A method to repair horizontal fractures on upper centrals

Posted on November 05 2016

Patient not happy with the composite repair of a horizontal fracture on her upper central. I find hiding incisal 1/3 horizontal fractures the most difficult to do.

Before

Step 1

Will do composite repairs:

A) Mesial incisal fracture on #9

B) Replace composite on incisal 1/3 of #8

C) Composite veneer #7

#9 Restored. #8 Prepped.

Step 2

A) #9 mesial incisal restored with Filtek Supreme Ultra Body A1.

B) #8 enamel prepped with an uneven taper of 2 plus mm

Greater Curve Standard band provides isolation

Step 3

Enamel has been etched.

Incisal view of the tofflemire isolation

Step 4

Will also fill in endo access while also restoring the incisal of tooth #8.

Bonding sequence

Step 5

Etch enamel, Clean and boost (Apex Dental), Prelude SE (Danville), A1 Dentin Filtek Supreme Ultra snow plowed into Filtek A1 Flowable. The dentin composite was left short of the incisal by 1 mm and the dentin composite was not brought out to full facial contour.

Matching the white opaque stain of the adjacent teeth

Step 6

Filtek white opaque flowable was diluted with unfilled resin and painted with an applicator over the Filtek dentin to match the white opaque stain of the adjacent teeth.

Completing the restoration

Step 7

Filtek Supreme Ultra Body A1 completes the restoration. Body A1 was snow plowed into A1 Filtek flowable. Ready for shaping.

#8 Completed

Step 8

Composite was shaped to proper contour. 

Isolation of Tooth #7

Step 9

As seen in the photo the etched tooth is completely dry into the crucial and deep crevices of the interproximals.

Composite veneer was purposely over contoured

Step 10

A1 Body Filtek is snowplowed into A1 Filtek flowable

#7 contoured labially to the desired shape

Step 11

A #12 blade is a great tool for carving the interproximals.

Cut back labial 1/2 mm.

Step 12

Once I have established the proper contour for #7. I cut back the labial 1/2 mm.

Matching the white opaque stain of the adjacent teeth

Step 13

Diluted white opaque flowable is applied over the cut back surface as was done for #8. Followed by A1 Body Filtek snow plowed into A1 flowable. Composite shaped back to intended contour. The white opaque has show through the A1 Body.

Final veneer #7, and Restorations #’s 8&9

Step 14

I recommended recontouring the gingiva over the anterior teeth. Patient declined anything to do with cutting.

Another view of the final

Step 15

 

Money Shot

Step 16

Need to view the teeth from the incisal throughout the procedure. Many dentists fail to do this. As a result they leave the teeth over contoured. Thus, favoring the chiclet look.

6 comments

  • Dennis Brown: February 07, 2017

    Omar – The offset (contra angle) retainer is better for any lingual set up. The regular tofflemire retainer can be used, but it is easier with the contra angle.

  • Omar : January 05, 2017

    I would like to veneer lower anteriors similar to that #7.
    Do recommend the regular tofelmire or the offset one on the lingual ?

  • Vance Wascom: January 03, 2017

    Awesome, did you cure flowable before snow plowing filtek body, please don’t stop sending tips, you have helped me so much more than composite C E courses

  • Dick Cronley: January 03, 2017

    So much easier and more predictable than crown formers!

  • Cynthia Kibiuk: January 03, 2017

    I so respect your skill and commitment to our profession. Your work is inspiring and spurs motivation for doing better. Every case that I review ends with a “wow” !

  • Paul Vidrine: January 03, 2017

    Thanks for all the tips over the years! Awsome!

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