Direct Composite Repair of Fractured Central Incisor
Emergency repair with Shofu BeautiBond, Beautifil II, and Beautifil Flow Plus with UVeneer
All clinicians have busy days when almost everything seems to happen at once. It is even more challenging when a patient presents on that day in need of immediate esthetic attention. Suddenly, innovation, speed, and skill become key necessities.
In these circumstances, clinicians must have tools readily available within their armamentarium that provide excellent esthetics, an efficient workflow, and predictable results. The following article outlines a case with a same-day solution for the repair of a fractured central incisor using BeautiBond® (Shofu Dental Corporation, www.shofu.com), a seventh-generation bonding agent with two unique monomers to bond to enamel and dentin; Beautifil® II and Beautifil Flow Plus® (Shofu Dental Corporation), giomer composites that release and recharge with fluoride to add protection to the dentition; and UVeneer (Dental Art Innovations, www.uveneer.com), easy-to-use direct veneer templates.
A 27-year-old healthy man presented on a busy day for repair of a previously restored and now fractured right central incisor (Figure 1). He had an important interview to attend later that day. Upon review of his medical history and other pertinent information, the area was evaluated. Another dentist had previously restored the region. During the examination, the team assessed that the entire incisal third of the tooth was involved in the previous restoration.
The treatment plan indicated that a direct composite restoration would be placed. The fractured aspect of the tooth was quickly built up to help establish the proper incisal-lingual component of the tooth without etching or bonding the tooth. This process allows an immediate template to be created out of polyvinyl siloxane registration material for the final restoration. A technique by Dr. Dennis Brown was modified and used to create the index template with the registration material. The side of a plastic cup was cut to fit over the lingual and incisal of the anterior region, and the lingual and incisal edges were established with the composite mock-up, the registration material was expressed into the cut plastic and placed over the lingual and incisal of teeth Nos. 7 to 10. Once solidified, the excess from the facial was trimmed away to allow free access for the lingual and incisal build-up to be made (Figure 2).
An Isolation Mouthpiece (Isolite Dental, www.isolitesystems.com) was placed and the composite mock-up was removed from tooth No. 8. The tooth was then prepared for removal of the preexisting composite restoration. To provide retention and resistance, the clinician extended the preparation toward the middle third on the facial and lingual of the tooth, feathering the margin as the preparation came closer to the middle third of the tooth on each side. Teflon tape was placed on the adjacent teeth; tooth No. 8 was etched with 37% phosphoric acid to enhance adhesion to any uncut enamel. It was then rinsed and dried. A seventh-generation bonding agent, BeautiBond, was placed on all surfaces in need of restoration, as directed by the manufacturer. This product contains two unique monomers to enhance the bond to enamel and dentin. The dentin bonding monomer, carboxylic acid, has been shown to help inhibit matrix metalloproteinase breakdown of the hybrid layer in the dentin interface.1 Beautifil II shade A2O was selected because it is a giomer composite, which has the ability to release and recharge fluoride to help protect the teeth,2,3 and has been shown to have long substantive restorative benefits.4,5 It was placed on the lingual of the tooth to build it up with the aid of the template created earlier to establish lingual and incisal edges of the tooth (Figure 3). After curing from the facial, the index template was removed and the lingual was cured for an additional 20 seconds to ensure cure of the composite.
Creating a Direct Composite Veneer
The proper size and shape veneer template was selected from the UVeneer system and tried over the prepared tooth. This UVeneer template was then filled up two thirds of the way with Beautifil Flow Plus 00 shade A2 (Figure 4) and placed over the facial aspect of tooth No. 8, aligning it to the long axis of the tooth using the positioning line found in the center of each UVeneer. The composite in the veneer was cured for 30 seconds and then the UVeneer was removed from the restored tooth (Figure 5). The Teflon tape was removed from the adjacent teeth and the composite restoration on No. 8 was trimmed using composite finishing carbides. It is important to avoid using these on any part of the new veneer surface because they could ruin the high-luster finish provided by the UVeneer template on the facial of the tooth.
Super-Snap® X-Treme™ disks (Shofu Dental Corporation) were used to polish the embrasures and incisal edge of the tooth; OneGloss® (Shofu Dental Corporation) polishers were used on the lingual of No. 8. The occlusion and excursions were checked with Microcopy Bite-Chek® articulating paper (http://microcopydental.com). The final result (Figure 6) looked excellent and the patient was very satisfied with the results.
Clinicians can benefit from keeping emergency items in the dental office for surprise cases. It makes the day that much easier to have key items, such as mouthpieces, bonding agents, and polishers, on hand for those patients in need of emergency dental procedures. In this case, having BeautiBond, Beautifil II, and Beautifil Flow Plus with the UVeneer system on hand saved this patient’s restoration.
1. Almahdy A, Koller G, Sauro S, et al. Effects of MMP inhibitors incorporated within dental adhesives. J Dent Res. 2012;91(6):605-611.
2. Nakamura A, Yamada A, Iwamoto T. Two-year clinical evaluation of flowable composite resin containing pre-reacted glass-ionomer. Pediatric Dental Journal. 2009;19(1):89-97.
3. Fujimoto Y, Iwasa M, Murayama R, et al. Detection of ions released from S-PRG fillers and their modulation effect. Dent Mater J. 2010;29(4): 392-397.
4. Gordan VV, Mondragon E, Watson RE, et al. A clinical evaluation of a self-etching primer and a giomer restorative material: results at eight years. J Am Dent Assoc. 2007;138(5):621-627.
5. Gordan VV, Blaser PK, Watson RE, et al. A clinical evaluation of a giomer restorative system containing surface prereacted glass ionomer filler: results from a 13-year recall examination. J Am Dent Assoc. 2014;145(10):1036-1043.
About the Author
John C. Comisi, DDS, MAGD
Ithaca, New York