Introduction: Restoring a fractured and severely discolored upper central incisor presents a significant aesthetic and structural challenge. This case report describes the minimally invasive management of a traumatized maxillary central incisor using a combination of internal bleaching and direct composite restoration guided by a palatal index.
Case Description: A 23 yrs old patient presented with a fractured and dark, discolored upper central incisor following historical trauma.upon thorough examination and investigation, the tooth was diagnosed with severe pulpitis with symptomatic apical periodontitis so endodontic treatment was done and To address the severe intrinsic discoloration, an internal bleaching protocol was initiated using a “walking bleach” technique with 35% hydrogen peroxide. The bleaching agent was placed inside the pulp chamber and renewed until the shade matched the adjacent natural dentition.
Following a two-week stabilization period to ensure adequate composite bond strength, the structural defect was addressed. A palatal silicon index was fabricated from a diagnostic wax-up to precisely guide the anatomical reconstruction.
Conclusion: The combination of internal bleaching and direct composite restoration using a palatal index offers a highly conservative, predictable, and cost-effective solution for fractured, discolored anterior teeth. This approach successfully restored optimal aesthetics and function while preserving maximum healthy tooth structure.
References:
https://www.nature.com/articles/sj.bdj.2018.819.pdf
https://www.researchgate.net/publication/391434504_Internal_tooth_bleaching_a_review/fulltext/6a34e18d4c90c5542269f0d6/Internal-tooth-bleaching-a-review.pdf?origin=publication_detail&_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6InB1YmxpY2F0aW9uIiwicGFnZSI6InB1YmxpY2F0aW9uRG93bmxvYWQiLCJwcmV2aW91c1BhZ2UiOiJwdWJsaWNhdGlvbiJ9fQ
https://pmc.ncbi.nlm.nih.gov/articles/PMC4121941/
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