Clinical Case Report by Dr. Koray Kendir

PEG-SHAPED LATERAL INCISOR RESTORED WITH UNIVERSAL COMPOSITE (6-MONTH FOLLOW-UP)

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, anatomy-driven 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.

Fig. 1. Initial clinical situation: Vestibular view of the existing restoration.

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.

Fig. 2. Initial clinical situation: Palatal view of the existing restoration.

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:

• Incisocervical positioning of mesial and distal contact areas.
• Contact area geometry (point vs. surface contact).
• Incisal edge position and line angle symmetry.
• Correct palatal wall orientation.

Fig. 3. Failing composite completely removed without compromising the tooth structure.

ADHESIVE PROTOCOL AND MATERIAL SELECTION

To support a streamlined workflow and maintain focus on anatomical reconstruction, the Universal Excellence product series was selected.

• Bonding: CLEARFIL™ Universal Bond Quick 2 was applied using a simplified one-step protocol, providing rapid and reliable adhesion.
• Restoration: CLEARFIL MAJESTY™ ES-2 Universal in U shade was chosen to provide predictable and harmonious aesthetics with a single-shade approach, allowing the clinician to focus on the primary anatomical determinants of form and function rather than complex multi-shade layering.

STRATIFICATION AND POLYMERIZATION

The composite was applied using a layering technique to minimize polymerization shrinkage stress, while gradually building the predetermined anatomical landmarks. Post-operative results demonstrated a seamless integration with the surrounding dentition.

Fig. 4. Single-shade layering of the vestibular surface.

Fig. 5. Palatal view of the tooth during layering.

Fig. 6. Finished and polished restoration surface.

Fig. 7. The composite restorations seamlessly integrated with the adjacent tooth structure.

Fig. 8. Frontal view of all maxillary anterior teeth.

SIX-MONTH FOLLOW-UP

The patient was recalled after six months for evaluation. Due to the superior polishability and high mechanical strength of CLEARFIL MAJESTY ES-2 Universal, the restoration maintained its surface lustre and marginal integrity with no signs of wear or staining.

Fig. 9. Appearance of the restorations six months after treatment.

Fig. 10. Close-up of the restoration, confirming smooth optical integration.

Fig. 11. The surface of the restoration still appears well-polished and unstained after six months.

CONCLUSION

While complex layering techniques can enhance optical properties, they may inadvertently shift focus away from fundamental anatomical principles. The Excellence system from Kuraray Noritake Dental Inc. offers a practical and dependable solution for complex morphological challenges, supporting both clinician focus and long-term clinical success.

Read more about Universal Excellence: https://www.kuraraynoritake.eu/en/newsroom/universal-excellence-smart-streamlined-solutions-for-modern-restorative-dentistry

Discover Universal Excellence products in practice: https://www.kuraraynoritake.eu/en/newsroom/universal-excellence-in-restorative-dentistry

More Clinical Cases from Dr Kendir:

https://www.kuraraynoritake.eu/en/newsroom/posterior-direct-composite-restoration-within-the-universal-excellence-concept

https://www.kuraraynoritake.eu/en/newsroom/restoring-confidence-after-trauma-a-biomimetic-approach

Case by Dt. Koray Kendir, DDS, Turkey (İzmir)

INTRODUCTION

Trauma-related fractures of anterior teeth require a precise balance between aesthetics and function, often under emotional pressure from the patient. This clinical case demonstrates the restorative rehabilitation of a previously mismanaged central incisor using CLEARFIL MAJESTY™ ES-2 Premium and PANAVIA™ V5 (both Kuraray Noritake Dental Inc.). The team followed a biomimetic approach to re-establish biological, functional, and aesthetic harmony.

CASE SUMMARY

A 23-year-old female patient presented one month after a traumatic injury involving tooth #11 (FDI notation). Immediate root canal treatment and a direct composite build-up had been performed elsewhere in a single visit. The existing restoration showed poor aesthetics and marginal adaptation (Fig. 1).

Fig. 1. Initial clinical situation.

CLINICAL PROCEDURE

STEP 1: ISOLATION AND REMOVAL OF OLD RESTORATION

For the planned rehabilitation, the tooth was isolated with rubber dam (Figs. 2 and 3) and the existing composite restoration was removed. Gutta-percha from the previous endodontic treatment was found to be severely coronally trimmed (Fig. 4). This poses a risk of future discolouration. Consequently, the gutta-percha was condensed apically to a more biologically appropriate level using a downpack device (Figs. 5 to 9).

Fig. 2. Isolation of the working field with rubber dam: Labial view.

Fig. 3. Isolation of the working field with rubber dam: Occlusal view.

Fig. 4. Gutta-percha from the previous treatment.

Fig. 5. Gutta-percha removed, …

Fig. 6. … placed back into the root canal …

Fig. 7. … and condensed …

Fig. 8. … with a downpack device.

Fig. 9. Result of the procedure: Occlusal view.

STEP 2: CORE BUILD-UP

Subsequently, a fiber-reinforced composite was used to provide root-anchored support for the core structure. Then, the bonding surface was treated with phosphoric acid etchant, CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.) was applied as a universal adhesive and the core build-up was performed with CLEARFIL MAJESTY™ ES-2 Premium A1D (Figs. 10 to 13).

Fig. 10. Etching with phosphoric acid etchant.

Fig. 11. Application of the universal adhesive.

Fig. 12. Core build-up after thorough light curing.

Fig. 13. Intra-oral periapical radiograph or the treated tooth.

STEP 3: PREPARATION AND DIGITAL IMPRESSION

For definitive restoration, a 3/4 crown preparation was performed and an intraoral scan was taken. Moreover, a temporary crown was fabricated (Fig. 14) and shade photos were taken to finalize the session.

Fig. 14. Temporary restoration in place.

STEP 4: FINAL CEMENTATION

Once the lithium disilicate restoration was received from the laboratory, the temporary crown was removed and the abutment tooth was evaluated (Figs. 15 and 16). Try-in was performed using PANAVIA™ V5 Try-in Paste White to check shade and fit (Fig. 17). No modifications were required; the selected try-in paste contributed to a lifelike appearance of the restoration. For definitive placement, the intaglio surface of the crown was etched with hydrofluoric acid (Fig. 18). Figure 19 shows the appearance of the intaglio after this measure. To provide for optimal bonding conditions, the tooth surface was then cleaned with KATANA™ Cleaner (Kuraray Noritake Dental Inc.), which should be applied with a rubbing motion to the contaminated prepared tooth for more than ten seconds (Figs. 20 to 22). It may also be used to clean the intaglio of a restoration, which is contaminated with blood and saliva e.g. after try-in.

Fig. 15. Situation after removal of the temporary crown: Labial view.

Fig. 16. Situation after removal of the temporary crown: Occlusal view.

Fig. 17. Try-in of the lithium disilicate crown.

Fig. 18. Etching of the crown’s intaglio surface with hydrofluoric acid.

Fig. 19. Appearance of the etched surface.

Fig. 20. Cleaning of the abutment tooth …

Fig. 21. … surface covered with the cleaning agent.

Fig. 22. Thorough rinsing, which should be followed by drying with air.

Adhesive cementation itself was accomplished with the three-component PANAVIA™ V5 (Figs. 23 to 28): The prepared tooth structure and build-up was treated with PANAVIA™ V5 Tooth Primer, the intaglio surface of the crown with CLEARFIL™ CERAMIC PRIMER PLUS. Finally, PANAVIA™ V5 Universal (White) was extruded into the crown and the crown placed. Excess cement is best removed in the gel phase – i.e. after brief polymerization for 3 to 5 seconds before final light curing is performed. Alternatively, it may be removed immediately after seating the restoration with a brush or similar instrument. In this case the first option was chosen. The treatment outcome after rubber dam removal and final clinical and aesthetic evaluation is displayed in Figure 29.

Fig. 23. Priming of the tooth structure.

Fig. 24. Selected resin cement.

Fig. 25. Tooth structure ready for crown placement.

Fig. 26. Restoration in place.

Fig. 27. Lateral view of the restoration.

Fig. 28. Final light curing of the crown.

Fig. 29. Treatment outcome immediately after rubber dam removal.

CONCLUSION

This case highlights a comprehensive restorative approach to preserving a traumatized anterior tooth at risk of loss, while restoring both function and aesthetics. The strong core foundation provided by CLEARFIL MAJESTY™ ES-2 Premium and the reliable adhesive performance of PANAVIA™ V5 played a pivotal role in the successful procedure and outcome.