composite direct restoration of incisors

Direct mock-up and BRB matrix. Express solution to incisor trauma

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.

broken upper right incisors

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.

chipped teeth

Fig.2

Initial situation.

BRB matrix for immediate silicone key

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.

silicone index for provisional composite restoration

Fig.4

Try in of the silicone key to fabricate a mock-up.

palatal composite mock-up with silicone key

Fig.5

Mock-up of the palatal wall.

direct composite mock up of upper incisors

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.

prepared cavities under rubber dam isolation

Fig.7

After the isolation with the rubber dam, teeth were prepared, sandblasted with 27-micron aluminum oxide particles.

occlusal view of class IV cavities

Fig.8

Occlusal view of the prepared teeth. A fourth-generation adhesive was used in this case.

Silicone index try in on prepared cavities

Fig.9

After proper trimming, the silicone index was tried in to check the fit after rubber dam isolation.

palatal build up with composite for restoration of teeth

Fig.10

Palatal wall was built using Tokuyama Estelite Asteria OcE shade.

sectional matrices for proximal incisor build-up

Fig.11

Sectional matrices were used to build the proximal anatomy.

occlusal view of palatal shell in composite restoration

Fig.12

As you can see from the axial view, the matrices adapt perfectly to the dental structure.

sectional matrix fixed with wedge for mesial restoration of lateral incisor

Fig.13

The same strategy was used on tooth 12.

composite direct restoration of incisors

Fig.14

After creating the proximal surfaces, the teeth are ready to fill with the inner masses.

dentin layering in direct composite filling

Fig.15

A dentin layer was created using Tokuyama Estelite Asteria A3, 5B and A3B shades.

raw composite inside class IV cavities

Fig.16

Covering the incisal third was enhanced with a transparent tint.

teeth with raw composite restoration

Fig.17

For the buccal layer, the OcE shade was used as for the palatal.

composite restorations after finishing before polishing

Fig.18

After conturing and finishing the surface texture.

buccal shape check with mirror

Fig.19

Buccal anatomy should be checked for optimum results.

teeth after finishing

Fig.20

After finishing and polishing.

x-ray showing adaptation and seal of composite restorations

Fig.21

Radiographic check.

composite restorations after rehydration

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