Endo-restorative treatment of discolored upper incisor

Fig. 1

Fig 1

A 16-year-old female patient came to my clinic with a discolored tooth, a maxillary left central incisor, which was compromising the aesthetic of her smile.

On elaborating the dental history of the patient, it was noted that the same tooth had been traumatized previously. 

The tooth has an old improper root canal therapy, observed through pre-treatment X-ray.

By clinical examination sinus tract was detected. 

Failure of the direct resin restoration by tooth discoloration was detected.

A poor marginal adaptation and mismatching color of a class IV resin composite restoration was observed, which was placed due to a traumatic dental injury.

Fig. 2

From the above mentioned findings, in agreement with the patient, a conservative aesthetic rehabilitation was decided.

The treatment was divided into two stages:

1-Endodontic retreatment stage 

2-Restorative stage

The diagnosis for retreatment was made according to the signs and symptoms reported by the patient and the preoperative radiographs showing apical radiolucency. 

Fig. 4

The crucial factor for achieving successful retreatment is thorough reshaping and cleaning of the canals to eliminate bacteria.

Hand files and ultrasonic device were used to remove old gutta-percha and sealer.

Subsequently the tooth was prepared with rotary Ni-Ti instruments to working length and irrigated with 5.25% NaOCl.

Fig. 5

Master cone radiograph 

Fig. 6

The obturation was done to level below cementoenamel junction 

Fig. 7

The walking bleach technique was carried out.

The bleach agent is collocated inside the pulp chamber, after putting a seal with glass-ionomeric cement at the coronal portion of the canal.

Fig. 8

Restorative stage

1-Shade and size selection

2-Tooth margins and prepared surfaces were then etched for 30 seconds with a 37% phosphoric acid etchant gel.

The tooth were rinsed and dried, and thereafter separated by interproximal matrices. A dental bonding agent was applied to all prepared surfaces, followed by gentle air-drying from the cervical to the incisal aspect and light-curing for 20 seconds. 

Fig. 9

Palatal shell

Fig. 10

Distal wall build up

Fig. 11

Halo effect

Fig. 12

1-Dentin shaded composite was free-handed and then used to restore with the corresponding preparations of a conventional direct composite restoration and light-curing for 40 seconds.

2-Enamel Layer 

Fig. 13

Contours and occlusal interferences were adjusted with a high speed bur and margins were refined and polished by strips for interproximal areas, flexible aluminum oxide discs, which are ideal to adjust the incisal angles, and silicone rubber polishers were used for the polishing steps.

Fig. 14

The final smile