5th Time Repair
with direct-bonded composite resin
(and protected by NTI-tss bite-guard appliance,
not shown here)
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Trauma caused fracture of central incisor. Patient
was treated by a paedodontist (children’s dentist). He
restored the tooth with direct-bonded composite resin. However,
the patient grinds her teeth at night when sleeping. This habit,
in a deep overbite, is blamed for loss of the restoration. The
restoration was placed 4 times. Then the patient was referred
to Dr. Perlmutter, perhaps to make an indirect porcelain restoration.
However, Dr. Perlmutter was concerned that, in this environment
of bruxism and deep overbite, even the porcelain might fracture.
Also, more cutting of tooth would be needed for porcelain, than
for direct-bonded composite resin. With the consent of the mother
and the patient, it was agreed to repair this tooth for a 5th
time with direct-bonded composite resin, but with two important
changes from the previous 4 restorations: Dr. Perlmutter prepared
a substantial bevel 360 degrees around the tooth, for more surface
area for bonding to create more retention, and, the patient
would wear an NTI-tss bite-guard appliance when sleeping, to
protect the restoration. |
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For dentists, I describe the technical
details. Some previous, residual resin was removed from the
labial surface of tooth 1.1. A substantial bevel was placed
circumferentially in enamel, with no increased exposure of dentin,
of this young, vital tooth. Phosphoric acid etch was applied
and washed off. OptibondFl bonding resin was applied, followed
by 4 Seasons microhybrid composite resin.
The dentin shade was applied first, overlapping the bevel and
extending incisally.
Then the enamel shade was applied, covering all of the dentin
shade and completing the total bulk. Restoration was carved
and polished. (I did not spend extra time with additional shades
for incisal translucency or characterization.) The use of one
dentin shade and one enamel shade was adequate to hide the fracture
line and create a natural appearance. |
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Treatment
by Dr. Mel Perlmutter, 2003 |
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