- Dr Anudeep Myakal
Abstract
Occlusal caries in molars and premolars is the most common problem we encounter in our patients. With patients being more conscious about their esthetics now, more and more patients demand tooth-coloured fillings for posterior teeth over silver ones. Caries involving enamel and dentin with cuspal involvement too, can be successfully treated using direct composite resin with good esthetic and functional outcome. Anterior crown fractures are common among school children. This impacts their function, esthetics, speech and psychology. An esthetic zone clinician must propose an exact and minimally invasive treatment plan. Achieving promising result in both esthetics and strength, is the greatest desire for patients as well as for parents. This case series describes a case each of esthetic direct composite restoration on a mandibular right first molar and fractured permanent maxillary central incisors, with a special note on shade selection.
Introduction
Caries in posterior teeth is very common as permanent mandibular molars are the first to erupt in the oral cavity and difficult to reach for cleaning. Coronal fractures resulting from dental trauma most frequently occur in the maxillary anterior teeth of children and adolescents. Adult anterior teeth may also suffer due to accidents, though less frequently than adolescents. Direct and indirect restorations are clinically successful treatment options for carious posterior teeth and fractured anterior teeth. Direct restorations are performed without laboratory phases. They usually involve enamel /dentin acid etching technique with adhesive systems and one or more types of composite resins.
This article reports a case each of a compound cavity on mandibular 1st molar and permanent maxillary central incisors with incisal crown fracture, restored using composite resin as direct restorations. Since shade selection is crucial for the anterior zone, it is described in elaborate detail in case report 2.
Case Report 1
A young engineering student reported to the clinic unhappy with the cement restoration on his mandibular right first molar.
We discussed and showed him some of our esthetic composite cases and patient immediately agreed to the treatment plan suggested to him.
- G-aenial A3 shade was perfectly matching shade in this case. (See section on ‘Shade Selection’ for this more details)
- After isolation, etching and bonding procedure was done as instructed by manufacturer.
- We started with first layer of flowable composite, then cusp by cusp build up according to the digital prescription with packable composite.
- We used LM Arte™ instruments for making natural pits n fissure which were then stained with yellow and ochre color from Coltene which makes restoration life-like.
- Finishing of the restoration done with red and yellow ring diamond burs (Mani) and a finishing kit (Shofu).
- Polishing of the restoration was done (AstropolPolishing kit , Ivoclar Vivadent).
Case Report 2
A 10 yrs old naughty child presented first time to the clinic with broken upper front teeth due to trauma.
where patient was not even ready to smile.
On examination, we found that there is Ellis class II fracture involving enamel and little dentin on upper 11,21. After clinical & radiological examination, we found that there is no pulpal involvement and no periapical pathology with 11 or 21. Vertical and horizontal tender on percussion (TOP) test was negative for both 11 & 21.
which was used for making palatal index.
We decided to go with minimally invasive and best treatment option in this case i.e ‘direct composite restoration ’ and explained the procedure to the child’s parents.
- The tooth was prepared by giving bevel of first 45˚, then 15˚ with finishing & polishing of both buccal & palatal surface.
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