CDE0111

I 09 clinical technique _ fractured maxillary central incisors I cosmeticdentistry 1_2011 Fig. 20_Beads of different shades of Herculite XRV Ultra (Kerr) placed and set directly onto the left central incisor (from left: Incisal, Enamel A1, Dentine A2 shades). Fig. 21_Silicone index placed onto placed surfaces of incisors to ensure correct seating. Fig. 22_Complete isolation of each tooth with a rubber dam. Fig. 23_Split-dam technique used to isolate the anterior maxillary sextant. Fig. 24_A 1 mm chamfer being prepared around the circumference edge of the fracture. Notice the visible gingival retraction cord on the mesial aspect. Fig. 25_Enchant is applied for 20 seconds using the total etch technique. incremental layering or stratification placement. The latter techniques are commonly utilised to reduce polymerisation stresses by lowering the C-factor and for emulating the shade nuances and characterisations within natural teeth, for example incisal halos, mamelons and translu- cencies. Clinical technique After two weeks, the symptoms associated with the left central incisor had subsided (that is, sensitivity and buccal tenderness), and no re- sponse was elicited with gentle percussion. In addition to the preoperative colour analy- sis with shade tabs carried out earlier, small beads of Herculite XRV Ultra shades Incisal, Enamel A1, and Dentine A2 were directly placed on the tooth and light-cured to ensure a precise shade match (Fig. 20). This method allows a di- rect comparison of set composite on the natural tooth substrate and is an excellent method for selecting the correct enamel and dentine shades ofcomposite.Next,thesiliconeindexwasplaced againsttheteethtoconfirmcorrectlocationand exact seating (Fig. 21). Isolation is essential for composite resin fill- ings to accomplish a moisture-free environ- ment. Various methods are available, including gingival retraction cords, cotton wool rolls, aspiration and a rubber dam. Several techniques are advocated for rubber dam use, including complete isolation of individual teeth (Fig. 22) and the split-dam technique for isolating a number of teeth (Fig. 23). However, when build- ing-up anterior teeth, for which aesthetics is of paramount concern, using a rubber dam can be disadvantageous owing to excessive dehy- dration of teeth, making accurate shade assess- ment challenging. Therefore, for this patient, a dry retraction cord was carefully eased into the gingival sulcus to absorb the crevicular fluid, together with cotton wool rolls in the sulci and continuous aspiration to maintain a dry field. This protocol prevented desiccation of the teeth, allowing a precise shade assessment during the layering placement of the composite build-up. After composite shade selection, silicone in- dex verification and tooth isolation, the tooth was prepared for resin build-up. The reattached fragmentontherightcentralincisorwasleftun- touched and served as a guide to mimic shape, colour and characterisations of the build-up on the left central incisor (Fig. 20). Several designs are suggested for preparing the tooth substrate, including no preparation, simple chamfer or the stair-step chamfer. In this instance, a simple 1 mm chamber was created on the buccal and lingual surfaces using a tapered round-ended diamond bur (Fig. 24). The prepared tooth was etched with phosphoric acid and dried (not desiccated), and OptiBond Solo Plus was applied according to the manufacturer’s instructions (Figs. 25 & 26). The stages for the layered com- posite build-up are as follows: _Step 1: Using the CompoRoller (KerrHawe SA), a thin layer (1 to 1.5 mm) of Herculite XRV Ultra Fig. 21 Fig. 22Fig. 20 Fig. 24 Fig. 25Fig. 23