Reattachment of fractured teeth and margin correction

Fractured teeth represent a challenge in our daily practice, learn how to treat them in a conservative and aesthetic way, no RCT, no post, no crown.

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Fig.1
Preoperative picture showing the damage of 21 and cracks and fractures of the incisal edge of both teeth.

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Fig.2
The image shows the perfect fit of the fractured fragment with the tooth crown.

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Fig.3
A silicone index is impressed onto the incisors while fitting the fragment. The silicone matrix will allow handling the fragment for adhesive procedures without contaminating it. Moreover, a precise repositioning of the fragment can be obtained during the luting stage thus preventing material leakage on the palatal side, which is always difficult to check and remove.

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Fig.4
Minimal cavity cleaning only aimed at the eliminating unsupported enamel prisms and cleansing and disinfection, using a delicate bicarbonate sandblasting.

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Fig.5
The repositioning of the fragment after cleansing shows a gap that would have made it impossible to correctly position the fragment, had the index not previously been made.

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Fig.6
Etching of the tooth.

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Fig.7
Etching of the fragment, without removing the fragment from the index.

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Fig.8
Adhesive application on the tooth.

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Fig.9
Adhesive phases on the fragment, without removing the fragment from the index.

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Fig.10
Cementation with composite heated at 39° C in a special oven. Using composite rather than an adhesive cement gives many undeniable advantages related to having a ready made material; working time can be determined as required, excess material (very viscous material) can be easily removed, and fitting of the fragment is improved by the heavily loaded material. The index stabilizes the fragment during the removal of excess material and the polymerization step of the composite.

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Fig.11
Final image after cementation and immediately after the removal of the rubber dam. A surface finishing was performed using fine grained (30 microns) diamond flame shaped burs, silicone rubbers and diamond paste of decreasing particle size applied with a brush wheel.

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Fig.12
Extra hard plaster model with diagnostic wax and laboratory-prepared silicone index matrix.

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Fig.13
Conservative preparation of the incisal edges of 11 and 21 with the creation of a buccal chamfer margin by eliminating the parts of cracked enamel and unsupported prisms using a fine-grained ball diamond bur (30 microns). Followed by, polishing with silicone rubbers at low speed to encourage the flow and the adaptation of the composite. Index matrix trial and adhesive procedures.

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Fig.14
Construction of palatal walls with enamel using the matrix template as a guide. Construction of the incisal frame with high value enamel.

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Fig.15
Construction of the dentin body and opalescence incisal.

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Fig.16
Covering the dentin body with a generic surface enamel.

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Fig.17
Reopening with a round fine-grained bur the transition line of the restoration.

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Fig.18
Applying a thin layer of flowable composite and a layer of dentin adhesive without curing.

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Fig.19
Two step coverage with the desaturation of the dentinal mass color up to the edge of enamel and application of a thin layer of generic enamel composite.

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Fig.20
The case at the end of treatment after finishing and polishing margins and the new transition line in composite.

Conclusions

Bibliography

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