Due to the loss of tooth vitality and a large portion of the tooth crown, the prognosis of the tooth remained questionable. Still, it seemed appropriate to try if a conservative treatment approach would offer the intended long-term stability.
Given the patient’s young age, we felt it desirable to save as much healthy tooth structure as possible. If the selected approach turned out to be unsuccessful, it would still be possible to place a crown without causing any additional harm. In order to avoid the necessity of reopening the root canal in this case, we decided to place a glass fiber post immediately and integrate it in the composite restoration.
The maxillary left central incisor of this 29-year-old female patient showed a huge fracture after dental trauma. Endodontic treatment was required. Nevertheless, we decided to opt for a conservative treatment approach using a composite.
Fig.1
Initial clinical situation with a fractured maxillary central incisor. A large portion of the crown is lost, and the margin is irregular. Enamel prisms are broken at different angles, which leads to variations in opacity. Endodontic treatment is required.
Fig.2
Intra-operative view during post try-in, after endodontic treatment, removal of the tooth structure with broken enamel prisms and creation of a bevel. The smooth and rounded bevel is particularly important for the creation of an invisible margin.
Fig.3
Preparation for the bonding procedure: The adjacent teeth are protected with contoured sectional posterior matrices placed in an upright position.
Fig.4
Build-up of the first interproximal wall with 3M™ Filtek™ Universal Restorative in the shade A1. The material was specifically developed for the single-shade technique. It is available in a universal opacity, which blends in nicely with the surrounding tooth structure.
Fig.5
View after build-up of the second interproximal wall, light-curing and removal of the matrix.
Fig.6
Shortened fiber post (3M™ RelyX™ Fiber Post 3D), placed with 3M™ RelyX™ Unicem 2 Automix Self-Adhesive Resin Cement. With the aid of an endo tip, the root canal may be filled from the bottom to the top, preventing voids formation.
Fig.7
Build-up of the dentin core around the post. The post may be pre-treated in the same manner as the tooth structure, i.e. with 3M™ Scotchbond™ Universal Adhesive.
Fig.8
Addition of the last vestibular layer of universal composite.
Fig.9
Appearance of the restoration after shaping of the incisal edge and rubber dam removal. The irregularities seen in the incisal edge of the adjacent incisor were copied.
Fig.10
Beginning of the finishing and polishing procedures: Use of 3M™ Sof-Lex™ Extra-Thin Contouring and Polishing Discs.
Fig.11
Pre-polishing of the surface with the beige Spiral Wheel of 3M™ Sof-Lex™ Diamond Polishing System.
Fig.12
High-gloss polishing using the pink Spiral Wheels of Sof-Lex™ Diamond Polishing System.
Fig.13
Post-operative result showing a natural tooth anatomy and a good optical integration of the restoration.
Conclusions
As in the case of fractured teeth, one of the challenges in the direct procedure was the creation of an optically invisible margin between the tooth structure and the composite. Even in such difficult situation, the Filtek Universal Restorative has well covered the margin of the restoration and using only one shade it was possible to restore the tooth, achieving a good aesthetic result.
Bibliography
M.C. Cagidiaco, I. Radovic, M. Simonetti, F. Tay, M. Ferrari, Clinical performance of fiber post restorations in endodontically treated teeth: 2-year results, Int. J. Prosthodont. 20 (2007) 293–298.
– R. Hirata, W. Kabbach, O.S. de Andrade, E.A. Bonfante, M. Giannini, P.G. Coelho, Bulk Fill Composites: An Anatomic Sculpting Technique, J. Esthet. Restor. Dent. Off. Publ. Am. Acad. Esthet. Dent. Al. 27 (2015) 335–343. doi:10.1111/jerd.12159.
– R. Monterubbianesi, G. Orsini, G. Tosi, C. Conti, V. Librando, M. Procaccini, A. Putignano, Spectroscopic and Mechanical Properties of a New Generation of Bulk Fill Composites, Front. Physiol. 7 (2016). doi:10.3389/fphys.2016.00652.
– F.H. Coelho-de-Souza, D.S. Gonçalves, M.P. Sales, M.C.G. Erhardt, M.B. Corrêa, N.J.M. Opdam, F.F. Demarco, Direct anterior composite veneers in vital and non-vital teeth: a retrospective clinical evaluation, J. Dent. 43 (2015) 1330–1336. doi:10.1016/j.jdent.2015.08.011.
– S. Grandini, C. Goracci, F. Monticelli, F.R. Tay, M. Ferrari, Fatigue resistance and structural characteristics of fiber posts: three-point bending test and SEM evaluation, Dent. Mater. Off. Publ. Acad. Dent. Mater. 21 (2005) 75–82. doi:10.1016/j.dental.2004.02.012.
