Direct incisal restorations

A clinical case by our Community member Dr Kemen Hou

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 young male patient visited the dental office seeking an aesthetic solution for his smile. He had fractured his central incisors by accidentally biting a fork. We proposed orthodontic treatment since he has a constricted occlusion. We suggested a conservative approach with minimally invasive treatment, using composite restorations on teeth 11 and 21. Digital impressions were taken for a wax-up, and a silicone matrix was fabricated using a 3D-printed model.

styleitaliano style italiano photographic study of dental color direct anterior incisal restorations composite restoration

Fig.1
Our starting point was to select the color shade, prioritizing the hydration of the teeth. The button technique was used, and shades UD2 and UE3 were selected for this case. Different sources of light were employed, including hard light, cross-polarized light, and black and grey lighting.

styleitaliano style italiano rubber dam isolation for direct composite restoration direct anterior incisal restorations composite restoration

Fig.2
Total isolation was achieved using a rubber dam (Nictone medium).

styleitaliano style italiano silicone index try in direct anterior incisal restorations composite restoration

Fig.3
The silicone index was tried in to ensure proper fit and adaptation.

styleitaliano style italiano sandblasing of incisal edges direct anterior incisal restorations composite restoration

Fig.4
The teeth were sandblasted with 50 µm aluminum oxide. A short bevel was made, and cervical enamel defects became more visible due to dehydration caused by the rubber dam.

styleitaliano style italiano composite palatal incisal shells direct anterior incisal restorations composite restoration

Fig.5
After following the bonding protocol (using Prime & Bond Universal from Dentsply), the palatal shells were layered.

styleitaliano style italiano layering dentin shade in the incisal area direct anterior incisal restorations composite restoration

Fig.6
Stratification was done using a dentin shade (ENA HRi UD2 from Micerium).

styleitaliano style italiano staining incisal edge direct anterior incisal restorations composite restoration

Fig.7
White stains (IPS Empress Direct) were applied to replicate the natural anatomy, including the incisal opaque halo and intra-mamelons.

styleitaliano style italiano using a translucent composite for direct composite restoration direct anterior incisal restorations composite restoration

Fig.8
Effects to replicate the translucency were achieved using the OBN shade (Micerium).

styleitaliano style italiano layering enamel composite direct anterior incisal restorations composite restoration

Fig.9
The enamel layer of 21 was applied using ENA HRi UE3 from Micerium.

styleitaliano style italiano teeth with restored incisal edges, before finishing and polishing direct anterior incisal restorations composite restoration

Fig.10
The enamel layer of 11 and the cervical lesions were treated using ENA HRi UE3 from Micerium.

styleitaliano style italiano final aspect of restored incisal edges direct anterior incisal restorations composite restoration

Fig.11
The immediate final touch involved finishing and polishing using a 12 blade, coarse Sof-Lex disc (3M), Jiffy spirals (Ultradent), and diamond paste (ABC from Micerium).

styleitaliano style italiano smile after restoration of incisors with direct composite direct anterior incisal restorations composite restoration

Fig.12
The patient’s smile.

styleitaliano style italiano stages of direct composite incisor restoration direct anterior incisal restorations composite restoration

Fig.13

Conclusions

Restoring just 1 mm in the incisal edges made a significant difference, affirming the “less is more” approach. The patient was delighted and couldn’t stop smiling. Now motivated, they are eager to further enhance their smile through orthodontic treatment.

Bibliography

  1. Perdigao et Al. Adhesive dentistry: Current concepts and clinical considerations Journal of Esthetic and Restorative Dentistry 2020;1-18.
  2. Demarco F F et al. Anterior composite restorations: A systematic review on long-term survival and reasons for failure. Dent Mater. 2015 Oct;31(10).
  3. Razaghy M. A Predictable Approach to Exquisite Anterior Direct Restorations: the Additive Solution. Compend Contin Educ Dent. 2023;44(9):e5-e8.
  4. Varvară, Bianca & Mesaros, Anca & Culic, Bogdan & Adrian Mihai, Varvara & Dudea, Diana. (2018). Resin composite layering technique for direct anterior teeth restorations. Palestrica Of The Third Millennium – Civilization And Sport. 19. 234-238.
  5. Demarco FF, Cenci MS, Montagner AF, et al. Longevity of composite restorations is definitely not only about materials. Dent Mater. 2023;39(1):1-12. doi:10.1016/j.dental.2022.11.009.
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