Trauma to Central Incisor, Repaired with Composite

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Posted on By Jeffrey Sims In Composite Resin

This young female weight lifter was working out and her ankle rolled on her, lost her balance and the wieght in her hand flipped up and hit her right central. She found two pieces of her tooth on the ground and brought them to her late afternoon appointment. There appeared to be a pinpoint exposure on the mesial lingual without bleeding. Oddly, she was not in pain, only slight sensitivity.
I got her numb and placed the fractured pieces back on her tooth, took an index with a bite material to obtain the incisal edge outline then removed. After the facial was beveled, the tooth was scrubbed with pumice to remove any contaminates and biofilm, etched, rinsed then placed optibond solo and cured.
The incisal matrix was then placed back in her mouth without the tooth fragments, and a thin palatal, mesial and distal shelf of Tokuyama's Milky White composite was placed and cured. The second layer was DA1 and cured followed by DA2 and cured. Next, I placed some white opaque tint over the DA2 from Cosmedent and cured followed by a final enamel layer of Milky White (MW) and cured.
After shaping with 3M thin soft flex disks, I placed a final polish with cosmedent's Enamelize and FlexiBuff disks.
All photos were taken the day of treatment. This patient was informed that this tooth may require Endodontics at some future date or worse, resorbtion.

Pre op
Palatal view

Tooth fragments in bite material
After palatal shelf and DA1 placed


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