University J Dent Scie 2015; 1(1):1-2

Abstract : Esthetic restorations always play an important role for emotional and psychological well
being of the patient. A beautiful smile quickly radiates excitement, passion, and charisma among
the people. The fracture of anterior teeth always becomes cosmetic problem in many cases. Before
closing the space, proper diagnosis of the cause, knowing the hope and expectation of patient,
available treatment options, effective cost durability and time consumption should be taken into
consideration. With the modern flagship of cosmetic dentistry, the direct composite is often a better
choice for some patients in their first few decades of life who have tooth fracture. Direct composite
restorations are less time consuming and more cost effective along with successful delivery of
restoration having high degree of initial patient acceptability. In the present article, an esthetic
rehabilitation of fractured anterior teeth restored with direct composite resin is presented.
Keywords :
Composite, esthetic, fracture,
restoration, trauma.
Source of support : Nil
Conflict of interest : Nil

RESTORING FRACTURED
ANTERIOR TOOTH USING DIRECT
COMPOSITE RESTORATION :
A CASE REPORT
1234 Rajat Sharma, Rajendra K Tewari, Surendra K Mishra, Syed S. Ahmed
Junior Residentm, Professor, Department of Conservative Dentistry and Endodontics,
1 2 ,3

4 Professor, Department of Oral and Maxillofacial Surgery,

Dr. Z. A. Dental College & Hospital, Aligarh Muslim university, Aligarh, India
Introduction
Coronal fracture by trauma is the most frequent type of dental
injury in the permanent dentition (1). Two generic groups of
predisposing factors exist which lead to trauma.
Group 1: fracture of previously sound teeth of children and
teenagers resulting from trauma during sports activities; from
falls and bicycle, skate and ski accidents; or during other
leisure activities.
Group 2: fracture of the teeth of adult patients which have
been rendered fragile by large restorations, caries lesion,
and/or endodontic treatment. Fracture may result from trauma
in automobile accidents, sports activities, fights, and even
from occlusal function or parafunctional stresses (24).
Intensity of trauma, direction of the trauma, elasticity of the
substance, and tolerance of the soft tissue are the major factors
that determine the extent of the fracture (5). Various injuries
may occur on dentition and cause fractures of different
classifications (6). The most frequent type is enamel-dentin
fracture with or without pulp exposure (3).
The presence of fracture of anterior tooth severely
compromises the aesthetic value of the patient. A complete
understanding of the desire of the patient is absolutely critical
for success. The repair of tooth fracture with the help of crown
and bridge requires high financial expenses, is more time
consuming, needs multiple appointment therapy and is a less
conservative approach. In the treatment plan the initial option
considered should be the most conservative one that will
achieve all the desired objectives of both the patient as well as
the dentist. Direct composite restoration technique is
minimally invasive, economical and successful in repairing
tooth fracture with excellent longevity in carefully selected
cases and with superior matching ability.
Case Presentation:
A 19 yr old female patient reported to the Department of
Conservative Dentistry and Endodontics of Dr. Ziauddin
Ahmad Dental College, AMU with a complaint of fracture in
upper front tooth (Fig. 1). Dental history revealed that she met
with an accident 2 days back resulting in an injury. Extraoral
examination revealed no significant findings. During the
intra-oral examination, a class II Ellis fracture of right
maxillary central incisor was diagnosed. There was no other
pathology associated with the injury. Mild calculus deposits
were present but dental caries was not found. Intraoral
periapical radiograph clearly shows enamel and dentin
fracture without involvement of pulp in the tooth 11 (Fig. 2).
Root formation of 11 was complete with no periapical
pathology. Neither the patient nor her husband was interested
in irreversible and indirect treatment option but they are
inclined to pursue immediate, more conservative restoration.
Fig. 1. Clinical appearance of the tooth before the restoration.
Journal of
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Case
Report
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Treatment Planning:
To fully evaluate the case a visual assessment was performed
and the patient's occlusion was analysed. Shade matching was
done and A1 shade was selected for the case.
After getting proper isolation on tooth 11 was thoroughly
cleaned and scrubbed. The enamel of the upper right central
incisor adjacent to fracture line was roughened in collar like
manner and two retentive groves were made on the mesial and
distal edge of fracture line. Following the preparation the
tooth was pumiced, rinsed and dried, then the surface was
etched (N-Etch, Ivoclar Vivadent) for 40 seconds. Again the
tooth was washed and dried using air-water syringe.
The bonding agent (Tetric N-Bond, Ivoclar Vivadent) was
then applied to the prepared surface and light cured for 20
seconds. A thin layer of composite (Tetric-N-Ceram, Ivoclar
Vivadent) not more than 1mm in thickness was placed on the
right central incisor which covers from facial to lingual
preparation. Once the composite placement process was done
in accurate and precise position the material was cured for 40
seconds on each surface. During the restoration of right
central incisor the adjacent tooth was isolated with Mylar
Strip.
Finishing And Polishing:
After 1 week, during the finishing stage the contouring and
gross reduction of the composite resin was performed with the
help of variety of burs and diamond points (Astropol,
Vivadent). A composite finishing and polishing kit (Astropol,
Vivadent) was also used for this purpose. In this case incisal
edge was established with ultrafine polishing disc. Once the
restoration was refined a final polishing was done with the
polishing points.
Discussion
The prevalence of dental trauma is increasing both for the
deciduous and permanent dentition because of higher
participation in contact sports (912). Some authors reported
that 35% of all children and adults suffer dental accidents to
their permanent teeth (1316). Socioeconomic status of the
family is less consistently related to dental trauma than sex,
age, some behavioural characteristics, physical and sporting
activities (17). Maxillary central incisors tend to be the most
affected. The most frequent type of crown fractures is fracture
of enamel and enamel-dentin (18, 19). The bevelling
procedure is essential and very important in terms of esthetics
and adhesion of the composite restoration of fractured
anterior teeth. The surface area is increased by bevelling
procedure and this causes a more efficient adhesion (8).
Nowadays, microhybrid composite is frequently utilized for
anterior restorations. Decreasing particle size of these
materials provides more polishability of restorative materials
(8). Microhybrid composite was utilized for the restoration of
outer surfaces. Thus, more polished and smoother surfaces
are obtained. A second visit is recommended 1 week after the
restorative procedure because of the water sorption of
composite resins. As most of the water sorption can be
observed during the first week, the polishing procedures can
be performed in the second visit in order to get a more esthetic
view (20, 21). Another advantage of this procedure is to
reduce the chair time consumed in the first visit. In the present
case, 1-week recalls and a second polishing procedure were
performed. There are several treatment alternatives for
fractured anterior teeth such as composite resin restorations
and prosthetic restorations. However, for the patients who are
younger than 1820 years of age, prosthetic restorations
cannot be performed because of the continuing development
of the jaws. Composite restorations should be preferred in this
kind of patient (7).
Conclusion
When considering the manner in which to apply a minimal
intervention approach to repair a tooth fracture, it is perhaps
prudent to remember that our first objective in treatment is to
do no harm to the patient. The recent advancement in
composite materials enables us to reproduce the natural
anatomic form and function in a beautifully conservative
manner. When we implement conservative approach
techniques we are in fact allowing for the possibility of further
cosmetic options in the future, which is particularly important
for a young patient.
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Fig. 2. Radiographic appearance of the tooth before the restoration.
Fig. 3. Clinical appearance of the teeth after the restoration
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52
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Correspondence :
Dr. Rajat Sharma,
Department of Conservative Dentistry and Endodontics,
Dr. Z. A. Dental College & Hospital,
Aligarh Muslim university, Aligarh, India
Email: rajatbds@gmail.com
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