Restoring One Maxillary Fractured Incisor With A Porcelain Veneer A Case Report

Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Restoring One Maxillary Fractured Incisor with a

Porcelain Veneer: A Case Report
1 4
Dr. Balkis khadhraoui Dr. Zohra Nouira ( Professor)
Department of Fixed Prosthodontics, Department of Fixed Prosthodontics,
Dental Faculty of Monastir, Dental Faculty of Monastir,
University of Monastir, Tunisia University of Monastir, Tunisia
2 5
Dr. Zeineb Riahi (Assistant Professor) Dr. Dalenda Hadyaoui( Professor)
3 6
Dr. Imen Kalghoum (Assistant Professor) Dr. Belhassen Harzallah ( Professor)
7
Dr. Mounir Cherif ( Professor)
Department of Fixed Prosthodontics,
Dental Faculty of Monastir,
University of Monastir, Tunisia
Abstract:- Nowadays, facial appearance takes an When it occurs in the aesthetic area it may represent a
important place in social life especially when it comes to challenge. The dental changes resulting from this clinical
the smile. In fact having even one unaesthetic tooth will occurrence lead to a reduced quality of life of patients
negatively affect the social integration and self-esteem of because it affects their self-esteem (3), (4). The aesthetic
the person particularly among young people. So the factor is even more critical considering the standards of
ultimate challenge for the dentist is to restore the beauty socially imposed, where minimal changes in shape,
patient's smile with the most conservative and aesthetic color and/or positioning have become highly valued.
way. Within the philosophy of less is more and
respecting the therapeutic gradient the indication of When choosing the type of treatment, some clinical
minimally invasive restoration took a place. Dental aspects are key to be considered, like the age of the patient,
porcelain veneer present a suitable option for aesthetic the quality of the remaining tooth structure, the location of
restoration since their introduction in 1983 and this is the fracture line, and the presence of occlusion dysfunction.
based on their strength, longevity, conservative (5), (6).
preparation, aesthetics, and biocompatibility.The
clinical success that the technique can be attributed to Although composite resins can be used in certain
many reasons such as the conservative preparation of clinical cases, all-ceramic restorations offer superior
the teeth; proper selection of ceramics to use; proper esthetic outcomes and durability. Direct restorative
selection of the materials and methods of cementation; materials have limitations in terms of maintaining shine,
and proper planning and communication with the shade, and longevity, whereas all-ceramic restorations are
ceramist. In this article we will illustrate step by step the better equipped to preserve these qualities over time (7).
restoration of one fractured maxillary incisor with a Etching the ceramic surface has been shown to enhance the
feldspathic veneer. long-term bonding effectiveness of composite materials and
tooth tissues, making all-ceramic restorations a viable
Keywords: Central Incisor; Veneer; Bonding; Esthetic,; treatment option (8). Furthermore, by utilizing partial
Dentistry. preparations such as veneers, all-ceramic restorations can
help maintain dental integrity by reducing the amount of
I. INTRODUCTION tooth structure removed (9). In addition, ceramics are often
mentioned as the material of choice in terms of fracture
Dental trauma is a common reason for tissue loss and resistance and color stability (10).
it frequently involves the anterior region (1). Rehabilitation
options for fractured incisors depends on the injuries
characteristics (2).
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ISSN No:-2456-2165
II. CASE DESCRIPTION
A 28-year-old female patient attended at the department

of fixed prosthodontics of the dental clinic of Monastir. She
was complainig about the unesthetic appearence of her
maxillary central incisor.
A clinical examination was conducted. It revealed

overlapped central maxillary incisors. The tooth #11 was
rotated medially, with a composite restoration poorly
bonded on the incisal edge. Her Oral hygiene was
satisfactory (Figure 1).
Fig 3 Smile View of the Aesthetic Mock Up
Fig 4 Intra-Oral View of the Prepared Tooth

Fig 1 Intra-oral frontal view
When the diagnostic mock‐up was placed in mouth
An orthodontic treatment followed by prosthodontic the smile line, occlusion, phonetics, and esthetics were
intervention was suggested to the patient but she rejected evaluated.
that option. The minimally invasive ceramic veneers on
tooth #11 was selected. Shade selection was performed and photographs were
taken with and without shade tabs at various angles.
Study impressions were first performed and casted. A
diagnostic wax up was made to prefigure the final result of The preparation was made over the mock up (figure
our esthetic project. (figure 2) 4).
A rounded diamond bur was used to mark three depth
grooves through the mock-up, taking into account that the
minimal thickness of the veneer was 0.3 – 0.5 mm.
Fig 2 Diagnostic Wax-Up
The wax-up was necessary to make modifications in

central teeth arrangement and obtain the patient’s consent
to the treatment plan. A silicon matrix was then performed
to make the intraoral mock up (figure 3).
Fig 5 Full Arch Impression

ISSN No:-2456-2165
A Cervical groove is created to initiate a sketch of the
future cervical finish line. A right angle (butt-joint)
preparation with incisal overlap of 1 to 1.5mm was
achieved to manage enough space providing edge
translucency. Proximal contact areas were not included to
the tooth preparation. Chamfer finish line was maintained
in the cervical region at the level of the gingival margin.
All internal angles were smoothed to reduce stress
concentration.
Fig 7 (b) Application of the Bonding Agent
Layering ceramic (IPS e-max ceram ; Ivoclar

Vivadent AG) was used to guarantee a lifelike play of light
and improve it appearance.
Fig 6 Computer Aided Design of the Ceramic Veneer
Maxillary and full-arch impressions were made using

polyvinyl siloxane material (Zetaplus Zhermack) (figure 5).
The die shade was evaluated using IPS natural die

Material (IvoclarVivadent). The bite registration and
photographs were also sent to the ceramist with a complete
laboratory prescription detailing the required outcome and
patient desires.
The veneer was fabricated with a high-translucency Fig 8 (a) Final Result, Buccal View
Lithium Disilicate reinforced glass ceramic (IPS e-max;
Ivoclar Vivadent AG) using CAD/CAM technique (Figure
6).
Fig 8 (b) Final Result, Lateral View
The prepared tooth was cleaned and the veneer was

tried-in using a transparent try-in paste (Variolink Veneer
try-in paste, Ivoclar).
The form, adaptation and shade match of the

Fig 7 (a) Tooth Surface Etching restoration were checked and the ceramic veneer was

ISSN No:-2456-2165
adhesively luted in accordance with the guidelines of the laminate veneers tolerates stress distribution better than the
manufacturer of the composite resin (Figure 7). butt-joint design (14).
The patient was provided strict oral hygiene With advancements in laboratory techniques and
instructions and regular examination appointments. (Figure dental materials, it is now possible to produce ultrathin
8) feldspathic veneers with thicknesses as small as 0.1-0.5
mm, which can be bonded to tooth structure with minimal
III. DISCUSSION or no preparation required, restoring fractured teeth (15).
Maxillary incisor fracture, especially occurring at a Conservative tooth preparation with ceramic veneers
young age, can cause psychosocial discomfort in addition can help prevent excessive removal of tooth structure and
to esthetic impairment. (1), (9). provide a second opportunity to the tooth in case a
secondary restoration, such as a full coverage crown, is
This case report showed a restoring sequence of a needed in the future. It is important to note that restorations
maxillary central incisor fractured and rotated using are not permanent, and therefore, conservative approaches
ceramic veneer. like ceramic veneers can help preserve the natural tooth
structure.
Orthodontic management followed by prosthetic
treatment would have been the ideal line of treatment for The choice of material for single-tooth porcelain
this case. However, orthodontic treatment was rejected by veneer seems to be case-specific. It is influenced by several
the patient. factors such as the die shade, the opacity of natural teeth
and cost and benefit analysis. Therefore, a thorough
The conservative option with ceramic veneer seems a knowledge of the different materials available for this
reliable and successful alternative in such case, with a purpose, and their applications as limitations will enable the
survival rate of 93.3% after 15 years (10). dentist to select the best option available for each patient’s
needs (16).
Nevertheless, appropriate treatment planning is
needed for such cases. Creating a proper diagnostic wax-up Milled veneers can satisfy esthetic requirements of
is crucial for diagnosing and treating fractured teeth with recovering normal color abutment teeth. The thickness,
veneer restorations (11). shade, and type of ceramic materials become important
variables in manipulating the final color of ceramic
It offers valuable information related to the size laminate veneers because the target color of veneer
discrepancies between healthy and fractured teeth, available restorations and abutment shades cannot always be chosen
restorative space, occlusal scheme, and other required by clinicians. In practice, the thickness of a veneer
treatments in the opposing arch (12). The diagnostic wax- restoration is restricted by the minimal amount of tooth
up can be transferred to the patient's mouth as a mock-up to preparation and target restorative space. In addition, the
allow them to evaluate the proposed restorations both different resin cement shades might be selected to slightly
visually and tactilely. modify the final color of ceramic laminate veneer.
Therefore, clinicians must consider which kind of CAD-
Additionally, the diagnostic wax-up can serve as a CAM material can better recover the optical properties of
treatment tool by providing diagnostic and preparation natural teeth to achieve a good color match .The abutment
guides. The diagnostic guide helps the clinician to tooth color is the primary source of the final esthetic
determine the thickness of the future restoration required to outcome of ceramic veneers (17).
replace the fractured tooth segment, while the reduction Ever since the inception of glass-ceramics in dentistry,
guide can assist in reducing the extension of tooth materials with different compositions have been developed.
preparation if necessary. In both cases, reduction guides However, their popularity surged after the introduction of
were used for planning and executing the final restorations. lithium disilicate glass-ceramic in 1998, marketed as
e.max® (IPS Empress® 2, Ivoclar Vivadent). As compared
The diagnostic wax-up was essential to provide a to feldspathic, ceramic-reinforced polymers, and leucite
mock-up for patients and clinicians to evaluate the glass-ceramics, lithium disilicate-based materials have
proposed restorations visually and tactilely, and the guides, displayed superior mechanical properties (18), (19).
which were fabricated from the diagnostic wax-up, aided in
evaluating the facial space required for the final IV. CONCLUSION
restorations (13).
Restoring fractured maxillary central incisors is
As for the preparation, a cervical chamfer design challenging for many clinicians and the lack of a good
might be a better choice for porcelain veneers because it clinical protocol could be a contributing factor to the
has a lower maximum principle stress, a more uniform unsuccessful management of such cases. Reliable and
stress distribution in the cement layer, and a high clinical positive long-term outcomes have been observed with
success rate. The palatal chamfer design for porcelain adhesive ceramic restorations.

ISSN No:-2456-2165
Advancements in laboratory techniques have made it [8]. BOWEN, R. L., & BOWEN, R. L. (1965).
possible to create ultrathin handcrafted ceramic restorations ADHESIVE BONDING OF VARIOUS
that offer an extremely conservative and aesthetically MATERIALS TO HARD TOOTH TISSUES. I.
pleasing solution for rehabilitating fractured central METHOD OF DETERMINING BOND
incisors. This case report of a fractured central incisor STRENGTH. https://doi.org/10.1177/0022034565
showed that such restorations were clinically successful and 0440041501
met the patients' esthetic requirements. [9]. Edelhoff, D., Sorensen, J. A., Edelhoff, D., &
Sorensen, J. A. (2002). Tooth structure removal
ACKNOWLEDGMENT associated with various preparation designs for
anterior teeth. https://doi.org/10.1067/mpr.2002.124
All authors are members of the Research Laboratory 094
of Occlusodontics and Ceramic Prosthesis LR16ES15 [10]. Peumans, M., Meerbeek, B. V., Lambrechts, P.,
Vanherle, G., Peumans, M., Meerbeek, B. V.,
 Conflicts of Interest Vanherle, G. (2000). Porcelain veneers: a review of
The authors declare no conflicts of interest. the literature. https://doi.org/10.1016/s0300-5712
(99)00066-4
 Authors’s Contributions [11]. 3rd, L. W. C., Richardson, J. T., 3rd, L. W. C., &
All the authors to the production of this article. They Richardson, J. T. (1985). The diagnostic wax-up: an
read and approved the final version of this manuscript. aid in treatment planning. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/pubmed/3856360
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Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology

Restoring One Maxillary Fractured Incisor with a

IJISRT23MAY877 www.ijisrt.com 3769

A 28-year-old female patient attended at the department

A clinical examination was conducted. It revealed

Fig 4 Intra-Oral View of the Prepared Tooth

Fig 2 Diagnostic Wax-Up

The wax-up was necessary to make modifications in

Fig 5 Full Arch Impression

IJISRT23MAY877 www.ijisrt.com 3770

Fig 7 (b) Application of the Bonding Agent

Layering ceramic (IPS e-max ceram ; Ivoclar

Fig 6 Computer Aided Design of the Ceramic Veneer

Maxillary and full-arch impressions were made using

The die shade was evaluated using IPS natural die

Fig 8 (b) Final Result, Lateral View

The prepared tooth was cleaned and the veneer was

The form, adaptation and shade match of the

IJISRT23MAY877 www.ijisrt.com 3771

IJISRT23MAY877 www.ijisrt.com 3772

IJISRT23MAY877 www.ijisrt.com 3773

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