CDE0111

I 13 clinical technique _ fractured maxillary central incisors I cosmeticdentistry 1_2011 amouthguardandadvisedtoattendforperiodic review appointments, or earlier, if endodontic symptoms developed. In addition, oral-hygiene procedures were re-enforced. _Post-operative results Figures 46 to 48 demonstrate the post-oper- ative results at two weeks. Observe the impec- cable gingival health; correct anatomical form of the composite build-up on the left central incisor; a seamless transition between the com- posite and natural tooth substrate; dentine mamelons in the coronal build-up on the left central incisor and an incisal halo, opalescence, incisal edge translucency within the build-up on theleftcentralincisor,mimickingthereattached natural tooth fragment on the right central in- cisor. It is important to note that the composite build-up on the left central incisor is similar but not identical to the right central incisor. It is clin- ically difficult to produce a facsimile by direct free-hand composite build-up, and it is unusual to find identical teeth in any one individual den- tition, and slavishly copying an existing tooth appears contrived and artificial, which is rarely observed in nature. Nature is creative, rather than perfect. Finally, any artificial prostheses or restoration should broadly conform to the exist- ing dentition by blending with the surrounding teeth. The full-face images show restitution of dental aesthetics that are in harmony with the surrounding lips (Figs. 49 & 50). _Conclusion Acute dental trauma is distressing for the pa- tient and challenging for the clinician. Following initialemergencytreatmenttoalleviatepainand sepsis, the goal is salvaging as much natural tooth as possible. The restoration of health, function and aesthetics is achievable with direct composite restorations and is less destructive than many indirect approaches that remove additional tooth substrate, which further com- promises the damaged tooth. The free-hand build-up, guided by a silicone index, is con- servative and minimally invasive, but requires a degree of patience and expertise of the opera- tor, and endurance of lengthy appointments by the patient. Salvaged and usable fragments of fracturedteethareidealforreconstructingteeth to their former morphology and aesthetics._ Fig. 44_OptiDiscs of varying coarsenesswithaninter-proximalstrip. Fig. 45_The finished and polished restorations, showing correct anatomy and surface texture, as well as seamless transition between the remaining tooth and composite fillings. Fig. 46_Post-op facial view (compare with Figs. 2 & 5). Fig. 47_Post-op incisal view (compare with Figs. 3 & 7). Fig. 48_Post-op dento-facial view (compare with Fig. 1). Fig. 49_Pre-op full-face view. Fig. 50_Post-op full-face view. Dr Irfan Ahmad The Ridgeway Dental Surgery 173The Ridgeway North Harrow Middlesex,HA2 7DF UK iahmadbds@aol.com www.irfanahmadtrds.co.uk cosmeticdentistry_contact Fig. 49 Fig. 50 Fig. 48 Fig. 45 Fig. 46Fig. 44 Fig. 47