Dr. Niharika Jain Gupta (Jabalpur, India) is a micro-endodontist and an Associate Professor at Triveni Dental College & Hospital, Bilaspur, India. She is also a research collaborate to Ph.D research projects at IIITM, Jabalpur and a key opinion leader for Micromega, Meta-Biomed, Bombay Dental & Surgical. She is one of the coveted speakers at the DRDCA 2020 International.
Introduction
Oro-facial trauma, the second most common cause of tooth loss, has a significant effect on patient’s appearance and mastication. It mainly affects children and adolescents, especially involving the crowns of maxillary central incisors. A thorough understanding of the expectation of the patient is absolutely critical for success. The repair of tooth fracture with the help of full crown or indirect veneer requires high financial expenses, is more time consuming and needs multiple appointment therapy. In this case report, single visit esthetic rehabilitation of fractured anterior tooth restored with direct veneer, after one visit endodontic therapy is presented.
Case Report
A 22-year-old male patient presented to the dental clinic, with a chief complaint of fractured maxillary central incisor caused by an accidental fall 1 month back. Thorough intraoral examination revealed Ellis Class III fracture irt 21 and Ellis class II irt 11 (Figure 1). Root canal treatment of 21 was considered as the pulp was involved. As the patient requested urgency in the treatment, a one-visit technique was planned including single visit endodontics in 21 followed by prefabricated composite resin veneer in 11 and 21.
Endodontic Procedure
Direct access was gained to the root apices under rubber-dam after local anesthetic administration. Working length was determined and glide path was established up to a size 20 K-file. Root canal preparation was done using a Self Adjusting File (four minutes) and the Vatea irrigation pump to deliver 3% sodium hypochlorite during canal preparation (Figure 2). Obturation was completed with gutta percha (F3 ProTaper Gutta Percha Cone,Dentsply Maillefer, Ballaigues, Switzerland) and calcium hydroxide based sealer (Sealapex, Kerr) using an obturating system (EQV Obturating System, Meta-Biomed, Japan)
Restorative Approach
The post space was prepared (Figure 3) to receive the fiber reinforced post. The fiber post was checked for the fit and cemented using dual cure cement . Core build up was done with composite resin (Tetric N ceram, Vivadent, Lichtenstein).
Minimum Tooth preparation was done i.r.t. 11 (0.5 mm) with a diamond bur in the buccal surface to facilitate the insertion of prefabricated composite resin veneers (PCRV) (Figure 4). The PCRVs for the patient presented in this case report (Edelweiss Veneers, Edelweiss Dentistry, Wolfurt, Austria) are fabricated with a nanohybrid composite cured with high temperature and high pressure, producing a veneer with enhanced mechanical properties compared to a conventional composite restoration. In addition, these veneers are fabricated by a proprietary laser sintering technology which extracts the resin component from the composite shell and produces a veneer with high inorganic content and a highly esthetic, laser-sintered surface.
Edelweiss Prefabricated Veneers are available in four sizes (XS, S, M, L) and a custom sizing guide is provided to select the veneer which best fits the tooth preparation. For the patient in this case, medium size veneer was selected.
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