CATEGORY AUSTRALASIAN DENTIST77 Treatment plan Treatment for tooth 21 was planned across two sessions: an emergency appointment to restore immediate function and record tooth form, followed by a definitive restoration using a layered direct composite approach. Tooth 11 would be addressed by a straightforward free-hand build-up within the same definitive appointment. Tetric plus was selected as the sole restorative material to be used. The patient's clinical profile – moderate shade complexity, intact surrounding tooth structure, and no significant underlying discolouration or extreme translucency demands – placed this case within the range of anterior indications where the material's simplified monochromatic shade concept can be used effectively. No specialised multi-material aesthetic system was required. For this patient, three sculptable shades (Bleach, A2 plus and A3 plus) and one flowable shade (A2) were selected. These were sufficient to achieve the shade harmony and optical integration required for an anterior restoration. How were these shades developed? A brief overview: The limited, nature-inspired Tetric plus shade range covers a broad part of the VITA Classical shade guide with only four plus shades: A2 plus, A3 plus, A3.5 plus and Bleach plus. Together, they cover 16 VITA classical shades and several bleach shades. This cluster concept is based on spectrophotometric analysis of 368 anterior teeth from about 120 patients using the CIEL*A*B colour space method. Natural tooth shades clustered mainly around A2, A3 and A3.5, forming the basis for three plus shades, while Bleach plus was developed separately to meet the clinical demand for exceptionally white teeth. In vitro testing with extracted anterior teeth confirmed that each plus shade integrates with multiple natural tooth shades, including the five VITA shades covered by A2 plus: A1, A2, B2, C1 and D2.1 Materials used in Case 2 u Tetric plus Flow, Shade A2 plus (deep cavity liner, tooth 21) u Tetric plus Fill, Shade Bleach plus (palatal/interproximal frame, tooth 21) u Tetric plus Fill, Shade A2 plus (body layer, tooth 21; restoration, tooth 11) u Tetric plus Fill, Shade A3 plus (bevel transition, tooth 21) Devices used: Bluephase PowerCure curing light, OptraGloss polishing system Curing protocol: 5-second exposures (anterior) PROCEDURE FOR CASE 2 Emergency session and index fabrication In the emergency treatment, a free-hand composite build-up was placed on tooth 21, restoring immediate function and establishing the morphological template for the definitive restoration. A clear silicone index was then taken over this build-up. This index records the ideal labial and palatal contour of the reconstructed tooth and will guide the placement of the palatal and interproximal composite frame in the definitive session, ensuring that the final restoration maintains the morphology established at the emergency stage. Cavity preparation and adhesive protocol At the definitive appointment, the emergency composite was removed, and a buccal bevel was prepared at the fracture margin of tooth 21. Chairside tip: Creating long enamel bevels can significantly improve the aesthetics of an anterior restoration. Long enamel bevels increase the surface area of the etched enamel and create a more gradual transition that encourages optimal light exchange between the composite and the tooth structure. This maximises the chameleon effect, meaning your restorations can now seamlessly blend into the surrounding tooth structure. Rubber dam isolation was established with customised sectional matrices placed and stabilised with Teflon balls in the interproximal spaces. Orthophosphoric acid was applied to the enamel surfaces and bevel, followed by the adhesive protocol. Curing of the bonding agent was performed with the Bluephase PowerCure at a 5-second exposure, the recommended protocol for anterior restorations (Figs. 1113). Palatal frame and liner A small drop of Tetric plus Flow A2 plus was injected into the deepest part of the cavity first, adapting to the base of the preparation and ensuring a void-free foundation. The silicone index was then seated against the teeth, and Tetric plus Fill Bleach plus was applied to reconstruct the palatal and interproximal walls in a single stage, using the index to define the correct palatal contour. The Bleach plus shade was selected here for its higher value and masking capacity, which helps to establish a luminous, natural-looking palatal frame that will anchor and support the subsequent body layers. Once shaped, the CLINICAL Fig. 9: Initial clinical situation, buccal view. Tooth 21 presents with a major mesio-incisal fracture extending into the mid-third of the crown. A smaller chip fracture is present on the mesial incisal edge of tooth 11. Natural tooth colour is warm and homogeneous, providing a reliable shade reference. Fig. 10: Initial clinical situation, palatal view. The extent of the tooth 21 fracture is confirmed from the palatal aspect. Minor lip trauma is also visible. More than ever, Buy Australian. Support Australian jobs.
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