CATEGORY AUSTRALASIAN DENTIST 91 shade selection and ability to mask discolouration using Uveneer (Ultradent, South Jordan, Utah, United States) template (Fig 2). 3. Tooth isolation was ensured with the split dam technique placing a w2a clamp on the first maxillary premolars. This allows optimal moisture control while at the same time the ability to visuaise maxillary anterior teeth alignment during the restorative buildup. 4. Enamel surface freshened with coarse diamond bur. 5. Enamel and dentine sandblasted with Aquacare Twin Aluminium Oxide 29 micron, rinsed and dried (Fig 3). 6. Phosphoric acid etch for 15 seconds, washedanddried to frostedappearance (Figs 4a & 4b). 7. Scotchbond Universal Adhesive (3M, St. Paul, Minneapolis, United States), rubbed 20 seconds, gentle air dry to dissolve the solvent, light cured 10 seconds (Fig 5). 8. Palatal build-up utilising Paladex silicone matrix and enamel shade flowable high filled composite (Figs 6a-6c). 9. IPS Empress Direct Bleach-L (Ivoclar, Schaan, Liechtenstein) was applied on the tooth as the bulk first layer composite and cured. 10. IPS Empress Direct Bleach-L (Ivoclar, Schaan, Liechtenstein) was reapplied for second layer tooptimise themasking characteristics of the composite and left uncured. 11. While uncured Uveneer Extra template with G-aenial Injectable Bleach White (GC, Bunkyo-ku, Tokyo, Japan) is pressed as the final layer (aligning the vertical groove on the Uveneer with the long axis of the tooth) and light cured (Figs 7a-7c). Repeat steps 6-11 for the adjacent veneered teeth (Fig 8a). 12. The purpose of two Ivoclar composite layers is to increase the opaqueness and mask the underlying tooth shade (Fig 8b). In contrast, the purpose of the injectable high filled composite is to capture the facial anatomy of the Uveneer and establish a natural longlasting gloss. (Fig 8c). 13. Final polishing: completed with soflex (3M, St. Paul, Minneapolis, United States) followed by diamond polishing paste (Ultradent, South Jordan, Utah, United States) on the FlexiBuff disc (Cosmedent, Chicago, Illinois, United States). 14. The patient is then seated upright to determine the final incisal level balancing with the resting lip contours and interpupillary line (Figs 9a-9c). 15. Evaluate postoperative outcome and occlusion (Figs 10a-10b, 11). Balanced incisal edge contacts during edge-edge static relationship to avoid stress in one area of the composite veneers. Discussion Diagnosis of TDI requires thorough history collection, clinical examination, and special testing. One should not automatically exclude alternative causes to enamel defects such fluorosis, childhood infections, hypoparathyroidism and metabolic disturbances (including rickets and celiac disease).4 Avulsion of primary teeth has been reported to affect up to 74.1% of the permanent successors.5 This occurs due to the proximity of the deciduous apex with the developing tooth germ. During avulsion the primary tooth root’s curvature produces a rotational movement that may injure the succedent bud. Depending on the timing of trauma a different stage of amelogenesis is disrupted. Amelogenesis is composed of three overarching stages:6 1. Presecretory Ameloblast prepare for the organic matrix synthesis. Defect here leads to enamel hypoplasia. LINICAL Figure 1. Pre-operative photograph Figure 2 Figure 4a Figure 5 Figure 6a Figure 6c Figure 7b Figure 6b Figure 7a Figure 7c Figure 4b Figure 3
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