A clinical case by our Community member Dr. Rasty Fariq Dara
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Peg-shaped lateral incisors are developmental anomalies affecting the maxillary anterior region. They usually appear as narrow, conical teeth with reduced crown dimensions. This abnormal shape can disturb dental symmetry and smile harmony. Because lateral incisors are highly visible, their esthetic correction requires careful planning. Treatment planning should consider tooth proportion, available space, gingival contour, and occlusion. Direct composite restoration is a conservative option for managing peg-shaped lateral incisors. It allows additive reshaping with minimal or no removal of healthy enamel. Composite resin can restore the mesial, distal, facial, and incisal contours. This helps transform the peg-shaped tooth into a more natural anatomical form. Modern composites provide favorable shade matching, polishability, and optical integration. Clinical success depends on proper isolation, bonding, contouring, finishing, and polishing. This case report describes a minimally invasive transformation of peg-shaped lateral incisors using direct composite restorations.
Fig.1
Initial situation, a 31-year-old postgraduate student comes to the clinic with a complaint about his smile.
Fig.2
Intra-oral photo with cheek retractor.
Fig.3
Rubber dam isolation for moisture control and improved operative visibility.
Fig.4
Using a floss ligature for maximum tooth isolation.
Fig.5
Covering all the facial surface with a 37% phosphoric acid, to make a microporosity.
Fig.6
Following etching, the enamel exhibited a characteristic chalky appearance. The adjacent mesial and distal teeth were covered to protect them during the procedure.
Fig.7
A transparent matrix was used to directly create the palatal shell.
Fig.8
An enamel shade was used to reproduce the natural translucency and anatomical appearance of the teeth.
Fig.9
Irregularly shaped mamelons were created using a dentin shade, which was also used to reproduce the incisal halo.
Fig.10
After finishing, pre-polishing, and polishing, a glossy surface was achieved. At this stage, the shade of the restoration did not match that of the adjacent teeth due to dehydration of the restored tooth.
Fig.11
Prominent transitional line angles were created, with the mesial line angle made longer and straighter, while the distal line angle was shorter and more rounded.
Fig.12
At the 4-day follow-up, the restoration exhibited a more natural and realistic appearance.
Fig.13
Rounded mesial and distal incisal edges were created to mimic the contours of the adjacent teeth.
Fig.14
Transforming a spaced, asymmetrical smile into a more harmonious and balanced appearance.
Fig.15
Final result: natural light reflection.
Conclusions
Peg-shaped lateral incisors can be successfully restored through a conservative and systematic direct composite approach. This clinical case demonstrates that abnormal lateral incisor morphology can be transformed into a natural and harmonious tooth form. The use of direct composite restoration allowed correction of tooth shape while preserving healthy dental structure. A well-planned step-by-step protocol was essential for achieving predictable esthetic and functional results. Proper isolation played a key role in creating an optimal bonding environment. Strategic composite layering helped reproduce natural tooth volume, contour, and optical characteristics. Careful anatomical shaping allowed the peg-shaped lateral incisors to integrate more harmoniously with the adjacent anterior teeth. Attention to line angles, incisal form, and emergence profile was important for creating a realistic morphology. Finishing and polishing procedures enhanced surface smoothness, gloss, and long-term esthetic stability. Each clinical step contributed to the final quality, durability, and natural appearance of the restorations. Modern composite materials, when used with precise clinical techniques, can provide excellent esthetic integration. This approach reduces the need for more invasive restorative options such as ceramic veneers or crowns. The case confirms that direct composite restoration is a reliable treatment option for peg-shaped lateral incisors.
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