Simple Recipes for Young Patients

27 Feb 2017 - 32693

Trauma 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 that 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

Fig. 1

Young patient is referred to us from the endodontist to solve the functional and esthetic problem.

Fig. 2

Previous x-ray.

Fig. 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.

Fig. 4

Cross polarized picture shows us the details without the reflection of light.

Fig. 5

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

Fig. 6

If we make our own wax up we practice on the anatomy we need to reproduce in the final tooth.

Fig. 7

Palatal anatomy is very important in the modeling.

Fig. 8

A color diagram can help us during the restorative process.

Fig. 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 cooperation from them.

Fig. 10

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

Fig. 11

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

Fig. 12

Etching the enamel is still the gold standard in adhesion even if we want to use self-etching systems to bond.

Fig. 13

It is very important to guarantee that there is no residual orthophosporic acid after rinsing.

Fig. 14

Self-etching system is used to bond the resin, two coats to obtain an even layer.

Fig. 15

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

Fig. 16

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

Fig. 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.

Fig. 18

Then we imitate the form of the mamelons that we see in the diagnostic pictures.

Fig. 19

The LM Arte Fissura instrument helps us in the modeling of the mamelons.

Fig. 20

LM Arte Misura allows us to precisely leave the 0,5 mm for the enamel layer.

Fig. 21

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

Fig. 22

Now we can apply the vestibular enamel.

Fig. 23

And smoothen it.

Fig. 24

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

Fig. 25

Final x-ray.

Fig. 26

Immediate result with the polarized photograph

Fig. 27

One week after the result is integrated in the mouth.

Fig. 28

The shape is very similar to that of the adjacent tooth.

Fig. 29

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

Fig. 30

Like the white spots in the incisal area.

 

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. Getting them to smile is the best gift that our job can give us.

Bibliography

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