By: Sable A Muntean, DMD, MHSA
This article originally appeared on DMG-Connect.com. Dr. Muntean granted permission for it to be shared with igniteDDS readers.
It is a super busy day at the office and you have a patient walk in with two chipped front teeth that need to be addressed because he has a big business meeting coming up where he needs to make a great impression. How did he do it? Swimming… right into the wall!
He is an absolute gem of a person and you are trying to work him in between patients to be able to give him the confidence back he so desires right before his important event.
You have no tooth fragment to bond to his natural tooth and you want to be able to create a seamless color match in the nick of time.
Sound all too familiar?
This was exactly what happened with my patient who had chipped #8 and 9 (Figure 1) the evening prior and I needed to work quickly and efficiently to help him out. You could say I was his lifeguard in his dire situation.
Figure 1: Initial Presentation of #A8 with IFL fracture and #9 with MIFL fracture
There was no need to crown the teeth due to the somewhat minimal extent of the break, no pulpal exposure, and no true need for anesthetic as preparation of the teeth was minor (though I still administered it for comfort).
Please also note that you should always look at the occlusion before any restoration. Notice how crowded his lower anterior teeth are- this also contributed to the manner in which his teeth fractured and how I need to restore them. Thankfully I did not need to suture the laceration in his lower lip too!
I wanted a composite that came in a universal shade that was easy to match to his existing dentition, as well as a composite that handles well to be able to manipulate to rebuild the tooth since I didn’t have time to make a wax up and stent. I also wanted one that would be durable… in case he decides to go for the gold in his swimming endeavors!
The first step was to prepare the teeth by not only slightly roughening up the enamel, but more importantly, creating a long bevel to minimize the transition between his natural tooth and the new resin restoration. Making the bevel with a bit of a zigzag/starburst design helps with that even more, instead of a straight line (Figure 2).
Figure 2: Preparation of #9 with a long bevel and
protection of #8 using Teflon tape during the restoration of #9
Next, it was important to do these fillings separately, so Teflon tape was placed to protect the neighboring tooth (Figure 2). Etching the enamel for a sufficient time to allow for a frosted white look, followed by primer and bonding agent, is essential in the system of preparing the tooth for restoration.
Now came the star of the show: Ecosite Elements (fun fact Ecosite is meant to be pronounced the German way as “Echo-Sit” which just makes it sound even more cool).
This composite system is made for anterior and posterior teeth and has a compact shade system that allows for the provider to use either one or multiple layers to easily match to the VITA shade guide with any combination.
I did freehand this restoration using a clear matrix to build the lingual layer first, cure it, and then proceed to further layering of my packable composite. In his case, Ecosite’s A3 shade was used. I personally like to make my final layer flowable to allow for a smoother finish and seamless blend between the composite and natural tooth structure.
Another noteworthy trait of Ecosite Elements is its NC1 technology which basically means that because the composite does not cluster, it allows for a more homogenous mixture that makes it much easier to be polished and gives a more aesthetically pleasing result. This was yet another reason as to why I chose this composite, especially for these anterior restorations. As you can see in the final photograph (Figure 3), I have a beautiful, natural shine, and the patient felt as if he had his natural tooth structure back (of course with minimal to no contact in maximum intercuspation and excursive movements).
Figure 3: Final restorations after polishing
Happy Patient= Happy Dentist= A Great Day
The race to the finish line is not always about time but a long-lasting, predictable, and
aesthetic result which DMG’s Ecosite Elements was able to deliver.
Photo by Daniel Frank
