Introduction to the case

1
Name Ng Shay Lee
Supervisor Dr. Shalini Kanagasingam
University Universiti Kebangsaan Malaysia
Foto
of University
Introduction to the case
A 34 year-old woman presented with a missing
left lateral incisor (22) and discoloured
restorations on her right lateral incisor (12).
She had lost tooth 22 seven months ago due to
extensive caries. The patient was embarrassed to
smile due to the missing tooth and also suffered
from restricted phonetics. By using
pre-impregnated fiberglass ribbon and
CeramXduo system, it was possible to achieve
excellent aesthetic oral rehabilitation.
Before
After
Pre-operative labial view Tooth 12 had mesial
and distal discoloured restorations, with
underlying secondary caries. Mild enamel
hypoplasia was noted on the labial surface.
Missing tooth 22 left a 9mm space between 21 and
23.
Post-operative labial view Final result 2 weeks
after direct adhesive restorations with CeramX
duo system. The patient has regained her
confident smile.
Step 1 Cavity preparation tooth 12
Step 2 Restoration of tooth 12
Step 3 Etching and bonding of 21 and 23
Step 4 Fiber frame establishment
After microbrasion, etching and bonding was
applied. The cavity was restored with dentin
shade D1 at the mesial, D2 at the distal and
enamel shade E2.
For the replacement of tooth 22, rubber dam
isolation was done. Palatal surfaces of tooth 21
and tooth 23 were etched with 36 phosphoric
acid. Then, bonding agent (XP Bond TM) was
applied in an even layer, air blown and
light-cured for 20 seconds.
Dentine and enamel shade determination was
carried out using the CeramX duo shade guide.
The existing restorations were removed and cavity
preparation was done with a short bevel finishing
line.
The fiber frame was bonded to the teeth surfaces
and covered entirely by flowable composite
(DENTSPLY Esthet X-FlowTM) and light-cured.
Step 5 Rebuilding the dentine core
Step 7 Shaping and polishing
Step 6 Rebuilding the enamel layer
Step 8 Final result
The restoration was shaped to the natural contour
of the tooth. Enhance Finishing and PoGo
Polishing Systems (DENTSPLY) were used to further
smoothen the surface and yield a natural glossy
appearance.
Palatal and labial views of completed
restorations of tooth 12 and replacement of tooth
22. The patients anterior dental aesthetics was
restored and the phonetic problem was solved. She
was very happy with the result.

The dentin core of tooth 22 was built-up with
CeramX duo, (D2 mesial and D3distal).
Incremental layering technique was used.
Final layer of enamel shade E2 CeramX duo was
applied.
Material and method
The DENTSPLY CeramX duo system (Shade E2 and
D2/3) was used in this case. Replacement of tooth
22 utilized a fiber frame which was made with
pre-impregnated fiberglass ribbon (everStick
Perio). It was attached to the prepared tooth
surfaces with flowable composite (DENTSPLY Esthet
X-FlowTM). By using the incremental layering
technique, the double translucency of CeramX
duo system mimics natural dentine and enamel.
Discussion and conclusion
The loss of an anterior tooth can affect a
patient psychologically and socially, as well as
restrict phonation. Treatment options include
adhesive bridge, fixed bridge, removable partial
denture and implant. A fiber-reinforced composite
bridge was provided as an interim restoration as
the patient was on the implant waiting list and
did not want a partial denture. The CeramX duo
system offers a conservative and quick fix to the
problem in a single visit.