29 Sep Restoration of an avulsed central incisor – Dr Cristian Scognamiglio e Dr Alessandro Perucchi
Restoration of an avulsed central incisor
by Dr. Cristian Scognamiglio e Dr. Alessandro Perucchi
Dr Cristian Scognamiglio
DDS, expert in dental aesthetics
Graduated with honours from the University of Varese (Italy) in 2018.
As of 2020, Dr. Scognamiglio works at Dr. Perucchi’s clinic in Mendrisio, Switzerland. Active as a researcher and speaker at several national and international congresses, since 2022 he is an opinion leader for Polydentia SA.
Member of the professional societies SSO, DDS, EAO and ITI.
Dr Alessandro Perucchi
DDS, specialist in oral surgery
Dr. Perucchi graduated in dentistry in 2005 in Bern. In 2011 he obtained the title of SSO specialist in oral surgery. In 2012 he opened his own dental clinic in Mendrisio. Since 2007 has been teaching at universities and training courses in Switzerland and Europe. Author of several scientific publications.
Member of the professional societies SSO, EAO, fellow ITI and founder of MINEC and DDS.
clinical case
The patient presented to the practice following an accident that caused a fracture and loss of the crown on tooth 12, which was found to be unrecoverable and therefore destined for extraction.
During the treatment phase, the patient expressed the wish to replace the incongruous and infiltrated restorations on incisors 11 and 21.
We therefore extracted the compromised tooth element, placed a zirconia dental implant under immediate load and in the meantime replaced the incongruous restorations at the level of the central incisors using Polydentia Unica matrices.
1: Pre-operative situation, occlusal view, showing the fractured lateral incisor.
2: Pre-operative X-ray after temporary repositioning of the fractured tooth 12.
3: After the extraction of the non-recoverable tooth, the patient, waiting for bone healing for implant placement at the level of tooth 12, requested an aesthetic replacement of the dated and infiltrated composites at the level of teeth 11 and 21.
4: Isolation of the operating field using the open dam technique; using this technique the cervical area of the teeth to be restored are easily accessible facilitating the use of the Polydentia Unica Anterior matrices and retractor wires.
5:Â Positioning of the Polydentia Unica Anterior matrices in combination with My Wedges. The versatility of the Unica Anterior matrices allows them to be used even when the adjacent tooth is missing, as in the case of tooth 11, by cutting the matrix in half and stabilising it only at the contact point where the adjacent tooth is present.
6: Incremental layering of the composite (dentine/incisal/enamel) in order to achieve an aesthetic direct composite restoration.
7:Â After removing the matrices, the wedges and pulling out the retractor wires, we are ready to finish and polish the restorations.
8:Â Final result after removing the rubber dam.
9:Â Healing of tissues adjacent to restorations and integration of fillings in teeth 11 and 21.
10:Â Placement of a zirconia dental implant in order to be able to replace the missing tooth 12, having achieved an insertion torque of more than 35N we can then place a provisional crown under immediate load.
11: During the few hours of waiting when our dental technician creates the provisional crown, a Zirconia healing screw is placed to protect the newly placed implant.
12: Provisional crown before delivery only 3 hours after implant surgery on the missing tooth 12.
13: Provisional screw-retained crown placement at implant level i12 and final result of highly aesthetic restorations at level 11 and 21.
14: 2 weeks follow up of restorations 11 and 21 and missing tooth 12.
15: Rubber dam removal, pre-polishing situation.
16: Initial and final result.
conclusion
Thanks to the use of Polydentia Unica Anterior anterior matrices and Polydentia myWedges wedges, we were able to achieve a highly aesthetic and natural result by greatly simplifying the procedure of reconstructing the fractured tooth element. Thanks to their ease of use, Polydentia Unica Anterior matrices make it possible to reconstruct anterior teeth that would otherwise have to be restored with veneers. In addition, they can be very useful for reconstructing the most cervical part of the tooth elements so that direct composite restorations (veneers) can be made.
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