Introduction to the case

1. Name: Ng Shay Lee Supervisor: Dr. Shalini Kanagasingam University: Universiti Kebangsaan Malaysia Foto of University Introduction to the case A 34 year-old woman presented with a missing left lateral incisor (22) and discoloured restorations on her right lateral incisor (12). She had lost tooth 22 seven months ago due to extensive caries. The patient was embarrassed to smile due to the missing tooth and also suffered from restricted phonetics. By using pre-impregnated fiberglass ribbon and Ceram•X™duo+ system, it was possible to achieve excellent aesthetic oral rehabilitation. Before After Pre-operative labial view: Tooth 12 had mesial and distal discoloured restorations, with underlying secondary caries. Mild enamel hypoplasia was noted on the labial surface. Missing tooth 22 left a 9mm space between 21 and 23. Post-operative labial view: Final result 2 weeks after direct adhesive restorations with Ceram•X™ duo+ system. The patient has regained her confident smile. Step 1 : Cavity preparation tooth 12 Step 2 : Restoration of tooth 12 Step 3 : Etching and bonding of 21 and 23 Step 4 : Fiber frame establishment After microbrasion, etching and bonding was applied. The cavity was restored with dentin shade D1 at the mesial, D2 at the distal and enamel shade E2. For the replacement of tooth 22, rubber dam isolation was done. Palatal surfaces of tooth 21 and tooth 23 were etched with 36% phosphoric acid. Then, bonding agent (XP Bond TM) was applied in an even layer, air blown and light-cured for 20 seconds. Dentine and enamel shade determination was carried out using the Ceram•X™ duo+ shade guide. The existing restorations were removed and cavity preparation was done with a short bevel finishing line. The fiber frame was bonded to the teeth surfaces and covered entirely by flowable composite (DENTSPLY Esthet X-FlowTM) and light-cured. Step 5 : Rebuilding the dentine core Step 7 : Shaping and polishing Step 6 : Rebuilding the enamel layer Step 8 : Final result The restoration was shaped to the natural contour of the tooth. Enhance® Finishing and PoGo™ Polishing Systems (DENTSPLY) were used to further smoothen the surface and yield a natural glossy appearance. Palatal and labial views of completed restorations of tooth 12 and replacement of tooth 22. The patient’s anterior dental aesthetics was restored and the phonetic problem was solved. She was very happy with the result. The dentin core of tooth 22 was built-up with Ceram•X™ duo+, (D2 mesial and D3distal). Incremental layering technique was used. Final layer of enamel shade E2 Ceram•X™ duo+ was applied. Material and method The DENTSPLY Ceram•X™ duo+ system (Shade E2 and D2/3) was used in this case. Replacement of tooth 22 utilized a fiber frame which was made with pre-impregnated fiberglass ribbon (everStick® Perio). It was attached to the prepared tooth surfaces with flowable composite (DENTSPLY Esthet X-FlowTM). By using the incremental layering technique, the double translucency of Ceram•X™ duo+ system mimics natural dentine and enamel. Discussion and conclusion The loss of an anterior tooth can affect a patient psychologically and socially, as well as restrict phonation. Treatment options include adhesive bridge, fixed bridge, removable partial denture and implant. A fiber-reinforced composite bridge was provided as an interim restoration as the patient was on the implant waiting list and did not want a partial denture. The Ceram•X™ duo+ system offers a conservative and quick fix to the problem in a single visit.