CDE0111

10 I I clinical technique _ fractured maxillary central incisors cosmeticdentistry 1_2011 Fig. 26_Dentine bonding agent is appliedonallsurfacesandlight-cured. Figs. 27 & 28_The CompoRoller (KerrHawe) is used to form a thin layer (1 to 1.5 mm thick) of incisal shade to place into the silicone index, which is used as a template to guide placement of the palatal incisal layer and ensure the correct length of the tooth. Fig. 29_Silicone index removed, showing the initial build-up layer. Fig. 30_A thin layer of dentine shade is placed at the mesial, incisal and distal edges to simulate an incisal halo. Fig. 31_A rounded conical-shaped hand instrument is used to create dentine mamelons. Incisal shade was rolled out (Fig. 27) and placed intoindextobuild-upthepalatalaspectandin- cisal edge, and subsequently light-cured with the index in situ (Fig. 28). _Step 2: The index was removed and the palatal incisal layer inspected to ensure that it was not too thick and that sufficient space was avail- able for the remaining layers (Fig. 29), and sub- sequently light-cured from the palatal aspect. _Step 3: A thin layer of Herculite XRV Ultra Den- tine A1 was placed at the incisal edge, mesial and distal aspects to re-create the incisal halo effect (Fig. 30). _Step 4: Using a suitably shaped instrument, Dentine A2 shade was used to copy the mamelon effect of the reattached fragment on the right central incisor (Fig. 31). _Step 5: CompoRoller tips of various shapes, for example conical and cylindrical, were used to sculpt the Enamel A1 covering layer (Figs. 32–34). _Step 6: The reconstruction was completed with a thin covering layer (0.5 mm) of Incisal shade at the incisal third of the build-up (Fig. 35). The final contouring and finishing were post- poned for one week. This allows re-evaluation of the shade and characterisations by both the patient and clinician. Necessary changes were performed before proceeding with the finishing and polishing. Composite layering is a lengthy and painstaking process, requiring meticulous attention by the operator and pro- tracted endurance by the patient. Both these factors contribute to tiredness and loss of concentration, and finishing and polishing after a long treatment session is inadvisable. The shade and characterisation of the build-up a week later was satisfactory, ready for adjust- ing morphology and finalising surface texture (Figs. 36 & 37). _Reattachment of fractured tooth segment The reattachment of fractured segments is a conservativeapproachtorestoringhealth,func- tion and aesthetics. It is particularly advanta- geous for aesthetic appearance, since the natu- ral tooth fragment is used to restore the original morphology and colour. However, if the remain- ing tooth substrate has discoloured owing to breakdown of the pulpal blood vessels, there may be a colour transition between the tooth and the reattached fragment. Depending on the amount of remaining tooth, this is usually not a concern, since the cervical aspects of teeth are darker than the incisal aspects. Clinical technique The procedure for reattaching a fragment is similar to a free-hand composite build-up but with the following differences. Firstly, the colour transition of the sandwiched composite be- tween the remaining tooth and reattached frag- ment should be a seamless. Secondly, to improve the fracture strength of the repaired complex (remaining tooth/composite/fragment), it is ad- visable to re-hydrate the fragment for at least 30 minutes prior to bonding with the resin com- posite. The sequence was as follows: Fig. 27 Fig. 28Fig. 26 Fig. 30 Fig. 31Fig. 29