Composite Resin as an imitator of the Natural Tooth

22 Jan 2018 - 16082

Composite resin restorations are, of course, not always the best option for broken teeth; these are a very usual emergency treatment in the dental office, the first option is to always try and reattach the original fragment of the natural tooth of the patient, if possible. In this article we present a clinical case that was treated four years ago with the reattachment of the patient’s own tooth fragment, but then the patient came back with no fragment, so we needed to treat the emergency with composite resin due to the age of the patient and with simple recipes, because this type of case always comes with no appointment in our agenda and that’s a fact that we need to take into account too for our daily practice. Here we present how we managed this case and how can we make this predictable to everybody

Fig. 1

A 16 years old girl comes to the office with an upper left central incisor broken due to an accident with a fork.

Fig. 3

This was the fragment 4 years before.

Fig. 4

And this was the result back then, in 2013.

Fig. 5

Back to 2017, we take clinical pictures again.

Fig. 6

Not only with DSLR cameras, even with mobile phone and MDP device.

Fig. 7

MDP allows us to obtain a fast polarized picture with any mobile phone.

Fig. 8

We took an alginate impression that was then poured with fast setting stone to create model to make our wax up and to have time to organize the agenda to treat the patient

Fig. 9

Wax up

Fig. 10

Fast wax up.

Fig. 11

Taking care of the palatal aspect.

Fig. 12

Silicone key.

Fig. 13

And the we proceeded with the restorative phase, rounding the angles with an oxide aluminum disc.

Fig. 14

Creating a small bevel and eliminating the white crack lines of the broken enamel.

Fig. 15

And then we isolated the field.

Fig. 16

The adjacent teeth were protected during sandblast with 29 microns aluminium oxide particles

 

Fig. 17

Pressure and water to make the sandblasting.

Fig. 18

Etching with orthophosphoric acid, 37%.

Fig. 19

Far away from the fracture line

Fig. 20

Universal adhesive system applied in several coats 

Fig. 21

Light-curing.

Fig. 22

With an LM Arte Fissura instrument we mark the limit of the fracture line in the silicone matrix.

Fig. 23

Apply the palatal enamel and polymerize it.

Fig. 24

With the palatal enamel we can continue the stratification process.

Fig. 25

With a sectional transparent matrix (Polydentia) and the help of an LM Arte Modella instrument we can create the inter-proximal walls.

Fig. 26

A brush allows us to smoothen the composite resin.

Fig. 27

We retire the matrix.

Fig. 28

Now that we have all the enamel built up, both palatal and interproximal, we continue with the stratification.

Fig. 29

Controlling the thickness of the dentine with the LM Arte Misura instrument and shaping the incisal mamelons with the Fissura.

Fig. 30

Smoothening of the surface with Compobrush.

Fig. 31

Finally applying the enamel according to the 0,5 mm thickness rule.

Fig. 32
Fig. 33

Final application before polymerization.

Fig. 34

Final polymerization.

Fig. 35

The power of the pencil.

Fig. 36

Decreasing grain SofLex discs were used.

Fig. 37

To improve the anatomy.

Fig. 38

Bur for secondary anatomy.

Fig. 39

Taking care of the embrasures.

Fig. 40

Interproximal finishing.

Fig. 41

Details.

Fig. 42

Always taking care of the palatal aspect.

Fig. 43

Final polishing.

Fig. 44

Final aspect before removing the rubber dam.

Fig. 45

Immediate post-op picture prior to rehydration.

Fig. 46

Immediate post-op.

Fig. 47

A few days later.

Fig. 48

Final aspect.

Fig. 49

Final result.

 

Conclusions

Natural fragments are always the best solution to treat fractures as we see in several publications; in this clinical case it was in fact a solution for four years in a young patient. When it is not possible we need to go for other options as composite resins that can imitate natural teeth in a very similar way with simple recipes. We need to know all possibilities that we have to give patients solutions for daily problems. In this case two accidents and still very young, do you think she will not have more? Hope not, but in that case we will be prepared.

Bibliography

  1. https://styleitaliano.org/villares-dental-fracture/
  2. https://styleitaliano.org/reattachment-fractured-teeth-margin-correction/
  3. https://styleitaliano.org/class-iv-reattachment-and-restoration-with-one-shade/
  4. https://styleitaliano.org/simple-recipes-for-young-patients/
  5. https://styleitaliano.org/power-of-pencil/