Case Background
An 18-year-old high school senior had been seeing her dentist for many years. During her adolescence, an accident occurred resulting in the fracture of her maxillary left central incisor. It was conservatively repaired with a Class IV direct composite restoration. At a recent 6 month recall examination, it was apparent that the restoration was breaking down and no longer matched the adjacent teeth. The patient and her parents were presented with two treatment options.
The conservative option: remove the existing restoration, replace with a new composite restoration. The main drawback to this technique is that the shape and color are extremely difficult to match with the adjacent teeth. In addition, the contouring and polishing phase is tedious and time consuming.
Option #2: prepare the tooth, take an impression and bond a laboratory fabricated porcelain restoration in place.
For financial reasons, the conservative treatment was decided upon, utilizing a silicone matrix. Similar techniques were published in the November/December 2006 and January/February 2007 issue of Practical Procedures & Aesthetic Dentistry by Newton Fahl, DDS, MS,1,2 and the September/October 2006 issue of the same journal by Marcos Vargas, DDS, MS.3 A silicone matrix is used as a lingual and incisal guide, allowing the clinician the ability to predictably and efficiently create ideal anatomical form while maintaining control of composite placement and shading.
Case Treatment
A vinyl polysiloxane putty impression material was used to create a matrix of the lingual and incisal portions of the tooth to be restored.
Figure 1: A Vinyl Polysiloxane Matrix of the Lingual and Incisal
The tooth was isolated and preparation was begun using a long, beveled bur.
Figure 2: Preparation of the Tooth
The completed prep was then etched and a bonding agent was applied. An initial lingual base layer of a pre-selected dentin shade was placed and cured. The opaqueness of the dentin shade minimizes “shine-thru” from the back of the mouth. Multiple layers of an enamel shade were then applied and cured. By doing this, the color of the restoration was controlled in a posterior-to-anterior direction.
Figure 3: Varying Dentin and Enamel Shades of Composite are Applied
Attention to placement was taken to thoroughly overlap the layers. Shading was also modified using a light-cured viscous liquid resin color modifier and paint brush. A final translucent layer was placed. Because all natural teeth have texture, a fine-grit finishing diamond, in a high-speed electric handpiece, set at its slowest speed, was used to recreate this natural texture. KOMET USA Q-Finishers were used to shape and contour the tooth.
Figure 4: Shaping and Contouring with Q-Finishers
These tungsten carbide Q-Finishers minimize the time required for contouring, finishing and polishing. Polishing discs and points were used to achieve the final high shine.1-4
Post Operative
The matrix technique is a predictable method to conservatively restore a Class IV fracture in an efficient, cost-effective manner. The advanced technology utilized in the manufacturing process of KOMET USA’s selection of Q-Finishers minimizes the time and armamentarium required to produce desirable results
Figure 5: Final Restoration
References
- Fahl N Jr. A polychromatic composite layering approach for solving a complex Class IV/direct veneer-diastema combination: part I. Pract Proced Aesthet Dent. 2006;18(10):641-645.
- Fahl N Jr. A polychromatic composite layering approach for solving a complex Class IV/direct veneer-diastema combination: part 2. Pract Proced Aesthet Dent. 2006;19(1):17-22.
- Vargas M. Conservative aesthetic enhancement of the anterior dentition using a predictable direct resin protocol. Pract Proced Aesthet Dent. 2006;18(8):501-507.
- Terry DA. Natural Aesthetics with Composite Resin. 1st ed. First Ed. Mahwah, NJ, Montage Media Corp, 2004.