A clinical case by our Community member Dr. Muhammed Bahadeen
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.
This patient presented to the clinic with a class IV fracture of both central incisors, and chipping of tooth 22, asking for a non-invasive esthetic treatment. A direct restorative approach was chosen and an impression was taken to get a wax up.
Impression was taken for creating a cast and perform the wax up.
The silicone index was then fabricated on the waxed-up model to build a composite palatal shell.
Shade selection should be done within 3 minutes to avoid color mismatch due to tooth dehydration.
Enamel is etched for 20 seconds.
Our silicone index is cut and we are ready to create the palatal shell.
A 7th generation bonding agent was used for our restoration.
The LM Arte Applica instrument by Styleitaliano was used for our layering. I like to clean the instrument with ethanol before starting, and between the layering steps to remove debris, and to prevent it from getting into the composite.
If the composite sticks to the instrument use a very little amount of composite modeling liquid. Too much liquid will create bubbles in the composite and during the finishing stage will appear.
The palatal shell is created using OBN from Enamel Plus HRi (Micerium), about 0.5mm to be rigid enough to resist breakage during the subsequent layering.
Lateral view shows there’s plenty of space for layering.
Mesial and distal walls are created using A2 Estelite Asteria (Tokuyama).
Dentin layer is applied and mamelons are recreated to give a natural translucency to the final restorations.
Occlusal check for the enamel spacing. An A2 enamel shade will be used.
The Applica instrument is used to place some translucent enamel composite on the incisal edges.
Final work after placing the A2 enamel layer. Tooth 22 was restored before removing the rubber dam.
Polishing strips (GC) were used to polish the mesial and distal walls.
Red coded rounded-end fissure bur was used to create surface texture, at slow speed to have a better control.
The restoration was done in two visits one visit for taking an impression and wax up, and the next visit for the restoration to provide accurate measurement for the restoration with proper shape and texture. Not every case can be done in a single visit some cases require more than a visit to provide the patient with the proper result.
Manauta J, Salat A. Layers: An atlas of composite resin stratification. Quintessence Pub, 2012.
Magne P, Belser UC. Biomimetic Restorative Dentistry. Quintessence Pub, 2021.