silicone index for restoration of fractured teeth

Restoring fractured young central incisors with composite

Restoring class IV cavities is one of the biggest challenges for a dentist, because of the difficulties in color matching, in emulating natural internal structure of the tooth, and in hiding the fracture line.

smile of young boy with broken teeth

Fig.1

This young boy broke his teeth playing hockey on a Saturday. Luckily none of the fractures was complicated by pulp exposure, and, because the fragments weren’t retrieved, a dentist sealed the dentin.

fracture upper incisors

Fig.2

Intra-oral view.

wax-up on model and silicone key

Fig.3

An impression was taken to do a wax-up based on which a silicone index was fabricated.

shade matching with vita shade guide

Fig.4

Also, early color matching was done, using a standard VITA Shade Guide.

direct mock-up with composite

Fig.5

I always do a direct mock-up with the exact composite shades and shapes that I want to use, so that the actual outcome of the final restoration is visible.

black and white picture for evaluation of composite value

Fig.6

A black and white picture is useful to analyze the value.

rubber dam isolation before inversion

Fig.7

Rubber dam isolation is mandatory to perform adhesive procedures.

rubber dam isolation of upper teeth with floss ligatures

Fig.8

For a more effective isolation, the rubber dam should be tucked into the sulcus. Floss ligatures provide extra retraction.

preapration of class IV cavities with bevel

Fig.9

The surface should be thoroughly cleaned. Creating a bevel is advantageous when trying to hide the fracture line. All edges were rounded.

enamel etching of two upper incisors and teflon isolation

Fig.10

I always etch a wider surface than the one I’m going to bond the restoration to, to avoid the risk of leaving part of the restoration unbonded, hence early staining and infiltration.

bonded enamel surface

Fig.11

A single-bottle universal adhesive was used.

marking the silicone key with fissura styleitaliano instrument

Fig.12

It’s useful to mark were the fracture line is in the silicone key, in order not to have a big excess in the palatal area.

palatal composite shells on central incisors

Fig.13

The palatal shell is built with an A3 enamel mass (Filtek Supreme XTE, 3M) with the aid of a palatal silicone key.

layering of mamelons with composite in class IV cavities

Fig.14

A small amount of A1 dentin (Filtek Supreme XTE, 3M) was applied, because of its opacity. A layer of A1 body shade (Filtek Supreme XTE, 3M) was used to reproduce the mamelons, and calibrated with Misura instrument (LM Arte kit powered by Styleitaliano), to ensure proper spacing for the enamel mass.

correction of incisal edge for restoration of child teeth

Fig.15

A correction can be done with a diamond bur at low speed to achieve a very precise incisal shape.

incisal halo reproduction with opaque composite

Fig.16

For the incisal halo, I used the same dentin selected for the rest of the layering.

layering of clear translucent mass between tmamelons and incisal edge

Fig.17

We can apply a clear translucent mass in between the mamelons and also on top of them for the contra-opalescence.

proximal restoration with posterior sectional matrix on incisor

Fig.18

Proximal walls are made with the same enamel shade by using posterior matrices in a vertical position.

white staining for a natural look of composite restorations

Fig.19

Some white spots were added for a more natural look.

LM condensa styleitaliano instrument used for composite packing

Fig.20

The last buccal layer was packed and adapted to the existing anatomy using the Condensa instrument (LM Arte kit, powered by Styleitaliano).

final composite restorations before polishing

Fig.21

The final aspect of the restorations.

composite restorations before rehydration of teeth

Fig.22

The restorations at the end of the session, before rehydration.

pop on disc for angle line correction

Fig.23

The correct polish is extremely important for the long-term success of the restoration. First correct the light reflecting angle lines.

surface texturing with diamond bur

Fig.24

Surface texture was created using a diamond bur at low speed and no irrigation.

spiral wheel for safe composite polishing

Fig.25

The final polishing was performed with spiral wheels (3M) at low speed under water irrigation.

aluminum oxide paste for composite polishing and felt

Fig.26

A felt with aluminium oxide paste was used to achieve highly glossy surfaces.

final aspect of composite restorations on upper incisors

Fig.27

At check-up, one month later.

smile with restored teeth

Fig.28

After rehydration, the fracture lines are invisible and the restorations look natural.

before and after direct restoration of broken incisors

Fig.29

Before and after, 6 months later.

Conclusions

Direct composite restorations can be a great solution to restore aesthetics and function in case of fracture of the anterior teeth. To achieve these goals, it is mandatory to follow a precise protocol. This protocol should include a good diagnosis, a complete planning with a restorative trial and a silicone key. Isolation and a good adhesive technique, together with a simplified restorative technique and heavy-duty finishing and polishing complete a successful session.

Bibliography

1. Lee YK, Lu H, Powers JM. Measurement of opalescence of resin composites. Dent Mater 2005;21:1068–1074.
2. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.Eur J Esthet Dent. 2010 Spring;5(1):102-24.
3. Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr.Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 2011;23(2):73-87.