Replacement of fractured tooth restoration with darkened substrate: Case report




Dental aesthetics; Composite resins; Dental veneers.; Dental veneers


Fractured and darkened teeth compromise the aesthetics of the smile and can result from situations of dental trauma, which can also negatively affect the individual's occlusion and psychosocial development. The objective of this study is to report a clinical case of replacement of class IV restoration in composite resin with the use of a silicone palatal guide on a fractured tooth with a darkened substrate. Female patient, 23 years old, sought care complaining of unsatisfactory restoration on tooth 21. It was proposed to replace the restoration and masking of the darkened substrate with direct composite resin. Molding of the upper arch and diagnostic waxing was performed to make a silicone palatal guide. The old restoration was removed; color selection of the restorative material; rubber dam isolation of the operative field; prophylaxis with pumice paste and water; conditioning with 35% phosphoric acid (30 seconds in enamel and 15 seconds in dentin); tooth washing and drying; applications two layers of universal adhesive and light curing. Sequentially, a highly translucent composite resin was inserted into the palatal guide, taken in the mouth, to make the palatal shell; construction of the opaque dentin body; contour definition and characterization with resin for enamel, followed by finishing and polishing. The treatment employed proved to be effective for returning the shape and color compatible with the adjacent teeth. The use of the silicone guide allowed good levels of marginal adaptation and facilitated the step of increasing the restorative material.


Arhakis, A., Athanasiadou, E. &Vlachou, C (2017). Social and Psychological Aspects of Dental Trauma, Behavior Management of Young Patients Who have Suffered Dental Trauma. TODJ. 11, 41-47.

Espíndola-Castro, L. F., Guimarães, R. P., Souza, F. B., Monteiro, G. Q. M., Menezes, P. F., Fernandes, L. O. & Silva C. H. V. (2019) A 14-year Resin Composite Occlusal Restorations: Split Mouth Randomised Clinical Trial and Wear Evaluation by Optical Coherence Tomography. Journal of Clinical and Diagnostic Research. 13(1), ZC10-ZC15.

Espíndola-Castro, L. F., Monteiro, G. Q. M., Ortigoza, L. S., Silva, C. H. V. & Souto-Maior, J. R. (2019). Multidisciplinary approach to smile restoration: gingivoplasty, tooth bleaching, and dental re-anatomization. Compendium of continuing education in dentistry. 40(9), 590-599.

Evangelista, I. K. F., Araújo, C. C., Melo, M. A. S., & Passos, V. F. (2017). Avaliação in vitro da Rugosidade de Superfície de Resinas Compostas Submetidas a Diferentes Técnicas de Acabamento e Polimento. Journal of Health Sciences, 19(5), 101-101.

Freitas, F., Pinheiro de Melo, T., Delgado, A. H., Monteiro, P., Rua, J., Proença, L., & et al. (2021). Varying the Polishing Protocol Influences the Color Stability and Surface Roughness of Bulk-Fill Resin-Based Composites. Journal of Functional Biomaterials, 12(1), 1.

Gao, Y., Li, J., Dong, B. & Zhang, M. (2020) Direct composite resin restoration of a class IV fracture by using 3D printing technology: A clinical report. J Prosthet Dent. 2020,1-5.

Jones, L. C. (2020) Dental Trauma. Oral Maxillofac Surg Clin North Am. 32(4), 631-638.

Kocaağaoğlu, H., Aslan, T. U. Ğ. R. U. L., Gürbulak, A., Albayrak, H. A. Y. D. A. R., Taşdemir, Z. E. K. E. R. İ. Y. A., & Gumus, H. (2017). Efficacy of polishing kits on the surface roughness and color stability of different composite resins. Nigerian journal of clinical practice. 20(5), 557-565.

Lam, R. (2016) Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent J. 61(1), 4-20.

Menezes, M. S., Vilela, A. L. R., Silva, F. P., Reis, G. R. & Borges, M. G (2014). Acabamento e polimento em resina composta: reprodução do natural. Rev Odontol Bras Central. 23(66), 124-129.

Lise, D. P., Siedschlag, G., Bernardon, J. K., & Baratieri, L. N. (2018). Randomized clinical trial of 2 nonvital tooth bleaching techniques: A 1-year follow-up. The Journal of prosthetic dentistry, 119(1), 53-59.

Nahsan, F. P. S., Mondelli, R. F. L., Franco, E. B., Naufel, F. S., Ueda, J. K., Schmitt, V. L. & et. al. (2012) Clinical strategies for esthetic excellence in anterior tooth restorations: understanding color and composite resin selection. J Appl Oral Sci. 20(2), 151-156

Paolone, G. (2014) Direct composite restorations in anterior teeth. Managing symmetry in central incisors. Int J Esthet Dent. 9(1), 12–25.

Pereira, D. A., Borges, M. G., Silva, F. P. & Menezes, M. S. (2016) Reabilitação estética do sorriso por meio de procedimento restaurador direto com resina composta nanoparticulada: relato de caso. Rev Odontol Bras Central. 25(72), 54-58.

Ramírez, J., Araújo, E. & Baratieri, L. N. (2014) Clinical Evaluation of Direct Composite Resin Restorations in Fractured Anterior Teeth. ODOVTOS-Int. J. Dental S.C. 16, 47-61.

Reddy, L. V., Bhattacharjee, R., Misch, E., Sokoya, M. & Ducic, Y. (2019) Dental Injuries and Management. Facial Plast Surg. 35, 607–613.

Romero, M. F. (2015) Esthetic anterior composite resin restorations using a single shade: Step-by-step technique. J Prosthet Dent. 114(1), 9-12.

Romero, M. F., Grant, J. A. & Todd, M. Restoration of a large class IV fracture using direct composite resin: A clinical report. J Prosthet Dent. 118(4), 447-451.

Ruschel, V. C., Stolf, S. C., Shibata, S. & Baratieri, L. N. (2017) A Conservative Technique for Repairing Class IV Composite Restorations. Oper Dent. 42(1), E10-E15.

Silva, A. Q., Almeida, R. A. C., Oliveira, N. G., Monteiro, G. Q. M. & Espíndola-Castro, L. F. (2020) Faceta Dentária em Resina Composta Associada a Pino de Fibra de Vidro Para Mascaramento de Substrato Escurecido: Relato de caso. Rev Ciên Saúde.5(1), 8-13.

Vandini, M., D’Amario, M., Angelis, F., Falco, A. & D’Arcangello, C. (2016) No-Prep Rehabilitation of Fractured Maxillary Incisors with Partial Veneers. J Esthet Restor Dent. 28(6), 351-358.

Yanikian, C. R. F., Yanikian, F., Sundfeld, Lins, R. B. E. & Martins, L. R. M. (2019). Direct Composite Resin Veneers in Nonvital Teeth: A Still Viable Alternative to Mask Dark Substrates. Oper Dent. 44(4), E159-E166.



How to Cite

COSTA, M. L. R. da .; ESPÍNDOLA-CASTRO, L. F.; MENEZES FILHO, P. F. .; MARIZ, A. L. de A. .; GUIMARÃES, R. P. .; SILVA, C. H. V. da . Replacement of fractured tooth restoration with darkened substrate: Case report. Research, Society and Development, [S. l.], v. 10, n. 5, p. e3410514535, 2021. DOI: 10.33448/rsd-v10i5.14535. Disponível em: Acesso em: 2 feb. 2023.



Health Sciences