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This 19 year old man was playing college basketball when he landed on his face and broke his two central incisors. The fractures went up to but did not involve the pulp. Radiographs were taken and local anesthesia administered prior to isolating the area with a slotted rubber dam. A moderately deep 2 mm bevel was placed around the tooth #8 , adjacent to the missing fragment of tooth. The entire tooth was air abraded washed with water and then sodium hypochlorite. Following a thorough rinsing with water, the whole tooth was etched with 37% phosphoric acid and rewashed with water and dried. Tublicid Red was applied to the exposed dentin with a moderately dry fuzzy stick applicator. Optibond Solo Plus (Kerr) was liberally placed over all aspects of the tooth and dried lightly and cured for 60 seconds. Cosmedent Hybrid A1 was placed on the palatal aspect of the fractured area to approximate the missing incisal edge of tooth #8 to a thickness of 1/3 to 1/2 of the thickness of the tooth. Hybrid resin is the first resin placed when using a layering technique and is selected for its strength. A thin layer of Cosmedent Opaquer sh
ade A1-B1 was painted over the entire layer of hybrid resin and extended 1 mm onto the circumferential bevel on the natural tooth. The purpose of the Opaquer resin layer is to prevent shine through of the restoration which lowers the value. Another reason for using the Opaquer layer is to eliminate a line of demarcation between the natural tooth and the restoration. The final layer of the build up was Cosmedent A1 Renamel Microfill and that was placed over the entire missing natural tooth (now restored in Hybrid) and the rest of the natural tooth. 
A sufficient thickness of Renamel Microfill was placed to restore the tooth to 95% of the contour of the final restoration. The remaining restoration was restored with Renamel Microfill shade Incisal light to bring the restoration to its final full natural contour.A Microfill is used because it is a highly polishable resin that maintains its shine for many years. It also is highly color stable over long periods of time. The restoration was completed using fine diamond diamonds and Medium Grit 5/8 inch sandpaper discs from Cosmedent. Finally, the resin was polished with Cosmedent blue cups then pink cups with the final shine of the Renamel Microfill obtained wit
h Cosmedent Enamelize placed on a polishing disc. Tooth #9 was treated next using all of the previously mentioned protocol to restore tooth #8.The rubber dam was removed and the restoration was equilibrated to be in harmony with the natural occlusion. The final photos were taken 4 years after the restorations were placed. The benefits of the layering technique are the strength of the hybrid, the virtual invisibility of the restoration and a glassy smooth shine for many years.
