Esthetic Management of Fractured Anterior Teeth Using Direct Composite: A Case Report

INTRODUCTION

Direct adhesive methods provide nearly endless possibilities to restore function and aesthetics while conserving healthy tooth tissue.1 The 'natural layering concept' has been proposed for anterior tooth restoration since it is a simple and successful approach capable of mimicking natural tooth structure.2 In this procedure, different colours of composite were used for enamel and dentine in order to match the optical properties of these structures and provide an outstanding aesthetic3. This case report aims to describes a case of a permanent maxillary central incisors with an uncomplicated crown fracture treated with a composite resin restoration.

CASE REPORT

A 32-year-old male patient reported to the college, with a complaint of fracture in upper front tooth (Figure. 1). Dental history revealed that he met with an accident 6 months back resulting in an injury. Extra-oral examination revealed no significant findings. During the intra-oral examination, a class II Ellis fracture of left and right maxillary central incisor was diagnosed. There was no other pathology associated with the injury. Intraoral periapical radiograph shows enamel and dentin fracture without involvement of pulp in the tooth 11 and 21.

An alginate impression of maxillary arch was made and the stone model was constructed. Wax-up of the fractured teeth 11,21 was done. Thereafter, mould with a heavy silicon base impression material was made, reproducing the shape and contour of the needed restoration. The restorative material and the matching shade were selected.

After application of rubber dam (figure2), the teeth were etched and bonding agent was applied. (figure 3,4). The silicon index was then placed to the palatal surface of the teeth (figure 5). A3 enamel shade restorative material (3M ESPE Filtek Z350 XT) was applied to the palatal portion of the silicon index, and light-cure was applied for 40 s. After obtaining palatal shelf, a layer of dentin was made using A2 dentin shade (3M ESPE Filtek Z350 XT) composite restorative material. Thereafter, final contouring of the proximal and labial surface was done by applying enamel shade A2 composite resin (3M ESPE Filtek Z350 XT). Finishing, polishing and adjustments were performed with abrasive burs and polishing paper discs. (Figure 6,7,8)

DISCUSSION

The appearance of a patient's teeth is a well-established psychological element impacting his or her attractiveness and self-confidence.4 Direct adhesive restorations are widely utilised for the rehabilitation of uncomplicated crown fractures involving enamel and dentin fractures without pulpal involvement.5,6 The silicon index was used as a reference guide in this case, which aided in the reconstruction of damaged anterior teeth Then, using a dentine shade composite, a layer of dentine was built up. On the proximal and labial surfaces, a final layer of enamel was applied. Following the conclusion of the restoration build up, finishing and polishing were done.

CONCLUSION

A lost tooth structure can be rebuilt with composite resin restorative material using natural layering approach to create a natural-looking repair. However, this procedure requires a complete knowledge and good expertise of the operator to provide a highly beautiful repair.

REFERENCES