A clinical case by our Community member Dr. Roma Turetsky
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.
The use of modern techniques and materials allows us to achieve maximum results in the shortest possible time.
This patient was quite unlucky, as she was unable to preserve fragments of her teeth. Luckily, modern materials and protocols make it possible to achieve very natural-looking optical and anatomical features of the restored tooth. Moreover, modern adhesives allow for a long-lasting and strong bond of the restoration to the dental tissues.
Fig.1
This patient came to restore the upper right incisors after trauma. Percussion and probing were slightly painful. The reaction to temperature stimuli was very painful. Since the dentin was exposed, we decided to restore the teeth immediately.
Fig.2
Initial situation.
Fig.3
To make a silicone key, the BRB matrix technique was used. An impression was taken, then, a projection of the teeth being restored was marked with a pencil. Part of the silicone was cut with a boron to modify the impression and create the palatal anatomy of the restoration.
Fig.4
Try in of the silicone key to fabricate a mock-up.
Fig.5
Mock-up of the palatal wall.
Fig.6
The direct mock-up was completed thus obtaining an accurate anatomy. An impression was taken to fabricate a precise index on this very shape.
Fig.7
After the isolation with the rubber dam, teeth were prepared, sandblasted with 27-micron aluminum oxide particles.
Fig.8
Occlusal view of the prepared teeth. A fourth-generation adhesive was used in this case.
Fig.9
After proper trimming, the silicone index was tried in to check the fit after rubber dam isolation.
Fig.10
Palatal wall was built using Tokuyama Estelite Asteria OcE shade.
Fig.11
Sectional matrices were used to build the proximal anatomy.
Fig.12
As you can see from the axial view, the matrices adapt perfectly to the dental structure.
Fig.13
The same strategy was used on tooth 12.
Fig.14
After creating the proximal surfaces, the teeth are ready to fill with the inner masses.
Fig.15
A dentin layer was created using Tokuyama Estelite Asteria A3, 5B and A3B shades.
Fig.16
Covering the incisal third was enhanced with a transparent tint.
Fig.17
For the buccal layer, the OcE shade was used as for the palatal.
Fig.18
After conturing and finishing the surface texture.
Fig.19
Buccal anatomy should be checked for optimum results.
Fig.20
After finishing and polishing.
Fig.21
Radiographic check.
Fig.22
After 2 weeks teeth were fully rehydrated, and the patient satisfied.
Conclusions
Creating a direct mock-up with composite can save time on creating a model and wax-up. The patient accepts the plan and gets the result on the first visit. We can evaluate the overall picture and easily make corrections. If necessary, creating a mock-up, we can recreate the color of the tooth to assess the correctness of the tone, and occlusal corrections may be performed as well. All other stages, of course, need a well-established protocol for optimum results.
Bibliography
1. Manauta J, Salat A. Layers. An Atlas of Composite Resin Stratification. Quintessence Publishing 2012.
2. Scherbakov V. Smile reconstruction. Dental Magazine
3. Scherbakov V. Finishing techniques for composite restorations. Dental magazine
