12 January 2022

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Direct composite restoration of 1.1 and 2.1

Allegra Comba

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Young male patient came to my attention after trauma involving the elements of the upper frontal sector. The patient reported not having collected the fragments thus, IV class reconstruction  of the involved dental elements was necessary.

The general medical history was negative. The oral examination detected a coronal fracture without pulp involvement of 1.1 and a complicated fracture with pulp exposure for more than 72h on 2.1. The radiographic examination highlighted the absence of root fractures of the elements involved in the trauma and did not detect the presence of carious lesions on the other dental elements.

A pulp viability test was performed on the elements involved which resulted to be positive on 1.1 and showed sign of irreversible pulpitis on 2.1. After explaining the patient the complications that may arise after a dental trauma, the decision was to continue with the initial photographs, the endodontic treatment of 2.1 and the direct restorative therapy of the fractured elements. (Fig. 1)

Palatal view of fractured elements showing pulp exposure of 2.1. (Fig. 2)

Isolation of the operating field. (Fig 3)

Cavity preparation of 1.1 and initial endodontic treatment on 2.1 (Fig. 4)

Endodontic treatment of 2.1 (Fig. 5)

Adhesive procedures on 1.1 and 2.1 (Fig. 6)

Reconstruction of the palatal wall of 1.1  and 2.1 with the help of a silicone index. (Fig. 7)

Layering of the composite material. (Fig. 8)

Restorations completed under dental dam isolation during finishing procedures (Fig. 9)

Color check after 2 months from the execution of the restorations (Fig. 10)

Two Year follow-up (Fig. 11)