This young, first-time, male patient in his early 20s came to my practice with this trauma. He wanted a quick repair of his 22 after. We went over the options of rehabilitation and he made clear not being able to spend a lot of money for the repair of his tooth.

Fig.1

As there was no pain and the tooth was perfectly vital, I was able to convince him to come back in a few days to repair not only the 22 but also element 11 which had an infiltrated restoration.

Fig.2

Impressions were taken in combination with quick pictures with the SmileLite MDP, to send to the lab.

Fig.3

The model was waxed-up to restore symmetry between the central incisors and restore the traumatized 22. To create a palatal shell, a palatal putty was fabricated on the wax-up, using also a VPS to reline the key for higher definition.

Fig.4

As a first step, on the day of the restoration, shade was taken with a button-try on the neighboring tooth. Ideally a direct mock-up could have been done, but the shades in the button try seemed quite accurate, so we didn’t need further verification.

Fig.5

Isolation with the rubber dam, and extra retraction was obtained with floss ligatures.

Fig.6

Preparations of 22 and 11. The old composite on 11 was removed and a bevel was done on both teeth and polished with a rubber tip.

Fig.7

Try-in of the silicone key.

Fig.8

Palatal walls in place.

Fig.9

A lumicontrast sectional matrix (Polydentia) was used to create the proximal enamel shell. As there is good visibility of the cavity, the convex side of the matrix can be placed on the buccal to guide in the shaping of the proximal wall. Using these special black lumicontrast matrices, it is very easy to control the thickness of this increment.

Fig.10

“The box” was hence created and the inner layer could be placed next.

Fig.11

Placement of the dentine layer.

Fig.12

Adding white tints to recreate the white spots in the 21.

Fig.13

A last increment of enamel was added, and the first pencil line on the incisal edge as described in the article “The Power of Pencil” by Caroline Werkhoven

Fig.14

Going on with the pencil lines primary anatomy is finished and the lines for the secondary anatomy are added.

Fig.15

Immediate result after polishing and finishing with spiral wheels, and diamond paste with a felt wheel. Nice luster and gloss were achieved.

Fig.16

Contrasted view of both restorations.

Fig.17

Immediate result after removing the rubber dam. A nice symmetry was achieved by using the silicone key, while keeping the rust very natural.

Fig.18

2-weeks follow-up. We can appreciate a nice halo in the restoration of tooth 11, also the white spot seems natural.

Fig.19

Comparison of the end result to the mirrored initial situation.

Conclusions

Sometimes, getting the patient to allow a little time to get a wax-up and to study a case is the key to a good result. Also, this might reduce pressure and chance of error.
Also not only focusing on the problem presented by the patient, but looking from a broader perspective can give a more satisfactory result than only treating the presented problem.

Bibliography

1. Manauta J, Salat A. Layers, an Atlas of composite resin stratification, Quintessence 2012.
2. Manauta J. Ahead of print.
3. Gönülol N, Yilmaz F. The effects of finishing and polishing techniques on surface roughness and color stability of nanocomposites. J Dent. 2012 Dec;40 Suppl 2:e64-70.
4. Schmitt VL, Puppin-Rontani RM, Naufel FS, Nahsan FPS, Coelho Sinhoreti MA and Baseggio W. Effect of the Polishing Procedures on Color Stability and Surface Roughness of Composite Resins. ISRN Dent. 2011; 2011: 617672 published online 2011 Jul 11. doi: 10.5402/2011/617672
5. Werkhoven C. The power of pencil. 2016. on styleitaliano.org