Management of a fractured central i ncisor II—moderate
Management of a fractured central incisor requiring a conservative (minimally invasive) Class IV partial porcelain laminate veneer is presented.
CASE STORY
A 26-year-old male presents to the dental office with the following chief complaint: “I broke my front tooth and need it fixed.” He had a bonded restoration placed at age 14 that has since been replaced twice, but it broke off when he accidentally bit on his fork. He is seeking “a better material,” and has inquired about a material that is strong and would give him a more “natural look.”
For more information regarding anterior restorations, refer to Cases 11-15.
Figure 1: Preoperative class IV fracture maxillary right central incisor (8).
Figure 2: Bonding surface should be equal to or exceed the amount of tooth structure being replaced.
Figure 3: Final restoration.
LEARNING GOALS AND OBJECTIVES
- Provide an aesthetic result using minimally invasive techniques.
- Color matching
- Restore form, function, and aesthetics.
- Care and maintenance for a porcelain laminate veneer(PLV)
Medical History
- No significant findings
Dental History
- Sporadic dental visits that the patient blames on his busy work schedule
- Oral hygiene is fair.
- Caries index is low.
Medications and Allergies
- I nhaler used for seasonal allergies (as needed)
- Food allergy to eggs and egg products
Review of Systems
- Vital signs:
- Blood pressure: 120/78
- Heart rate: 68 beats/minute
- Respiration rate: 18 breaths/minute
Social History
- Smoking: no history
- Alcohol: patient is a social drinker—approximately 6-8 beers per week
- Recreational drugs: No history
Significant Extraoral Findings
- No significant findings
Significant Soft Tissue Findings
- Lips: appear dry, symmetrical, and normal shape, size, and color
Clinical Findings/Problem List
- Anterior aesthetics, due to class IV fracture
- Critical color matching in a highly visible oral area
- To restore form, function, and aesthetics
Diagnosis
- Class IV fracture of the maxillary central incisor (8)
- Discoloration of enamel due to hypocalcification spots
Clinical Decision-Making Determining Factors
- There is often a need to provide an aesthetic result using minimally invasive techniques and contemporary restorative materials. The current evidence is that the veneered porcelain etched to intact and prepared enamel offers the advantages of increased strength, color stability, and aesthetics as compared to composite veneers (Strassler 2007; Spear and Holloway 2008).
- Consider the optical affects of metamerism during the critical color matching phase of treatment. Metamerism occurs when two samples appear identical under one set of viewing conditions, but not under another set of conditions. This is very relevant during the shade selection process— because under one light source the shade may appear to be a match, and yet under a different light environment it may appear mismatched. Therefore it is recommended to select the shade of the restorative material under a corrective light environment (O’Brien 1985; Kim, Lee et al. 2007).
- Several other factors can influence shade selection and these should be completely understood, especially during critical color matching in a highly visible area (Dagg, O’Connell et al. 2004). Of the many factors described in the literature that affect tooth color and therefore restoration color selection, hydration of teeth can impact the shade selected. It typically takes natural teeth about 10 minutes to dehydrate with a perceptible change in shade and up to 2 hours to rehydrate. It is therefore critical that shade selection is performed at the outset of treatment and prior to any tooth preparation (Riley, Sanderson et al. 1986). Additional factors that affect the shade selection are the presence of ambient daylight (/>
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