Dr. Grabiel is a 1979 graduate of the University of Michigan. Following dental school, he was a clinical instructor for 2 years at the university. He joined a private general practice in 1980 with Dr. John Bartlett. Dr. Grabiel is currently in a group private practice with 2 other general dentists in Birmingham, MI. Dr. Grabiel has lectured on various restorative and esthetic topics since 1987. He is a clinical instructor at the Kois Center in Seattle, WA, a member of the American Academy of Restorative Dentistry, a Fellow in the American College of Dentistry, and past president of the Oakland County Dental Society in Michigan. Dr. Grabiel has a passion for dentistry and enjoys sharing his experiences from 38 years in the profession.
The night before his best friend’s wedding, the groomsman was playing hockey and sustained traumatic fractures to his maxillary right central and lateral incisors. The bride-to-be was not amused as there were many wedding photos yet to be taken. He visited my dental office the next morning, and radiographs were reviewed to assess for root fracture along with pulpal vitality and mobility testing. It was decided that the quickest solution to save the wedding day would be Class IV composites to restore the teeth to their original color and shape.
Treatment
A VITA shade guide (VITA North America) was used to determine the appropriate shade. A small amount of the selected shade of Estelite Sigma Quick (Tokuyama) was placed on the tooth and light-cured to ensure the material color matched the tooth. The Estelite Sigma Quick composite was chosen because of its translucent appearance, excellent color-matching characteristics, and extremely good long-term surface luster.
Since Estelite Sigma Quick has excellent translucency, a more opaque composite was selected to be placed on the lingual surface to mimic the light transmission properties of the dentin. In addition to the dentin shade composite, translucent or clear composite could also be used at the incisal edges of the restoration to provide a translucent halo similar to the natural tooth.
Preparation
After injection of local anesthetic, the 2 teeth were prepared with long 3 mm to 4 mm bevels on the facial surfaces to assist in color blending. A short bevel was placed on the lingual surface. The dentin was protected with a self-etching resin cement liner. The phosphoric acid solution Ultra-Etch (Ultradent) was used to etch the enamel for 30 seconds, then rinsed and blotted dry. A single-bottle bonding resin was scrubbed into the enamel for 20 seconds, then blown dry so there was no visible movement. The bonding resin was then light-cured for 10 seconds.
A clear, straight celluloid matrix was wrapped around tooth No. 8 from the lingual with the free ends to the facial. The dentin shade composite was contoured to restore the lingual surface of tooth No. 8. Lobes were formed in the incisal portion to mimic the dentin of the adjacent central incisor. The dentinshaded composite was left short of the final incisal position to take advantage of the translucent properties of the Estelite Sigma Quick material and create the appearance of a more natural color and light transmission. The material was then light-cured for 40 seconds using Demi Plus (Kerr Restoratives).
Shaping and Contouring
Estelite Sigma Quick composite was placed in one increment on the facial surface. A composite-shaping instrument and a bristle brush with a sculpting medium were used to contour the facial surface as close to the final contour as possible. After light-curing for 40 seconds, the matrix was removed and the restoration was contoured to match the adjacent tooth. The facial surface was contoured with an ET9 bur (Brasseler USA) and a series of FlexiDisc polishing discs (Cosmedent). The lingual surface was contoured with a footballshaped bur and polished with an Enhance finishing cup (Dentsply Sirona Restorative). The occlusion was checked with 200-micron paper in a chewing motion to evaluate for contact in the chewing envelope. Any blue streaks were removed to help reduce the risk of fracturing the restoration. The same sequence of steps was repeated for the lateral incisor after complete contouring and adjustment of the central incisor. The groomsman flashed his restored smile at the bride, and the wedding and its accompanying photographs were a success.
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