As we all know in our profession, an emergency visit can be a stressful situation not only for the patient but also for the provider when someone fractures a front tooth. In other words, you never really know what to expect when a new patient calls and says they chipped or broke their front tooth. In some instances this means a small chip that can easily be smoothed or in other instances this means they have broken a major portion of the tooth.
Case Presentation
In this particular situation, a new patient presented to my office with about 2/3 the length of his right maxillary lateral tooth fractured off exposing the nerve (Figure 1). This seventeen-year-old male patient had broken this tooth from a skateboarding accident just thirty minutes prior and was complaining of constant throbbing pain.
A quick yet thorough health history indicated no medical complications. Radiographs were also taken of the area. Clinically, the soft tissue intra- and extraorally were not harmed in any way. Since the fracture extended into the pulpal region with hemorrhaging and pain present, it was in the patient’s best interest to have root canal therapy performed. All risks, benefits, and alternatives were reviewed with the patient and his mother and consent forms signed.
Anesthetic was quickly administered to get the patient anesthetized and comfortable. Utilizing the EndoTouch™ TC handpiece and K3 Nickel-Titanium Files the injured tooth was quickly cleaned, filled, and obturated. The preparation was beveled with a diamond bur not only to increase surface area, but also to avoid a butt joint margin on the facial aspect of the tooth that would make a finish line very noticeable. Because the patient was still very young and was in need of orthodontics in the future, it was decided not to place a post or crown at this time. Instead, our goal was to build the tooth up with composite over a fiber-reinforced (Ribbond® Original) substructure. This would allow the patient an opportunity to pursue orthodontic care without a concern of bonding to a porcelain restoration.
Once 4 mm of gutta percha was removed from the coronal aspect of the remaining tooth, a 37% phosphoric tooth conditioner was placed on the tooth preparation for fifteen seconds and then rinsed with copious amounts of water and dried. Using white plumbers tape the tooth was isolated to prevent getting any bonding agent on the adjacent teeth (Figure 2). A fifth-generation bonding agent (Optibond Solo Plus) was placed, lightly dried and cured for 10 seconds with an LED curing light (DEMI™ LED Light Curing System). Using a flowable composite (Premise), the fiber reinforced material (Ribbond® Original) was wetted with a thin layer, placed in the chamber, and cured (Figure 3). A nanofilled restorative material (Premise) of shade A1 was incrementally placed and cured. Once the bulk of the restoration was accomplished, it was time to trim and shape the restoration to give it a natural shape and luster.
In order to achieve this, I used the OptiDisc finishing and polishing discs (Figure 4). The OptiDisc comes in a three grit system to obtain a final polish similar to that of natural dentition. An Extra-Coarse disc was first utilized for gross removal prior to finishing and polishing (Figure 5). Once the general shape was accomplished, the medium and fine grit discs were used to obtain the final shape and luster (Figure 6).
Comments
According to the manufacturer, the translucent, flexible, color-coded, polyester discs are indicated for finishing and polishing composites, glass ionomers, amalgams, and semiprecious/precious metals. I found that OptiDiscs patented retention system and special coating of the mandrel provided great protection against scratching and discoloration. Some of the other advantages I personally found compared to other systems on the market were:
- Translucent disc. Enhances work surface visibility.
- Flush-mounted mandrel. Protects neighboring teeth and tissue. No scratches or black lines.
- Identifiable color-coding system. Color indicates grit type. Abrasive side is always green.
- Three-step polishing system. Achieves natural high gloss with fewer steps.
- Contouring disc. Extra-Coarse grit available for contouring prior to finishing and polishing.
Conclusion
An emergency in the dental office of a new patient is a great opportunity to not only provide your services to remedy their condition, but also impress them so that they will return for routine care and refer friends and family. With the OptiDisc finishing and polishing disc system by Kerr Hawe, we were able to restore the patient’s tooth to a healthy and natural looking condition. Since he and his mother were so impressed with the restoration of this tooth, they signed up for orthodontic care with our office to further enhance his smile!
Figure 1: Fractured tooth #7 from an accident.
Figure 2: Isolated tooth prepared for bonding.
Figure 3: Ribbond material for reinforcement.
Figure 4: OptiDiscs used for shaping and finishing.
Figure 5: Coarse disc used for shaping.
Figure 6: Completed composite restoration.