Patients arrive in our offices with all types of problems. These problems require the dental team, led by the dentist and supported by his staff, to be knowledgeable about techniques and methods to solve our patient's dental problem. What is the most simple, least invasive treatment I can provide for my patient and achieve the best outcome is how I start my treatment plan possibilities. The case presented below gives an example of treatment using materials and methods that allow for "tooth conservative" dentistry. It is really trying to find the BALANCE - providing beautiful dentistry, using scientific principles and methods, and at the same time, doing it in an efficient, cost effective way. I received a phone call at 3 pm on a Sunday. The patient was hit in the mouth and broke off his right upper central incisor (Figure 1). He had no pain and even though we can see the pulp, there was no bleeding and the tooth was certainly vital. Going through a check list of treatments and wanting to do the most conservative treatment, it was decided to cement the piece of tooth back on using Bistite II DC Clear cement. The patient was fully informed that future treatment may be necessary, but we would try this conservative approach.

Figure 1

A rubber dam was placed around the tooth without a clamp so that no additional pressure was placed on the tooth. The pulp was exposed, but there was no evidence of bleeding and the patient did not complain of any discomfort (Figure 2).

Figure 2

The piece was tested in place to assess the fit of the broken piece; the fit of the fragment was "perfect" (Figure 3). An articulating paper forcep was used to hold the piece of tooth because of the ease-of-use, no pressure is required to keep the piece of tooth in place.

Figure 3

Acid etch was placed on the enamel surface of the tooth, but none on the dentin or exposed pulp (Figure 4). Bistite II DC is a self-etching cement, but acid was still required on surfaces of the tooth untouched by a bur. The fragment was micro-etched with air abrasion and two small quarter-round bur holes were placed for additional retention. The fragment and the tooth were treated with the Bistite II DC primers for conditioning the tooth to receive the cement (Figure 5).

Figure 4

Figure 5

The fragment was moved into place with the Bistite II DC Clear cement and light cured for initial stabilization (Figure 6). The tooth fragment was restored in proper position with a wonderful cosmetic result (Figure 7). Note the lack of a cement line. The fragment has been in place for 4 years and the tooth shows no x-ray pathology or symptoms.

Figure 6

Figure 7

I followed a conservative restorative procedure because of the right set of circumstances. The fragment fit was ideal and there was no bleeding pulp. Because of its very low film thickness and lack of color, Bistite II DC resin cement allowed for an invisible and beautiful restoration. Excellent results were achieved. About the author:
Dr. Hoos maintains a private practice in Stratford, CT with an emphasis on implants and cosmetic dentistry. He graduated from Tufts University College of Dentistry and is a Fellow of the Academy of General Dentistry and the Academy of Implantology.