Clinical Cases and Chairside

From trauma to harmony: a minimally invasive approach to anterior aesthetics

Case by Dr. Sofien Riahi

Anterior dental trauma often results in aesthetic concerns that require careful and conservative management. Today, minimally invasive adhesive techniques enable clinicians to restore function and appearance with highly predictable and natural-looking results. Direct composite restorations, in particular, offer an effective solution by combining tissue preservation with excellent aesthetic integration.

TREATMENT NEED

A 31-year-old patient attended our practice seeking aesthetic improvement following a previous uncomplicated trauma to her upper and lower incisors. At the initial clinical visit, a consultation was carried out, including photographic documentation and intraoral scans.

Fig. 1. Initial clinical situation revealing fractures in the incisor region.

Fig. 2. Close-up of the upper incisors that need to be restored.

TREATMENT PLAN

The proposed treatment plan involved direct composite restorations as the least invasive and most predictable treatment option. The patient accepted the proposed measures. We proceeded with digital planning of the restorations. Models of the proposed design were printed, and a silicone index was produced. At the subsequent clinical visit, shade selection was performed using the composite button technique. A1 enamel and dentin shades of CLEARFIL MAJESTY™ ES-2 (Kuraray Noritake Dental Inc.) were selected.

Fig. 3. Digital treatment planning (wax-up).

Fig. 4. Shade selection using the composite button technique.

CLINICAL PROCEDURE

Local anaesthesia was administered, and the operative field was isolated with rubber dam. A smooth bevel was created using diamond burs, an Arkansas stone, and 3M™ Sof-Lex™ discs (Solventum). The surfaces of the involved teeth were sandblasted and etched with phosphoric acid etchant, while the adjacent teeth were protected using a metal strip. Then, the two-bottle self-etch adhesive CLEARFIL™ SE Bond 2 (Kuraray Noritake Dental Inc.) was applied.

The silicone index was filled with CLEARFIL MAJESTY ES-2 (A1 enamel shade) and inserted to build up the palatal shell of the restorations. The proximal walls were restored using Garrison matrices and CLEARFIL MAJESTY™ ES Flow (Kuraray Noritake Dental Inc.) in A1 shade. The internal anatomy of the restorations was recreated using A1 dentin shade of CLEARFIL MAJESTY ES-2. A clear effect shade was used to mimic the natural translucency of the incisal edges. The halo effect was reproduced using A1 dentin shade. Layering was completed with A1 enamel shade. The restorations were then finished and polished.

Fig. 5. Operative field after isolation with rubber dam.

Fig. 6. Minimally invasive tooth preparation with a diamond bur.

Fig. 7. Use of an Arkansas stone for tooth preparation.

Fig. 8. Preparation finishing with a Sof-Lex™ disc.

Fig. 9. Silicone index …

Fig. 10. … filled with composite to build up the palatal shell.

Fig. 11. Palatal enamel consisting of CLEARFIL MAJESTY ES-2, A1 enamel shade.

Fig. 12. Proximal walls shaped with the aid of Garrison matrices using flowable composite.

Fig. 13. Recreation of the internal anatomy.

Fig. 14. Internal anatomy completed.

Fig. 15. Application of a clear effect shade in the incisal area.

Fig. 16. Reproduction of the halo effect.

Fig. 17. Completion of the anatomical shape with a final enamel layer.

Fig. 18. Both restorations built up.

Fig. 19. Light-curing through a layer of glycerin gel to block oxygen.

Fig. 20. Finishing procedure carried out with a diamond bur.

Fig. 21. Immediate treatment outcome.

TREATMENT OUTCOME

The patient was satisfied with the achieved result. The restorations were virtually indistinguishable from natural tooth structure – with a smooth transition from teeth to composite and natural incisal effects. The surface structure also contributed to a natural appearance. As the patient was happy with the procedure and the outcome, the lower incisors were restored in the same way.

Fig. 22. Smile of the patient.

Fig. 23. Lateral view of the restorations revealing a natural surface texture.

Fig. 24. Lateral view from the right completing the picture.

Fig. 25. Successfully restored lower incisors.

CONCLUSION

The presented case shows that modern adhesive dentistry enables predictable and minimally invasive procedures that deliver fast and true-to-life results. The CLEARFIL MAJESTY ES-2 system offers a wide range of shades and translucencies, allowing seamless outcomes through a polychromatic layering technique.