CASE PRESENTATIONS-

ANTERIOR COMPOSITE RESTORATIONS

 INTRODUCTION
• Operative techniques and materials with enhanced optical properties have been
refined to such a highly sophisticated level that they present a first line
approach, delivering predictable and reliable restorations of aesthetic and
functional excellence, rivalling the best ceramics.
• The great popularity of composite resin restorations also results from their
acceptable longevity at relatively low financial cost.
• While anterior composites restorations are ubiquitous, advanced multiple-
layering techniques using a range of shades, opacities and translucencies remain
the domain of relatively few practitioners.
• Dentists commonly report that such techniques are time-consuming or
complicated and do not offer predictability in terms of aesthetics.
While the procedure was considered a provisional method of long-term
stabilization prior to a definitive indirect restoration, it was noted that the
technique offered a number of benefits:
 The procedure maximized preservation of natural tooth tissue;
 Minimal preparation (confined to enamel) provided a large area for
retention via the acid-etch technique;
 The patient’s appearance was immediately improved via a ‘very good and
simple means of restoring aesthetics’;
 The technique allowed the endodontic status to be monitored over a
number of years and left all other future restorative options open.
occlusion
 Clinical technique

 Initial clinical procedure

 Tooth preperation for restoration
 Adhesion technique
 Restorative technique for composite
restoration
A-Initial clinical procedures,

Local anesthesia

Preparation of operating site

Shade selection
Principles of Shade Selection
Clinical technique
 Visual shade selection

VITA Master 3D colour

VITA Classic Guide guide
Automated Shade
Selection
Isolation of operating site
 composite preparation

Beveled conventional
 Pulp protection
In deep cavities pulp protection may be necessary prior to acid
etching and bonding.

- Calcium hydroxide, GIC ,

- RMGI ZnOE is
contraindicated
Adhesion

• ETCHING

Syringe for dispensing gel etchant

Applicator tip for liquid etchant
Etching Procedure
ETCHING ENAMEL-
ETCHING DENTIN-
 PRIMER or CONDITIONERS
• Primers condition the dentin surface, & improve
bonding.
• Acidic in nature
• eg. EDTA,nitricacid, Maleic acid

Functions:-
• Removes smear layer & provides subtle opening of
dentinal tubules.
• Provides modest etching of the inter-tubular
dentine.
Bonding agent
Curing Of the Composite:
 Finishing and Polishing:
.
Finishing &
Polishing
 After restoring with Composite Resin Material
Before the restoration procedure.
 Case 1: Management of fractured
anterior teeth

Patient’s Name: Surya jyothi

OP:D08842
Age/Gender: 51years/female
Diagnosis: Ellis class 1 fracture w.r.t 21
Treatment done: composite restoration done wrt 21
Clinical challenges of FLUOROSIS TEETH
 Case 2: Management of fractured
anterior teeth

Patient’s Name: Revathi

OP:D001954
Age/Gender:23/Female
Diagnosis: Eills class1 # w.r.t 21
Treatment Done: composite restoration done wrt 21
 Case3 : Management of diastema

Patient’s Name: sudheer

OP:D0014432
Age/Gender:23/Male
Chief complaint : spacing in the front teeth region
Diagnosis: Midline spacing w.r.t 11,21
 TREATMENT OPTIONS

OPTION 1 OPTION 2
Orthodontic Restorative approach

Orthodontic treatment
Indirect veneers-11,21
Direct composite using a Direct composite
putty technique veneers-11,21

Treatment Done: Direct composite restoration done wrt 11,21

 Case 4 : Management of diastema

 Patient’s Name: kishore

 OP:D014387
 Age/Gender:25/Male
 Diagnosis: Midline spacing w.r.t 11,21
 Chief complaint : spacing in the front teeth region
 Treatment Done: composite restoration done wrt ,1121
Clinical challenges of midline diastema

Black Triangle
 Case 5 : Management of peg shaped
laterals

 Patient’s Name: nagaraj

OP:D091588
 Age/Gender:26/male
 Chief complaint - spacing and irregularly shaped tooth
in his upper front jaw region.
 Diagnosis: Ellis class 1 # wrt 11,white spot lesion on
21,peg shape laterals wrt 12,22
 TREATMENT OPTIONS

OPTION 1 OPTION 2
Orthodontic Restorative approach

Orthodontic treatment Indirect veneers-12,22

Direct composite
direct composites using veneers-12,22
a putty technique

Treatment Done: Direct composite restoration done wrt

12,11,21,22
 Case 6 : Management of peg shaped laterals

 Patient’s Name: Sunil kumar

OP:D001954
 Age/Gender:24/male
 Chief complaint - spacing and irregularly shaped tooth
in his upper front jaw region
 Diagnosis: peg shape laterals wrt 12,22
 Treatment Done: composite restoration done wrt
12,22
Clinical challenges of PEG SHAPED
LATERALS
 OTHER CLINICAL CONSIDERATION
COMPOSITE MATERIAL
 SMALL PARTICLE FILLED COMPOSITE
 MICROFILLED COMPOSITE
 HYBRID COMPOSITE
 NANOFILLED COMPOSITE
 NANOHYBRID COMPOSITE
Post-op Instructions for Composite fillings
Composite restorations are very technique sensitive so
utmost care is necessary before, During and after
manipulation.
The Visible Modes Of Failures

1) Discoloration-Especially At Margins
2)Marginal Fracture
3)Recurrent Caries
4) Post Operative
Sensitivity
5) Cross Fracture Of
Restoration
6) Lack Of
Maintaining
Contact
Case presentation
ANJALI
 CASE: ANGLE BUILD UP
PATIENT’S NAME: KALPANA GOWDA
OPD NO: B018980
AGE/GENDER: 45/FEMALE
CHIEF COMPLAINT: PATIENT C/O FRACTURED RESTORATION
DIAGNOSIS: DENTAL CARIES WRT 21 11 12 13
TREATMENT DONE: COMPOSITE BUILD UP WRT 21 11 12 13
PRE- OP

OLD COMPOSITE
RESTORATION
REMOVED

WAX MOCK UP DONE

SHADE SELECTION

PUTTY INDEX AND PALATAL BUILD UP

POST- OP
 CLINICAL CHALLENGES
• Problem 1: Choosing wrong shade
• Problem 2: There's a visible line- The junction between tooth structure
and restorative material was not masked by the dentin layer.
• Problem 3: It's too opaque- The dentin layer was too thick.
• Problem 4: Proper Bevelling was not given.
• Problem 5: Shifting of midline
• Problem 6: Black triangle
 CASE: ANGLE BUILD UP
PATIENT’S NAME: RAJEEV LOHAR
OPD NO: E004226
AGE/GENDER: 20/MALE
CHIEF COMPLAINT: PATIENT C/O DISCOLOURED TEETH IN FRONT UPPER TEETH
DIAGNOSIS: DENTAL CARIES WRT 11 12 13 21 22
TREATMENT DONE: COMPOSITE BUILD UP WRT 11 12 13 21 22
PRE OP

POST OP
 CLINICAL CHALLENGES
• Problem 1: Choosing wrong shade

• Problem 2: There's a visible line- The junction between tooth structure and
restorative material was not masked by the dentin layer.

• Problem 3: Too much or too little characterization

• Problem 4: Proper Bevelling was not given.

• Problem 5: Shifting of midline

• Problem 6: Isolation protocol for subgingival caries

Case presentation
AYUSHI SANCHETI
• CASE NUMBER – 1
 
• Patient Name: shrikant

• Age/Sex : 20/M

• Case : anterior composite buildup

• CASE NUMBER – 2
 
• Patient Name: Anand K

• Age/Sex : 32/F

• Case : Angle buildup

Case presentation
JISNA
 ANTERIOR ESTHETIC REHABILITATION

• PATIENT NAME: ANITHA A B (D061415)

• AGE /GENDER: 39 /F

• DIAGNOSIS : CLASS III DENTAL CARIES 12,22

• TREATMENT DONE: COMPOSITE RESTORATION DONE irt 12,22

PRE OP POST OP
 ANTERIOR ESTHETIC REHABILITATION

• PATIENT NAME: NOOR PASHA (D070888)

• AGE /GENDER: 36 /M

• DIAGNOSIS : ELLIS CLASS II FRACTURE irt 21,CLASS I FRACTURE irt 11,12

• TREATMENT DONE : COMPOSITE RESTORATION DONE irt 11,12,21

PRE OP POST OP
 ANTERIOR ESTHETIC REHABILITATION

• PATIENT NAME: KINAKA PRAVEEN KUMAR

• AGE /GENDER: 20/M

• DIAGNOSIS : ELLIS CLASS II FRACTURE irt 21

• TREATMENT DONE: COMPOSITE RESTORATION DONE irt 21

PRE OP POST OP
 ANTERIOR ESTHETIC REHABILITATION

• PATIENT NAME: MANOJ KUMAR (D063610)

• AGE /GENDER: 23 /M

• DIAGNOSIS : ELLIS CLASS II FRACTURE irt 21

• TREATMENT DONE : COMPOSITE RESTORATION DONE irt 21

PRE OP POST OP
 ANTERIOR ESTHETIC REHABILITATION

• PATIENT NAME: JAYASHEELAN(B081602)

• AGE /GENDER: 24 /M

• DIAGNOSIS : ELLIS CLASS II FRACTURE irt 21

• TREATMENT DONE : COMPOSITE RESTORATION DONE irt 21

PRE OP POST OP
Case presentation
PRATHYUSHA
PATIENT NAME : TRITIBALA DAS

OP NUMBER : D080354

AGE/ GENDER : FEMALE

CHIEF COMPLAINT : PATIENT COMPLAINS OF PRESENCE OF SPACINGS IN THE UPPER FRONT TEETH REGION.

DIAGNOSIS: PEG LATERALS IRT 12, 22

TREATMENT PLAN : ESTHETIC RECOUNTERING USING LIGHT CURE COMPOSITE .

RIGHT LATERAL LEFT LATERAL

 SHADE SELECTION
ISOLATION

POST OPERATVE RIGHT POST OPERATVE LEFT

LATERAL LATERAL
COMPOSITE BUILDUP
PATIENT NAME : SHARATH

OP NUMBER : D049721

AGE/SEX: 22/M

CHIEF COMPLAINT : PATIENT COMPLAINTS OF BROKEN TOOTH IN THE UPPER FRONT TOOTH REGION

CLINICAL DIAGNOSIS: V SHAPED ABRASION IRT LEFT CENTAL INCISOR

TREATMENT PLAN: COMPOSITE RESTORATION IRT 11, 21

 
PRE OPERATIVE IMAGE POST OPERATIVE IMAGE
 DIASTEMA CLOSURE
PATIENT NAME : PAVAN KUMAR

OP NUMBER : D056920

AGE/SEX: 22/M

CHIEF COMPLAINT :PATIENT COMPLAINTS OF SPACINGS IN THE UPPER FRONT TEETH REGION

CLINICAL DIAGNOSIS: MIDLINE DIASTEMA

TREATMENT PLAN: COMPOSITE RESTORATION IRT 21

ANGLE BUILD UP

PATIENT NAME : LEKHA

OP NUMBER : DO42389

AGE/SEX: 22/M

CHIEF COMPLAINT :PATIENT COMPLAINTS OF BROKEN TOOTH IN THE UPPER FRONT TEETH

REGION

CLINICAL DIAGNOSIS: ELLIS CLASS 2 FRACTURE

TREATMENT PLAN: COMPOSITE RESTORATION IRT 21

 MODEL

POST OPERATIVE IMAGE

Case presentation
MYTHILI
CASE: Management of Fractured teeth

• Patient’s Name: Subhash

• OP no: C076665
• Age/ Gender: 32/M
• Chief Complaint: Complains of broken teeth in his upper front tooth
region since one month
• Diagnosis: Ellis Class II fracture in relation to 11,21
• Treatment options: ceramic veneering, direct composite restoration
• Treatment plan: Direct composite build-up with respect to 11,21.
PRE-OPERATIVE

POST-OPERATIVE
 CONCLUSION
• With advances in material sciences, dentists can now more artistically and
predictably mimic natural dentition and create restorations that are not
only fully functioning, but are also beautiful. To perfectly emulate a
patients dentition, dentists must correlate form and color seamlessly, while
preventing any loss of function. With new composite systems that are
equal or better than most porcelain systems, great optical properties and
esthetics can be achieved.
• Successful anterior composites are satisfying for both patients and
clinicians. The time taken to study dental aesthetics and practice and
refine operative techniques
• Direct adhesive procedures have almost limitless potential to
restore function and aesthetics, while preserving healthy
tooth tissue and, as such, anterior composites are at the very
forefront of contemporary minimally invasive aesthetic
dentistry.
• However, it is ultimately up to the dentist, as an artist,
operator, and scientist, to understand the principles of
working with composite systems and how to correlate them
with natural tooth structures.