CATEGORY 52 AUSTRALASIAN DENTIST CLINICAL Fast and Predictable Aesthetics with Injectable Composites By Dr Amit Gulati, India Dr Amit Gulati Introduction Aesthetic Dentistry is a highly demanding clinical science specially when it comes to restoring anterior dentition in young individuals. Young permanent teeth display an array of characterizations. These characterizations range from visible dentinal effects like mamelon patterns to enamel effects like high translucency, opalescence, surface effects & macromicro textures. All these variations and characterizations make it challenging for clinicians to create natural life-like restorations in the anterior aesthetic zone with predictability and long term success. Achieving the desired aesthetic outcomes in such cases generally requires intricate layering of packable composites that consequently takes up a significant amount of clinical chairside time. However with the advances in composite resin technology today, clinicians have the option to replicate natural aesthetics with increased efficiency. The Beautifil range of bioactive nano-hybrid composites from Shofu provides, additional benefits of minimizing plaque accumulation1 with anti-bacterial2 and acid neutralizing properties to reduce secondary caries3, promote gingival health and enhance longevity of the restorations. The clinical case featured below showcases an anterior class IV restoration where bioactive Beautifil injectable X composites & colour tints were used to achieve a high degree of aesthetic success in a fraction of the chair time compared to the conventional layered technique commonly used for anterior restorations. Patient case A young, 15 years old female presented with an Ellis Class I fracture involving Tooth no #21 (Fig 1) caused due to a minor traumatic sports injury that occurred almost immediately after debonding of her orthodontic appliance a few months ago. The patient had no symptoms of pain or discomfort with respect to the said tooth and the concern was purely aesthetic. Upon intra oral examination there was no pain or sensitivity observed in relation to tooth no #21, the tooth was not tender to percussion & radiographic examination revealed healthy peri-radicular tissues. Vitality test was performed & tooth gave similar readings as the adjacent teeth. Therefore it was concluded that the tooth was healthy & free from any pulpal or peri-radicular pathology. After careful examination and discussion with the patient, it was decided to restore the fractured tooth with a minimally invasive treatment approach utilizing MiCD concepts. As the patient was a 15 year old, the restorative procedure was modified to reduce the clinical chairside time using a new types of bioactive injectable composite materials. Materials and restorative process Shade Selection, Mock-up and Putty Index Tooth #21 was thoroughly examined for internal & external characterizations. (Fig. 1) High degree of enamel translucency was observed in the incisal 1/3rd, along with fair amount of surface texture & incisal opalescence. Before commencing Isolation of the anterior segment with rubber dam, shade selection was completed using the VITA classical shade guide. The closest shade tab in terms of hue & chroma match was identified as A2 (Fig. 2). A quick Fig 1: Ellis Class-I fracture in tooth #21 Fig 2: Shade selection using Vita Classical shade guide Fig 5: Isolation achieved with rubber dam Fig 3: Free hand mock-up created with Beautifil II LS shade A2 Fig 6: Teeth polished with pumice slurry to remove the plaque biofilm Fig 4: Putty index made with A-silicon impression Fig 7: Minimal surface preparation & bevels done with a Fine Diamond point
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