A 9-year-old patient was referred following emergency treatment at another office for a fractured maxillary left central incisor (tooth No. 9). Initial records included clinical photography, necessary radiographs, and an intraoral digital scan. Evaluation of black and white photographs revealed lower value in the gingival one half of the tooth, raising the possibility of early pulpal degradation. An endodontic assessment indicated that root canal therapy was not needed at this time, although it might be required in the future. A conservative direct composite restoration was planned. A single-tooth wax-up guided the restorative design. The previous composite build-up was removed, and the facial surface was beveled in three planes to maximize the bonding surface area and facilitate a seamless blend with the natural tooth structure. A silicone stent fabricated from the wax-up guided initial lingual enamel placement with composite shade WE (CLEARFIL MAJESTY® ES-2, Kuraray Dental, kuraraydental.com). Layers of A1 dentin (CLEARFIL MAJESTY ES-2) were applied and mamelons were carefully sculpted to recreate natural incisal anatomy. Facial enamel shade WE was then layered over the dentin. Finishing included the use of red articulating paper to map and refine microanatomy. Final polish was completed with a featherlight gray polisher. Postoperative photography confirmed faithful recreation of facial anatomy and the tooth fully restored, with the patient ready to proceed with orthodontic treatment.
KEY TAKEAWAYS
- Layered composite technique using CLEARFIL MAJESTY® ES-2 allows precise recreation of incisal anatomy, mamelons, and natural translucency, delivering esthetic outcomes on par with indirect restorations.
- A silicone stent fabricated from a diagnostic wax-up or 3D-printed model provides a reliable lingual scaffold for enamel placement, ensuring accurate tooth contour and proper incisal length from the outset.
- Three-plane beveling that combines a 45-degree bevel, scalloped bevel, and infinite bevel maximizes bonding surface area and creates invisible margins that blend seamlessly with surrounding natural enamel.
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Michael J. Morgan, DDS
