Direct composite injection molding with bilayered three-dimensional-printed clear index: a fully digital workflow case report of post-orthodontic anterior tooth wear.

Abstract

This case report describes post-orthodontic direct composite restorations for anterior tooth wear using bilayered, three-dimensional (3D)-printed clear indices with a fully digital workflow. A patient with moderate incisal wear affecting the six maxillary anterior teeth underwent intraoral and facial scanning, followed by the creation of two digital wax-ups. Two sets of bilayered indices were fabricated, consisting of a rigid transparent outer shell for structural stability and a flexible inner liner for precise adaptation. Restoration was performed in two phases: alternate teeth were restored with the skipping-teeth first index, followed by restoration of the remaining teeth using the full-contour second index. The index design facilitated stable seating and controlled composite injection (Clearfil Majesty ES Flow Universal; Kuraray Noritake), which minimized material excess and simplified the finishing process while maintaining the planned morphology. The patient reported high satisfaction with comfort and treatment efficiency. At 15-month follow-up, all restorations remained intact with excellent marginal adaptation, surface quality, and esthetics. Within the limitations of this report, the use of bilayered 3D-printed clear indices suggests a feasible and conservative approach for managing anterior tooth wear.