Single Central Incisor. A case report.

A solitary tooth fracture can present a significant aesthetic concern for the patient’s well-being, as well as pose a meticulous challenge in terms of aesthetics.

The selection of enhanced restorative materials that mimic the physical properties and other characteristics of natural teeth, along with restorative techniques like proximal adaptation, palatal wall placement, and incremental layering, establishes the foundation for achieving an aesthetically pleasing restoration.

styleitaliano style italiano man with chipped incisor composite restoration

Fig.1
A 33-year-old man visited my dental practice seeking a solution for his fractured tooth. He expressed a preference for a conservative approach to restore his tooth without causing additional wear.

styleitaliano style italiano broken central incisor composite restoration

Fig.2
Close-up intraoral examination was conducted to analyze the fracture on the incisal edge of tooth 11.

styleitaliano style italiano button try color matching Kulzer Venus Pearl composite

Fig.3
As a first step, isolation was achieved using a rubber dam. Nowadays, dentists recognize the importance of the rubber dam in facilitating technical precision.
For color selection, the “button-try” technique was employed. Clear translucent CL (Venus Pearl, Kulzer GmbH) and Opaque medium chromatic OMC (Venus Pearl, Kulzer GmbH) were chosen for this case.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
styleitaliano style italiano preparation of chipped edge for adhesion

Fig.4
The surface was polished, and the edges were softened to prepare for the restoration. This step is crucial as sharp edges can affect the transition between the tooth and the restoration. With the preparation completed, the tooth was now ready to receive the restoration.

styleitaliano style italiano silicone index

Fig.5
Following the wax-up, a silicone palatal key was utilized to transfer the future design to the patient’s mouth.
When employing a rubber dam, positioning the silicone guide in the anterior region can pose its own challenges, so it’s essential to always double-check the position of the index. To facilitate this process, we utilize B4 clamps.

styleitaliano style italiano surface treatment for adhesion

Fig.6
The bonding agent, Bond, was applied and brushed onto the enamel surface for 20 seconds following a 30-second etching process. Subsequently, it was gently air-blown for at least 5 seconds and then light-cured for 20 seconds.

styleitaliano style italiano palatal build-up Kulzer Venus Pearl composite

Fig.7
The palatal wall was layered using the translucent composite CL (Venus Pearl, Kulzer GmbH). This specific composite was selected to augment the natural translucency of the teeth and enable light transmission through the surface.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
styleitaliano style italiano side view of palatal build up Kulzer Venus Pearl composite

Fig.8
Copying the translucency of tooth 11 to tooth 21.

styleitaliano style italiano staining of incisal composite restoration

Fig.9
We applied white stains between the final layer of dentin and the last layer of enamel to replicate the white spots present on the patient’s natural tooth.

styleitaliano style italiano final result after direct composite restoration

Fig.10
The final layer of enamel was added, and polishing was performed using Lucida™ Star Felt and Paste. This system enables a single-step polishing of the composite restorations, ensuring a smooth and glossy finish.

styleitaliano style italiano direct composite restoration

Fig.11
A close-up assessment of the micro and macro anatomy of the restoration.

Conclusions

The restoration of a single tooth presents a significant aesthetic challenge. Direct restorations offer a successful, minimally invasive treatment option with minimal cost and reduced chair time.

When attention is given to proper preparation design, adherence to adhesive protocols, and meticulous finishing and polishing procedures, direct restorations can achieve aesthetic results comparable to ceramics.

Bibliography

  1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
  2. Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, Haikel Y, Cuevas-Suárez CE. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021 Mar 7;13(5):814.
  3. 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 Mar 1;5(1):102-24.
  4. Devoto W, Pansecchi D. Composite restorations in the anterior region: clinical and aesthetic performances. Practical Procedures & Aesthetic Dentistry: PPAD. 2007 Sep 1;19(8):465-70.
  5. Ortensi L, Sigari G, La Rosa GR, Ferri A, Grande F, Pedullà E. Digital planning of composite customized veneers using Digital Smile Design: Evaluation of its accuracy and manufacturing. Clinical and Experimental Dental Research. 2022 Apr;8(2):537-43.

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