The Single Central Incisor Challenge

Restoring a single central incisor is a pretty common and challenging situation to be solved in our daily practice. With composite resin or porcelain, we must reproduce the characteristics of the existing and neighboring natural tooth, so that its color, shape and texture are as similar as possible.

A 24 year-old female patient came to us to solve her case. Tooth 21 had with a composite veneer, but with defective color and shape. The tooth had a root canal treatment performed. Our option was to redo the composite veneer using direct composite resin.

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Fig.1
Front view of the smile.

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Fig.2
Close view of the incisors.

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Fig.3
Left view of the incisors.

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Fig.4
Right view of the incisors.

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Fig.5
Aspect after composite removal. We have to pay attention to the depth of preparation and incisal reduction. It has to be adequate to the opaquer, layering and incisal effects to be applied.

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Fig.6
Acid etching (Ultra-ecth, Ultradent)

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Fig.7
After the adhesive (Optibond-FL Kerr), the first opaquer layer(A1-B1-LO – Cosmedent) was applied. A second layer of opaquer was applied on cervical and in the remaining dark areas. At that time, we have to obtain at least 70-80% of value correction.

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Fig.8
The enamel frame (Renamell OW-Cosmedent) and the first dentin layer (Premise Dentin A2-Kerr) was built on a free-hand technique.

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Fig.9
The mamelons were built with the second layer of dentin (Herculite Classic A1 – Kerr). The opalescence enamel (Supreme GT-3M) was applied between mamelons.

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Fig.10
The two layers of enamel (Durafill A2 / A1 – Heraeus Kulzer) were applied. The dehydeation can be observed on the adjacent teeth.

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Fig.11
Immediate aspect after removal of the retraction cord and definition of basic geometry of the tooth.

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Fig.12
Finishing and polishing around margins and anatomy details.

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Fig.13
Aspect after 30 days.

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Fig.14
Black and white shot to evaluate the final value obtained.

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Fig.15
Left view of the incisors.

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Fig.16
Right view of the incisors.

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Fig.17
Final aspect of the smile.

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Fig.18
Close view of the smile.

Conclusions

Here is how you can solve challenging cases by training your observing skills and knowing the properties of the materials you’re using.

Bibliography

Fahl N Jr. Achieving ultimate anterior esthetics with a new microhybrid composite. Compend Contin Educ Dent Suppl 2000;26:4-13.
Lombardi R E. The principles of visual perception and their clinical application to denture esthetics. J Prosthet Dent 1973;29:358-382.
Devoto W. Pansecchi D. Composite restorations in the anterior sector: clinical and aesthetic performances. Pract Proced Aesthtet Dent.2007 ; 19 (8) : 465-470.
Baratieri LN. Esthetic Principles [in Portuguese]. Sao Paulo,Brazil: Quintessence Publishing; 1998:48.
Terry DA. Contemporary composite resins. In: Terry DA. Natural Aesthetics With Composite Resin. Mahwah, NJ: Montage Media Corporation, 2004:20-37.
Fahl N Jr, Denehy GE, Jackson RD. Protocol for predictable restoration of anterior teeth with composite resins. Pract Periodont Aesthet Dent 1995;7(8):13-21.
Vargas MA, Lunn PS, Fortin D. Translucency of human enamel and dentin. J Dent Res 1994; AADR Abstracts(Abstract No.1747).
Vanini L, Mangani F, Klimovskaia O. Il restauro conservative dei denti anteriori – ACME sas, Viterbo, Italy; 2005.
Dietschi D. Free-hand composite resin restorations: A key to anterior aesthetics. Pract Periodontics Aesthet Dent 1995;7:15–25.
Croll TP. Simulating irregular enamel surface texture in composite resin restorations. Quint Int 1988;19(4):311-312.
Hasegawa A, Ikeda I, Kawaguchi S (2000). Color and translucency of in vivo natural central incisors. The Journal of Prosthetic Dentistry 83:418-423

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