CATEGORY 56 AUSTRALASIAN DENTIST CLINICAL Peg-shaped lateral incisors present a unique restorative challenge, combining aesthetic demands with the need for precise morphological reconstruction. While direct composite restorations offer a minimally invasive solution, long-term success is often compromised when anatomical principles are overlooked or when repeated additive approaches fail to address underlying structural deficiencies. This case report describes the management of a peg-shaped maxillary lateral incisor using a simplified, anatomydriven approach with a universal composite system. Initial presentation and clinical history A 35-year-old male patient presented with a unilateral peg-shaped maxillary left lateral incisor (tooth #22, FDI notation). The patient’s dental history revealed multiple direct composite restorations placed since the age of 16, all performed without tooth preparation. However, these restorations failed approximately every two years due to fractures or severe marginal discolouration. Clinical assessment and pre-operative evaluation Rubber dam isolation was performed and baseline clinical photographs were taken. The existing restoration was limited to closing the mesial and distal diastemas, resulting in significant marginal discrepancies and morphological disharmony. A palatal view revealed a more critical issue: concave, non-cleansable proximal contact areas, leading to food impaction and periodontal risk. Minimally invasive preparation The primary goal was the complete removal of the failing composite without compromising the underlying natural tooth structure. Following removal, the tooth required three-dimensional expansion: mesially and distally, incisally, and labially. Key anatomical considerations during reconstruction: u Incisocervical positioning of mesial and distal contact areas. u Contact area geometry (point vs. surface contact). u Incisal edge position and line angle symmetry. u Correct palatal wall orientation. Adhesive protocol and material selection To support a streamlined workflow and maintain focus on anatomical reconstruction, the Universal Excellence product series (Kuraray Noritake Dental Inc.) was selected. u Bonding: CLEARFIL™ Universal Bond Quick 2 was applied using a simplified one-step protocol, providing rapid and reliable adhesion. u Restoration: CLEARFIL MAJESTY™ ES-2 Universal in U shade was chosen to provide predictable and harmonious aesthetics with a singleshade approach, allowing the clinician to focus on the primary anatomical determinants of form and function rather than complex multi-shade layering. Simplifying Complexity Peg-Shaped Lateral Incisor restored with Universal Composite (6-month follow-up) Clinical Case Report By Dr Koray Kendir Figure 1: Initial clinical situation: Vestibular view of the existing restoration. Figure 2: Initial clinical situation: Palatal view of the existing restoration. Dr Koray Kendir SINCE 1989
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