broken upper incisors with plaque

Simplifying small but difficult composite restorations

INTRODUCTION
The restoration of anterior teeth is one of the biggest challenges for a dentist, because of the difficulties in color matching, and in recreating natural internal structure of the tooth.
Small median diastemas and small restorations are the most difficult ones to restore, so we will use a new matrix (UNICA matrix) to make the process easy.

smile with broken teeth

Fig.1

Initial smile of the 26 years old patient (shy smile).

broken incisors and bad oral hygiene

Fig.2

Initial occlusion intra-oral view, first of all we should improve oral hygiene by scaling and polishing the teeth, and also by giving instructions for good oral hygiene.

projections of broken teeth

Fig.3

Initial situation, side and occlusal intra-oral view.

occlusal and frontal view before restoration

Fig.4

Initial situation, frontal and occlusal intra-oral view.

rubber dam isolation of anterior sextant

Fig.5

Isolation with rubber dam is very important in order to provide a clean, clear and dry environment.

making margin bevel for composite restoration

Fig.6

All sharp edges were rounded up by diamond football bur.

finishing of the margin bevel with abrasive disc

Fig.7

Smoothening the bevel area with a coarse disc to ensure complete removal of sharp edges and unsustained enamel prisms.

blue rubber dam and teflon isolation

Fig.8

Isolate and protect the adjacent teeth (non working side) with teflon.

etching enamel with orthophosphoric acid

Fig.9

Conditioning the tooth surface with etching 37% phosphoric acid.

rinsing of the etchant from teeth

Fig.10

Rinsing the etching gel by water carefully to ensure complete removal.

brushing of bonding agent

Fig.11

Application of a generous amount of bonding.

light curing of bonding agent on incisors

Fig.12

Light curing of the adhesive.

UNICA anterior matrix for incisor composite filling

Fig.13

Insertion of two Unica matrices and fix it by wedge, its use to give anatomical contour and emergence profile that was the biggest challenge during diastema closure.

UNICA anterior matrix and wedge for class IV restoration

Fig.14

Bending the Unica matrix from palatal side to create the palatal in addition to the proximal wall in one step.

palatal and proximal composite shell

Fig.15

After removing the Unica matrix, the result is a three dimensional enamel composite mould.

composite layering for IV class restoration

Fig.16

Increment of the dentin shade with build-up of the first internal tooth structure.

Compo Brush for incisor composite layering

Fig.17

The restoration is completed by applying a layer of enamel composite and the CompoBrush (Smile Line,Powered by Styleitaliano) for better adaptation.

finishing of composite restorations with abrasive strips

Fig.18

Inter-dental finishing strips to finishing the area interdentally.

polishing paste and goat brush for composite

Fig.19

Polishing paste with goat brush.

rubber cup polishing of composite resin

Fig.20

A rubber cup is used make the surface glossy.

felt wheel for glossy composite

Fig.21

Final polishing with felt wheel.

bleeding gums after rubber dam removal

Fig.22

Immediate frontal intra-oral view, healing of the gum should be satisfying on the check-up appointment, along with the color after rehydration.

gum bleeding after composite restoration

Fig.23

Immediate intra-oral view.

upper incisors composite restorations

Fig.24

Frontal intra-oral view after one week. Aesthetics and function are completely restored.

composite restorations on upper teeth

Fig.25

Final occlusion intra-oral view to show complete color matching.

smile restored with direct composite

Fig.26

Final self-confident smile.

before and after restoring teeth and smile

Fig.27

Comparisons of occlusion and the patient’s smile before and after.

before and after composite incisor restoration

Fig.28

Comparisons of intra-oral frontal view and the patient’s smile before and after. The periapical x-ray shows there is no overhanging of the filling material.

before and after smile makeover

Fig. 29

Comparisons of patient frontal view: initial, immediate and one week later.

Conclusions

When dealing with aesthetic restorations, an optimal reconstruction of the tooth profile is paramount. In case of diastema closure and class IV restorations, various tools and procedures can help the clinician to correctly restore the emergency profile; among these, the new Unica anterior matrix stands out because of its simplicity and versatility, allowing to quickly and easily restore both cervical and interproximal profiles at the same time, strongly reducing the chair-side time, and bringing aesthetics restorations within everyone’s reach.

Bibliography

1. Chiodera G. Replacement of a class V composite restoration. https://polydentia.ch/en/dr-chiodera-giuseppe-replacement-of-a-class-v-composite-restoration/.

2. Manauta J. Direct Stratification Composite Veneers with UNICA Anterior. https://polydentia.ch/en/dr-manauta-jordi-direct-stratification-composite-veneers-unica-anterior/.

3. Lazar D. Class IV restorations with UNICA Anterior. https://polydentia.ch/en/dr-lazar-class-iv-restoration-unica-anterior.