The Single Discolored Central Incisor Challenge

A clinical case by our Community member Dr Rafael Decurcio

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Restoring single teeth with discoloration and shape change is a challenge in the day-to-day practice. Reestablishing the color morphology, shape and surface texture, so that the composite resin restoration blends in with the patient’s adjacent teeth is always our objective in these clinical situations.

style italiano styleitaliano intraoral picture showing discolored upper right central incisor

Fig.1
Frontal image of the upper maxilla demonstrating the Upper Central Incisor on the right side with a large composite resin restoration of the incisal edge extending into the buccal middle third with poor chromatic and morphological appearance.

style italiano styleitaliano old defective restoration and discolored tooth

Fig.2
Close-Up of Upper Central Incisors highlighting deficient aspects of the present composite resin restoration and substrate darkening in the Upper Right Central Incisor. The Upper Left Central incisor shows relevant incisal chromatic characteristics.

style italiano styleitaliano healthy tooth to be copied when restoring adjacent incisor

Fig.3
Lateral close-up of the upper left central incisor, highlighting the surface characteristics of macro and microtexture, vertical and horizontal.

style italiano styleitaliano polarized picture for color and anatomical analysis

Fig.4
Polarized image taken with Smile Lite MDP (Smile Line) showing intrinsic characteristics to the tooth structure.

style italiano styleitaliano wax up

Fig.5
Aesthetic Diagnostic wax-up for the fabrication of vertical and horizontal silicone indices for dental preparation.

style italiano styleitaliano guide bur for buccal preparation grooves

Fig.6
Initial orientation of the buccal reduction driven by an annular diamond bur, Style Indiretto V1 (Intensiv).

style italiano styleitaliano style indiretto v2 bur for veneer preparation

Fig.7
Dental preparation, with high-grained truncated-conical diamond tip, starting from the cervical third following the natural buccal inclination (Style Indiretto V2, Intensiv).

style italiano styleitaliano style indiretto v2 bur for veneer preparation

Fig.8
Dental preparation of the buccal middle third, with a high-grained truncated-conical diamond tip , Style Indiretto V2 (Intensiv), carried out by the initial grinding of central depth orientation.

style italiano styleitaliano style indiretto v2 bur for veneer preparation

Fig.9
Dental preparation of the incisal third, with a high-grained truncated-conical diamond tip (Style Indiretto V2, Intensiv), in the incisal third, carried out by the initial depth-oriented grinding.

style italiano styleitaliano buccal preparation of central incisor

Fig.10
Initial buccal tooth preparation following the three-thirds inclination of the Upper Central Incisor.

style italiano styleitaliano inicisal reduction removing old restoration

Fig.11
Incisal preparation, removing residues from the old composite resin restoration, providing space for the restoration of chromatic characteristics and incisal translucency. Furthermore, insertion of a retractor cord to refine the slightly subgingival cervical preparation due to the darkening of the entire substrate.

style italiano styleitaliano selective enamel etching

Fig.12
Selective etching with orthophosphoric acid, Ultra-Etch, Ultradent, restricted to enamel.

style italiano styleitaliano bonding dental surface with compobrush

Fig.13
Protection of the neighboring teeth using transparent strips during adhesive application (ScotchBond Universal Plus adhesive, 3M) with Compo-Brush (Smile Line) flat active tip brush.

style italiano styleitaliano 3m
style italiano styleitaliano 3m
style italiano styleitaliano veneer preparation with retraction cord

Fig.14
Palatal shell, guided by the wax-up, made with Filtek Supreme XTE WE, 3M composite resin.

style italiano styleitaliano palatal and proximal build up

Fig.15
Proximal walls made with composite resin Filtek Supreme XTE WE, 3M, with the aid of Unica Anterior Matrix (Polydentia) allowing restoration of the proximal surface and buccal composite volume.

filtek supreme style italiano dual-shade technique 3M
filtek supreme style italiano dual shade technique 3M
style italiano styleitaliano Application of composite resin Filtek Supreme XTE

Fig.16
Application of composite resin Filtek Supreme XTE DA1, 3M with cervical extension to the transition from the middle third to the incisal third, offering restorative space to the incisal characteristics of translucency.

style italiano styleitaliano layering of dentin shade

Fig.17
Use of Compo-Brush (Smile Line) flat active tip brush, providing an irregular dentin surface for natural light reflection.

style italiano styleitaliano layering of direct composite veneer

Fig.18
Application of Filtek Supreme XTE WB, 3M, in the transition between the middle and incisal thirds for restoration of morphological characteristics of dentin mamelons, with surface irregularity for more natural light reflection.

style italiano styleitaliano lm style italiano spatulas

Fig.19
The LM Arte by Style Italiano spatulas used in the restorative procedure.

style italiano styleitaliano incisal layering for direct veneer

Fig.20
Application of Filtek Supreme XTE BT, 3M translucent resin in the incisal edge region, in the space between the incisal edge and dentin mamelons.

style italiano styleitaliano application of final composite layer with solo anterior

Fig.21
After application of the chromatic features at the incisal edge using composite resin Filtek Supreme XTE WD, 3M, to mimic an extremely thin opaque halo and incisal white spots, Filtek Supreme XTE A3D, 3M was used to mimic small features. From the incisal edge, Filtek Supreme XTE WE, 3M composite resin was applied with an LM Arte Solo Anterior spatula on the buccal surface, evenly distributing the composite layer, obeying the three thirds of inclination.

filtek supreme style italiano dual-shade technique 3M
filtek supreme style italiano dual shade technique 3M
style italiano styleitaliano layered raw direct veneer with 3M composite

Fig.22
After light curing before and after applying an air-block water soluble gel, the retraction cord was carefully removed, and the basic three-thirds of inclination of the upper central incisor were restored.

style italiano styleitaliano direct veneer before polishing

Fig.23
Still dehydrated, the restoration was ready for morphological refinement procedures, highlighting the importance of establishing the three-dimensional limits in a mesio-distal direction, locating longitudinal ridges.

style italiano styleitaliano finishing direct veneer with soflex discs

Fig.24
Using SofLex PopOn Discs, 3M, the morphological adjustment procedure of the buccal surface begins, seeking to refine the 5 real inclinations of the central incisor.

style italiano styleitaliano polishing direct composite veneer

Fig.25
After all morphological adjustments to the vestibular surface, the finishing and polishing procedure begins with SofLex Spiral Diamond Discs, 3M, using light and constant irrigation to remove residues formed by the abrasion between surfaces, preventing their impaction on the surface of the composite and providing longevity to the polishing result and shine.

style italiano styleitaliano polishing composite veneer

Fig.26
After all the morphological adjustments of the vestibular surface, the finishing and polishing procedure begins with SofLex Spiral Diamond Discs, 3M, using light and constant irrigation to remove residues formed by the abrasion between surfaces, preventing their impaction on the surface of the composite and providing longevity to the polishing result and shine.

style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
style italiano styleitaliano finished composite direct veneer

Fig.27
After finishing and polishing, surface texture was natural and discreet, and natural light reflection was obtained by mimicking the characteristics of the upper left central incisor, used as a morphological and chromatic reference for the restoration.

style italiano styleitaliano direct composite veneer

Fig.28
Frontal image highlighting the morphological and chromatic integration with all the natural substrates present in the restoration performed.

style italiano styleitaliano surface texture of direct composite veneer

Fig.29
Close-Up of morphological characteristics of surface texture and polishing of the composite resin restoration.

Conclusions

The correct and obedient association of equipment, instruments, materials and restorative technique allows the rehabilitation of dental structures with naturalness and efficiency from the diagnostic and planning stage to the completion of the process, establishing the desired longevity and compatible with contemporary scientific evidence.

Bibliography

  1. Shah YR, Shiraguppi VL, Deosarkar BA, Shelke UR. Long-term survival and reasons for failure in direct anterior composite restorations: A systematic review.J Conserv Dent, 2021 Sep-Oct;24(5):415-420.
  2. Yamauchi K et al. Etch-and-rinse vs self-etch mode for dentin bonding effectiveness of universal adhesives. J Oral Sci, 2019 Nov 27;61(4):549-553.
  3. da Rosa WLO, Piva E, da Silva AF. Bond strength of universal adhesives: A systematic review and meta-analysis. J Dent, 2015 Jul;43(7):765-76.
  4. Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite shade guides and color matching. Int J Esthet Dent, . 2014 Summer;9(2):164-82.
  5. Terry DA. Dimensions of color: creating high-diffusion layers with composite resin. Compend Contin Educ Dent, . 2003 Feb;24(2 Suppl):3-13.
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style italiano styleitaliano Essential Dentistry kit online on demand course

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