The Single Central Incisor Challenge
A very common and challenging situation to be solved on the daily office, is when we have a central incisor to be reproduced following his homologue. With composite resin or porcelain, we must reproduce the characteristics of the existing natural tooth so that its colors and shape are as similar as possible.
A 24 year-old female patient came to us to solve her case. An anterior tooth – 2.1 – with a composite veneer, but with defective color and shape. The tooth had a root canal treatment performed. Our option was to redo the composite veneer using direct composite resin.
Img. 1 – Frontal aspect of the smile.
Img. 2 – Close view of the incisors.
Img. 3 – Left view of the incisors.
Img. 4 – Right view of the incisors.
Img. 5 – Aspect after composite removal. We have to pay attention to the depth of preparation and incisal reduction. It has to be adequate to the opaquer, layering and incisal effects to be applied.
Img. 6 – Acid etching (Ultra-ecth, Ultradent)
Img. 7 – After the adhesive (Optibond-FL Kerr), the first opaquer layer(A1-B1-LO – Cosmedent) was applied. A second layer of opaquer was applied on cervical and in the remaining dark areas. At that time, we have to obtain at least 70-80% of value correction.
Img. 8 – The enamel frame (Renamell OW-Cosmedent) and the first dentin layer (Premise Dentin A2-Kerr) was built on a free-hand technique.
Img. 9 – The mamelons were built with the second layer of dentin (Herculite Classic A1 – Kerr). The opalescence enamel (Supreme GT-3M) was applied between mamellons.
Img. 10 – The two layers of enamel (Durafill A2 / A1 – Heraeus Kulzer) were applied. The dehydeation can be observed on the adjacent teeth.
Img. 11 – Immediate aspect after the removal of retraction cord and definition of basic geometry of the tooth.
Img. 12 – Refinement of polishing around margins and anatomy details.
Img. 13 – Aspect after 30 days.
Img. 14 – Black and white shot to evaluate the final value obtained.
Img. 15 – Left view of the incisors.
Img. 16 – Right view of the incisors.
Img. 17 – Final aspect of the smile.
Img. 18 – Close view of incisors on smile.
With this article, we were able to demonstrate that the dentist, in his daily practice, has the conditions to solve challenging cases by training his observing sense and knowing the properties of the materials available in the market.