Composite overlays in anteriors. A 10 years check clinical case

Endodontics - Ortho and Kids - Laboratory - Bleaching - Indirect anteriors
21 Oct 2016

Modern adhesive dentistry has provided clinicians with simplify restorative procedures by opening new scenarios once unthinkable, thanks to the new adhesive techniques. To this end we nowadays have the possibility to perform partial restorations on anterior teeth, enabling us to get the best possible outcome.

Fig. 1

This is Italo, 32 years old, a few hours after a bicycle accident, coming from the hospital emergency room, on February 2006

Fig. 2

The patient has a pulp hemorrhage on tooth 2.1 suffering for a deep palatal fracture

Fig. 3

First of all it's removed the fractured fragment

Fig. 4

More than 5 mm fracture. Tooth 2.2 is still vital

Fig. 5

So, after the root canal treatment under the dam with correct pulp chamber opening, a cleaning of the cavity access and a root filling level control

Fig. 6

I performed an immediate dentin sealing on tooth 2.2 against bacterial leakage and sensitivity

Fig. 7

Due to the pulp hemorrhage tooth 2.1 has a discromy.

Fig. 8

In order to prevent the external root resorption caused by a not correct bleaching approach, I put a flow barrier on the gutta-percha

Fig. 9

Before performing an endo bleaching in office, under the dam, with 35% hydrogen peroxide and a composite stable temporary restoration with a coronal seal. Coronal seal is one of the most important factor of the clinical success during the time, because coronal bacterial infiltration are one of the main causes of failure after root canal treatment

Fig. 10

I performed an orthodontic extrusion for 6 months

Fig. 11

And then a wax up by my dental technician on model casts

Fig. 12

To prepare silicon keys to guide my build ups and preparations

Fig. 13

I decided to bond a fiber post for the build up retention, choosing the post on the basis of root canal shape and marking its correct hight with a pencil

Fig. 14

The post was also shaped to be covered by a uniform restorative material layer

Fig. 15

All the bonding post procedures with a dual composite cement were guided by the silicon key made on the wax up

Fig. 16

I used transparent matrices to protect the adiacent teeth during adhesion steps

Fig. 17

Layering was completed with a single shade dentin composite mass

Fig. 18

All the preparation came from a rational and not empirical project done by the wax up

Fig. 19

and guided by the silicon keys to respect the correct space for the restorative material

Fig. 20
Fig. 21

Despite having experience with both ceramic and composite materials, I decided to treat this clinical case with indirect composite overlays for the cost and benefits of this materials

Fig. 22

After about a week I bonded the composite overlays one by one under the dam. First step was to perfectly clean the preparation sandblasting them with glycine powder

Fig. 23

Then using 37% phosphoric acid gel for 15 seconds

Fig. 24

Applying the bonding brushing 2 or 3 times

Fig. 25
Fig. 26

I removed all the composite excess before curing for 60 seconds for each side with a high power led lamp

Fig. 27

I repeated the same steps on tooth 2.2

Fig. 28

Until the immediate final outcome

Fig. 29

Control one month check shows a natural smile

Fig. 30

And the vestibular

 

Conclusions

The evolution of restorative materials has led dental companies to produce composite products with a predictable and long lasting result during the time, with a favorable cost performance ratio

Bibliography

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Microhardness and color changes of human dentin with repeated intracoronal bleaching.
Lai YL, Yang ML, Lee SY.

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Tan et al, J Prosthet Dent 2005; 93:331-6. In vitro fracture resistance of endodontically treated central incisors with varying ferrule heights and configurations

Goto Y, Nicholls JI, Phillips KM, Junge T. Fatigue resistance of endodontically treated teeth restored with three dowel-and-core systems. J Prosthet Dent. 2005 Jan;93(1):45-50

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