NJ, Kelleher M, Briggs, P. Managing Discoloured Non-Vital Teeth: The Inside/Outside Bleaching Technique
– Manauta, Jordi, and Anna Salat. Layers: An atlas of composite resin stratification. Quintessenza Edizionei, 2012

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Biologically Guided Simplified Anterior Restoration

A simplified layering technique with only two composite opacities can solve most of our anterior restorations, if we respect the biology and the shape of the restoration.