A 20-year-female patient reported to the Department of Conservative Dentistry and Endodontics with chief complaint of irregular appearance of upper front tooth. Patient history revealed no systemic diseases or medical conditions. Intraoral examination revealed a peg shaped lateral incisor with 12 (Figure 1). Following clinical and radiographic evaluation direct composite restoration was planned and informed to the patient.

Maxillary and mandibular diagnostic impressions using irreversible hydrocolloid were made (Figure 2) and diagnostic cast were obtained on to which, wax-up was done on 12 using Ivory wax (Figure 3). A palatal putty silicone index using vinyl polysiloxane was fabricated (Figure 4). The palatal half was then checked for the fit to serve as the reference guide to reconstruct the palatal aspect (Figure 5). Following shade selection, bevels were incorporated both on the labial & palatal aspects. Tooth was etched, bonded and composite build up was done. Finishing and polishing was done using the composite polishing kit (Figure 6). Oral hygiene instructions were given to the patient. The patient was instructed to floss regularly and also to avoid pigmented liquids that may cause staining of the restoration.

A peg lateral poses two problems consisting of malformation and presence of diastema between teeth. The treatment options of peg laterals can vary from; A simple composite build up, porcelain laminates/ veneers, endodontic treatment followed by metal – ceramic or all ceramic crowns and extraction of the peg shaped tooth and orthodontic movement of canine into the space of lateral incisor which can be then re-contoured to resemble lateral incisors or replacement with a single – tooth implant/FPD supported restoration 3.

Resin composites do not have the potential to cause catastrophic fracture, nor does it cause abrasive wear of the opposing dentition. If the patient avoids smoking or drinking, beverages with staining potential that can alter the color of the teeth, these can last for many years.

Esthetic bonding with resin composite may be the most conservative approach because the sound tooth structure will not be removed, the procedure may not require administration of local anaesthetic, the procedure may be completed in a single appointment and the treatment is also relatively inexpensive. Direct composite restorations can easily change the emergence profile and alter the shape and length of the tooth. It can be repaired easily and be polished and repolished to a high lustre 3.

The clinical results for this report show that palatal putty index with direct composite restoration for aesthetic and functional restoration of peg laterals is a very reliable and inexpensive method.