What do you do when a new patient, who happens to be the spouse of one of your best patients, rushes into your office on a Friday afternoon with a major cosmetic problem, namely, a broken anterior tooth? You’re already running 20 minutes late and, to make matters worse, both you and the new patient are leaving town for the weekend.
The case described in this article represents this exact situation. Hopefully, the technique I used to provide a “quick fix” for this problem will benefit others who find themselves facing a similar dilemma. An alternative technique using flowable composite for direct repair of a broken tooth is also presented. It is important to emphasize that the key to success in such situations is LOW EXPECTATIONS! The treatment provided is not intended to be a permanent solution, but rather an emergency procedure designed to provide a temporary cosmetic solution until more definitive treatment can be provided.
|Figure 1. Patient with emergency broken tooth.|
The patient presented with a broken tooth No. 9 (Figure 1). The following technique was used to provide a quick cosmetic solution:
|Figure 2. Closed bite wax mock-up.|
Step 1. Using a dead soft wax, do a quick mock-up with the patient biting in a centric relationship (Figure 2). If necessary, use either an unfilled resin (E-bond, Danville Materials or Heliobond, Vivadent) or instrument lube (such as Danlube, Danville Materials) on a plastic instrument to shape as desired.
|Figure 3. Ninety-second impression of wax mock-up in closed bite position.|
Step 2. Take a quick closed bite impression (90 seconds with Mono-Phase by Danville Materials). If the use of a light-cured material is desired, it is possible to use a clear impression material (such as Clearbite Impression Material, Danville Materials, or Memosil CD, Kulzer) (Figure 3).
|Figure 4. Impression with wax in place.||Figure 5. Impression with wax taken out.|
Step 3. Remove the impression. Expect to remove the wax with the impression, then take out the wax (Figures 4 and 5). Once the wax has been removed, the teeth can be etched and bonded if desired for placement of the provisional restoration. Frequently, as in this case, no bonding is necessary. (Note: If a longer life for the restoration is desired, it might be wise to clean and bond to adjacent teeth; Clearfill Linerbond 2V by Kuraray is a good choice if you have a sensitive patient and do not wish to anesthetize.)
|Figure 6. TurboTemp 2 untrimmed.||Figure 7. Trim TurboTemp 2 with a No. 12a blade.|
|Figure 8. Easy removal of flash.|
Step 4. Place an auto-cure composite temporary material (such as TurboTemp 2, Danville Materials, or Luxatemp, DMG) into the impression, and have the patient bite into centric for 2.5 minutes. Trim at the margins with a 12a blade, cutting away the excess (Figures 6 and 7). The flash is easily removed once it has been trimmed (Figure 8).
|Figure 9. Quick shaping if necessary.||Figure 10. Flatten out lingual ridges using a porcelain-polishing wheel.|
|Figure 11. Polish with prophy paste.|
Step 5. Do a quick shaping and smoothing with a carbide bur (Figure 9). Flatten out lingual ridges and any other irregularities using a porcelain-polishing wheel, then polish with prophy paste (Figures 10 and 11).
|Figure 12. Final provisional.||Figure 13. Save the impression for future use, if necessary.|
Using this technique, an adequate provisional restoration was produced quickly, allowing the patient to escape cosmetic embarrassment (Figure 12). The provisional is easily removed and is not too durable, and the aesthetics are intended to be acceptable but not so attractive that the patient does not desire to have a more aesthetic permanent restoration. The patient was instructed to avoid chewing on the restoration and to return to the office for permanent treatment as soon as possible. The impression was saved in a zip lock bag with the patient’s name and date for future use, if necessary (Figure 13).
ALTERNATIVE TECHNIQUE USING DIRECT REPAIR WITH FLOWABLE COMPOSITE
An alternative technique for rapidly and directly repairing a broken tooth with flowable composite is as follows.
|Figure 14. Flowable composite can be used for quick repair of a broken tooth.||Figure 15. Add composite in small increments, curing as you go.|
|Figure 16. It is convenient to have the assistant ready with the light to cure as you go along.||Figure 17. Add several increments to rapidly restore anatomic shape, adjusting color as you go.|
|Figure 18. A translucent layer of composite can be added superficially to enhance aesthetics.||Figure 19. A 90-second impression can be taken for later use, if necessary.|
Add flowable composite (StarFlow, Danville Materials, or Luxaflow, DMG) to the broken tooth in small increments, curing as you go (Figures 14 and 15). Frequently, it is convenient to have the assistant ready with the light, to cure as you add increments (Figure 16). Add several increments to rapidly restore anatomic shape. The nice thing about using flowable composite in increments is that color can be easily adjusted while you go along (Figure 17). If you really want to enhance aesthetics, a translucent layer of composite can be added superficially (Translucent shade StarFlow, Danville Materials). Remember, it may be a mistake in such emergency situations to make a provisional that looks too good (Figure 18)!
When satisfied with the provisional restoration, take a 90-second impression for later use (Mono-Phase, Danville Materials), to fabricate a provisional restoration while the final restoration is being made, or for replacement of a lost or broken provisional (Figure 19).
Dr. Beggs maintains a private solo practice in Aptos, Calif. He is a California registered CE provider and lectures frequently on dental materials and techniques.
Disclosure: Dr. Beggs is a co-owner of Danville Materials and assists the company in the clinical application and development of its products.