CHIEF COMPLAINT:
Patient was aesthetically displeased with a composite resin restoration on her upper left central incisor, which fractured frequently.
DIAGNOSIS:
Female patient, twenty-seven years old, non-smoker. Presented a “Class IV” composite resin restoration, on the mesial angle of tooth 2.1. This restoration was aesthetically lacking and fractured frequently. The incisal edge of the right central incisor, as well as the remaining left central incisor, both presented rather prominent markings. Several translucent areas would make this a challenging restoration, both technically and aesthetically. No dentine was exposed in the fractured area. The patient expressed her preference for a conservative approach to this rehabilitation.
TREATMENT PLAN:
Two therapeutic options were presented to the patient:
• Restoration using composite resin;
• Application of a micro feldspathic ceramic restoration (MCR), using the palatine surface for retention.
Being given a clear understanding of the pros and cons of each option, the patient opted for the micro ceramic restoration.
TREATMENT NOTES:
A preliminary silicon impression was made, for a provisional dual polymerization composite resin restoration. Afterwards, all restorations were removed and dental preparation was performed. Preparation consisted in planning the dental angle and lightly prepping the palatine surface, for an interference-free settlement. A “one-step, double mix impression technique” was made, followed by a temporary restoration, using dual polymerization without bonding. In the lab, once the working model was available, a micro feldspathic ceramic restoration was fabricated. This micro ceramic restoration used the mesial palatine surface and the incisal angle for stability. On the vestibular surface, the ceramic piece overlapped the dental vestibular surface by about 2 mm. Back in the clinic, the temporary restoration was removed. Dental surface was appropriately prepared and the ceramic piece, once properly settled, was bonded to the tooth. The ceramic surface overlapping the dental vestibular surface was carefully eliminated, by gradually polishing it with rubber tips and discs.