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15065 Views - Feb 2017

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Traumatism in young kids is a very frequent pathology that we face everyday in our office. One of the most important aspects at the moment of treatment planning is time that passed since the trauma to try to save pulp vitality. Another important thing is to try and reattach the fragment if we got it. But when it is not possible to avoid the endodontic therapy, and there is no fragment, we need to use composite resins to solve the functional and esthetic problems thar are presented. It is important to have an easy protocol to obtain good results in an easy way with a few composite layers. A clinical case is presented to show the technique



Img. 1 - Young patient is referred to us from the endodontic office to solve the functional and esthetic problem

Img. 2 - Previous x-ray

Img. 3 - A macro close-up photograph shows us the details that we have to imitate in the incisal area to make a tooth similar to the adjacent one

Img. 4 - Cross polarized photograph displays us the details without the reflection of light

Img. 5 - We make a wax up to reproduce the form and obtain a silicone matrix that helps us during the stratification proccess of the restoration

Img. 6 - If we make our own wax up we practice the anatomy that we need to reproduce in the final tooth

Img. 7 - Palatal anatomy is very important in the modeling

Img. 8 - A color diagram can help us during the restorative process

Img. 9 - Rubber dam is mandatory to ensure the isolation of the field and reduce working time and distress. It is important to realize that with kids we need to be very fast to obtain a good cohoperation from them

Img. 10 - It is important to check the matrix with the rubber dam in place because sometimes clamps can interfere with the silicone

Img. 11 - For that reason we cut out the index near the cervical areas

Img. 12 - Etching the enamel is still the gold standard in adhesion even if we want to use autoeching systems to bond

Img. 13 - It is very important to guarantee that there is no remainder of orthophosporic acid after rinsing

Img. 14 - Autoetching system is used to bond the resin, three coats to obtain a uniform layer

Img. 15 - After polymerization a high value enamel is applied in the silicone index

Img. 16 - Now that we have the palatal shell we can continue with the rest of the layers

Img. 17 - During the preparation we make a small bevel and it is important to know the opacity of our dentin to be sure that we can disguise the fracture line

Img. 18 - Then we imitate the form of the mamelons that we see in the diagnostic photographs

Img. 19 - The fissura instument helps us in the construction of the mamelons

Img. 20 - Misura allows us to precisely maintain the 0,5 mm for the enamel layer

Img. 21 - White tints and a translucent color in the incisal area allow us to create the young tooth

Img. 22 - Now we can apply the vestibular enamel

Img. 23 - And smoothen it

Img. 24 - Immediate result after finishing and polishing procedures. The tooth needs to be rehydrated

Img. 25 - Final x-ray

Img. 26 - Immediate result with the polarized photograph

Img. 27 - One week after the result is integrated in the mouth

Img. 28 - The form is very similar to the adjacent tooth

Img. 29 - From the lateral view we can see of some details of the restoration...

Img. 30 - ...ike the white spots in the incisal area

Img. 31 - Black background photograph shows us the natural result

Conclusions

If you have a simple restorative protocol it will work in difficult cases and, if you know every step of the procedure and follow the recipe, results will come easy and fast. In young patients the most important thing is to be conservative, treat them fast and in a way that allows the nature to maintain the tooth as much as possible. Obtain their smiles is the best gift that our work can give us
 

Bibliography

  1. Baratieri LN., Araujo Jr E.M. Monteiro Jr S. Composite Restorations in Anterior Teeth: Fundamentals and Possibilities. Quintessence Books
  2. Dietschi D. Layering concepts in anterior composite Restorations. J. Adhes Dent 2001;3: 71-80
  3. Fahl N Jr. Achieving ultimate anterior esthetics with a new microhybrid composite. Compend Contin Educ Dent Suppl. 2000;(26):4-13; quiz 26.
  4. 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; 5: 102-124

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