Available online 12 April 2024

This clinical report presents combining a computer-aided design and computer-aided manufacturing (CAD-CAM) composite resin palatal wall with a direct composite resin layering technique for the esthetic and functional restoration of a large Class IV fracture of a maxillary central incisor to achieve optimal esthetic and functional outcomes.

A 42-year-old woman complained of fractured maxillary central incisors resulting from trauma 2 weeks previously, with no reported posttraumatic pain or discomfort. During the clinical examination, a horizontal fracture was observed in the left maxillary central incisor, along with a palatal defect parallel to the gingival margin. The pulp was not exposed. The right maxillary central incisor had only a minor enamel chip on the incisal edge. The vitality, periodontal health, and radiographic

In the direct placement of an extensive composite resin restoration, accurately shaping the functional palatal surface freehand is challenging, although a putty matrix or 3D printed template can be used for shaping the palatal layer.8, 9, 10 For this patient, a CAD-CAM composite resin palatal wall was digitally designed and milled, and a stop designed for accurate placement.

CAD-CAM composite resin blocks have higher fracture strength than the typical maximum occlusal force between molars,11

A CAD-CAM composite resin palatal wall was provided to assist in shaping the palatal surface of a fractured anterior tooth, providing a foundation for subsequent directly layered composite resin application. Combining a CAD-CAM composite resin palatal wall with a direct composite resin layering technique represents an excellent approach to restoring an extensive Class IV fracture, resulting in optimal esthetic and functional outcomes, reduced chairside time, and increased patient satisfaction.

Informed patient consent has been obtained.

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