Abstract
Objective: This clinical case aims to demonstrate a digitally guided hybrid restorative approach combining indirect and direct techniques to manage maxillary central incisors hypoplasia (teeth #11 and #21) in a pediatric patient, prioritizing esthetics, structure preservation, and immediate symptom resolution. Methods: An 8-year-old female patient presented with localized enamel hypoplasia and agenesis of multiple teeth, including significant loss of the coronal structure of the maxillary central incisors. The patient reported esthetic dissatisfaction and tooth sensitivity. Clinical and radiographic evaluations confirmed the diagnosis. A guardian-completed questionnaire revealed a history of high fever during early childhood; no familial or hereditary conditions linked to enamel defects were reported. A hybrid approach combining indirect and direct techniques was employed. Intraoral scanning and CAD/CAM (computer-aided design/computer-aided manufacturing) software were used to design and fabricate 3D (three-dimensional) printed composite palatal shells. These shells were bonded using a universal adhesive and flowable composite resin. The labial surfaces were restored using a stratified technique with dentin- and enamel-shaded composites to reproduce natural anatomy and translucency. Results:: At the three-month follow-up, the restorations showed excellent integration, surface luster, and color matching. Conclusions:: The patient reported complete satisfaction and resolution of sensitivity. Long-term follow-up is planned.