Rhona Eskander describes how a trauma case was treated with composite resin and tints to achieve an aesthetic and natural result.
A 19-year-old gentleman came to see me at the Chelsea Dental Clinic. I had been recommended to him by a family member. He had fallen and fractured two of his front teeth.
The patient presented two days after the accident with several grazes to his face and enamel dentine fractures to his UR1 and UR2 (Figures 1 and 2). The UR2 was slightly tender to percussion. An electric pulp test was undertaken and the UR2 had a delayed response, indicating that the vitality of the tooth may have been impaired. A periapical (PA) view was taken of both anterior and posterior teeth. No pathology was found.
In order to repair the fractures, the treatment options included veneers, crowns or composite. Veneers were considered but, due to the destructive preparation necessary and the possibility that root canal treatment might be needed in the future, the patient was advised to have composite restorations (Figure 3).
It was explained that composite treatment may not be permanent and would depend on the location in the mouth, the quality of oral hygiene and diet.
The patient was advised that he would need to be careful with his future food choices and must avoid eating toffees and biting into hard foods, such as carrots and apples. He was instructed to rinse daily with fluoride mouthwash, floss every day and avoid using his teeth to bite or hold hard objects. Composite can be repaired if damaged, but treating his teeth carefully and using general common sense would help prolong the life of the restorations.
As there had been some soft tissue trauma, the patient was given antibiotics to prevent infection. He was asked to return in a week for review. At the review appointment, both teeth were vital. The electric pulp test reading for the UR2 had increased and there was no evidence of pathology or further symptoms.
The patient returned two weeks later for the restorations. The UR1 and UR2 were isolated using a latex-free lip and cheek retractor. Working shades were matched and selected. Several fluorosis spots were noted. The teeth were etched with 37% phosphoric acid and Kulzer Ibond Universal was applied. I use Ibond Universal because of its superior bond strength.
Kulzer Venus Pearl was chosen to restore the UR1 and UR2 (Figures 4 and 5). Clear Light (CL) shade was used to create the palatal shell. Incremental layers of Opaque Light Chromatic (OLC) and A2 were used to build up the damaged teeth using a freehand composite technique.
Finally, Kulzer Venus Color, white tint, was added to recreate the fluorosis spots (Figure 6). Venus Pearl composite was chosen because it has good handling properties and creates long-lasting, highly aesthetic restorations. It also has great polishability and a superior shine.
The occlusion was checked in all excursions using Bausch Progress 100 blue articulating paper. Polishing was completed using the Kulzer Venus Supra Polishing Kit (Figure 7). The range of pre- and high-gloss polishers are suitable for all types of anterior and posterior restorations and are very easy to use.
The patient returned for review two months later. The restored teeth were vital with no adverse symptoms and the X-rays were clear. He was asked to return for a follow-up appointment in four months. The patient was very pleased that minimally invasive treatment was possible and further damage to his teeth was avoided (Figure 8). He was delighted to have his natural smile back (Figures 9 and 10). In his own words, the outcome was a ‘lifesaver!’