A new case by our ZERODONTO group expert dr. Vincenzo Vitale.
A 9 years old boy presented a fracture of a right upper central incisor.
The fracture extends largely on the crown involving dentin but without pulp exposure. It can be so classified as Ellis’s class II fracture.
Ellis classification
Radiographic and clinical tests are performed. The tooth is vital and does not show any radiographic sign.
Considering the patient’s age, a direct composite restoration is the elective treatment.
Central incisor reconstruction can be very challenging and time consuming, overall when more than 2/3 of crown is missing.
When treating younger patients, the treatment should be easy, durable and fast!
Patients get tired and annoyed very fast.
For this reason a decision is made to make the restoration at the second session previous a wax up done by yourself.
This helps in training skills, previsualize the shape and lines and, once intraorally, perform better and faster.
So, an alginate impression is taken of the upper jaw. Once casted, a wax up can be performed,
The wax up (that can be also be done with non-proper instrumentations such as a candle and some modelling spatulas) is performed coping the contralater tooth.
The particularity is that, the author, prefers modelling slightly in excess.
This excess counterweight the finishing and polishing phases that are subtractive steps.
Once made the wax up, a silicone index is made.
At the second appointment the direct composite restoration can be carried out.
Rubber dam isolation is achieved.
Selective enamel etching and bonding is performed.
With the help of silicon index, the palatal wall is constructed with a translucent enamel composite mass.
A slight amount of flowable composite is placed between palatal shell and enamel to reinforce it.
With the help of a sectional matrix, mesial and distal walls are built with enamel composite mass.
From cervical to incisal, composite dentinal masses are placed creating a dentinal substrate with a decreasing chroma. The final shape consists in creating mammelons.
Once built the dentinal substrate, enamel masses can be placed in a thickness of almost 0.5mm. Some super colours are added to better mask the composite-enamel interface.
Finishing and polishing is carried out with abrasive discs and silicon rubber.
At control, the patient is happy and the result is natural.
The aim of this article is to point out the benefit of making by yourself the wax up (even when devoid of instrumentation).
The training, previsualization and “hand-memory” are essential to perform better and faster overall when dealing with very young patient.
