Anterior Composite Stratification: A Clinical Case

A clinical case by our Community member Dr Ana Luiza Libório

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

The pursuit of aesthetically pleasing and natural smiles has been driving the advancement of restorative techniques in dentistry. Among these techniques, composite resin veneers have emerged as a versatile and minimally invasive option for anterior teeth aesthetic transformation. Success in utilizing these materials relies on the operator’s understanding and knowledge of their mechanical, physical, and optical properties, as well as their ability to master related clinical protocols. The objective of this clinical case is to demonstrate anterior composite layering technique.

style italiano styleitaliano direct anterior composite restoration composite stratification initial situation

Fig.1
Patient, 26 years old, presented to the private dental clinic following the completion of orthodontic treatment with invisible aligners, expressing dissatisfaction with the aesthetic appearance of her smile. She reported being bothered by the youthful aspect of her smile due to the rounded shape of her teeth, as well as by the unsatisfactory condition of previous restorations.

style italiano styleitaliano direct anterior composite restoration composite stratification initial photograph

Fig.2
Intraoral photograph revealing unsatisfactory restorations on teeth 11, 12, 21, and 22.

style italiano styleitaliano direct anterior composite restoration composite stratification initial situation

Fig.3
The procedure commenced with the partial removal of the restorations on the incisors, followed by digital scanning for three-dimensional (3D) planning.

style italiano styleitaliano digital scanning

Fig.4
Digital scanning and 3D planning.

style italiano styleitaliano Isolation and removal of old resin

Fig.5
Appearance after complete removal of the resin and absolute isolation with rubber dam.

style italiano styleitaliano Palatal barrier

Fig.6
Assessment of the palatal barrier, which serves as a guide for sculpting.

style italiano styleitaliano Adhesion procedure

Fig.7
The adhesive system was applied following the conditioning of enamel with 37% phosphoric acid.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.8
Placement of the PCE Estelite Posterior resin (Tokuyama, Japan) on the silicone guide.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.9
Palatal shell after polymerization. The thickness of this layer must be respected to accommodate the additional resin layers.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.10
After fabricating the palatal shell, the proximal walls were constructed using A1 enamel resin. This layer is crucial in guiding the desired final shape of the tooth. Proximal walls are built with the help of polyester matrix.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.11
Sculpting of the proximal wall of the lateral incisor. It is important to be cautious in order to avoid excess restoration material and to respect the emergence profile.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.12
Aspect following the sculpting of all proximal walls. At this stage, the tooth’s shape is virtually finalized. Subsequent layers of resin (dentin and final enamel) must adhere to these proximal wall delineations.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.13
Finalized proximal walls with A1 enamel in a lateral view.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.14
The “boxes” created by the palatal and proximal walls are filled with dentin composite resin. In this case it was used as dentin BW Palfique LX5- Tokuyama.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.15
Utilizing the LM Arte Condensa (LM, powered by Styleitaliano) and LM Arte Modella (LM, powered by Styleitaliano) instruments aid in compacting the material, preventing the entrapment of air bubbles during layering.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.16
After accommodating the dentin layer with the ideal volume and shape, the mamelons are designed using the LM Arte fissura (LM, powered by Styleitaliano).

style italistyle italiano styleitaliano Composite placement composite veneer restorationano styleitaliano

Fig.17
Use of white and blue pigments to highlight incisal effects.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.18
Use of white and blue pigments to highlight incisal effects.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.19
Accommodation of the final layer of achromatic enamel using the LM Arte Modella (LM, powered by Styleitaliano). At this stage, sculpture finalization is performed, and care should be taken to avoid working with excess material. The clinician has to be careful and has to respect the final shape and volume of the teeth.

style italiano styleitaliano Composite placement composite veneer restoration

Fig.20
Final layer of enamel after polymerization. The clinician must exercise caution and ensure the preservation of the final shape and volume of the teeth.

style italiano styleitaliano composite veneer restoration final finishing and polishing

Fig.21
In a second session, the final finishing and polishing are carried out. Initially, the edges are marked with a pencil to refine the primary anatomy.

style italiano styleitaliano Surface texture

Fig.22
After finalizing the primary anatomy, secondary anatomy (grooves and lobes) is achieved using a diamond-tipped FF instrument.

style italiano styleitaliano composite veneers restoration final outcome

Fig.23
Final outcome of the case after finishing and polishing.

style italiano styleitaliano composite veneers restoration final outcome

Fig.24
Intraoral photograph of the final outcome.

style italiano styleitaliano composite veneers restoration before and after

Fig.25
Intraoral photograph of the final outcome: before and after.

style italiano styleitaliano composite veneers restoration before and after

Fig.26
Extraoral photograph of the final outcome: before and after.

Conclusions

In conclusion, this clinical case highlights the successful application of layered composite resin veneers to achieve both aesthetically pleasing and functional results. Through meticulous attention to detail in stratification techniques, a remarkably natural appearance was attained, enhancing the patient’s smile while ensuring proper occlusal function. The integration of modern dental materials and precise digital planning underscores the potential for composite resin veneers to serve as a versatile and effective solution in cosmetic dentistry. This case exemplifies the importance of interdisciplinary collaboration, patient communication, and skillful execution in delivering optimal outcomes that meet both the patient’s aesthetic desires and functional needs.

Bibliography

    1. Coachman C, Calamita M. Digital smile design: A tool for treatment planning and communication in esthetic dentistry Quintessence of Dental Technology 35 103-111. 2012.
    2. Fahl Jr., Newton. (2015). Direct Composite Bonding in Anterior Dentistry: A Clinical Guide. Quintessence Publishing Co Inc.
    3. Chafaie, A., & Portier, R. (2021). Layering techniques in composite resin: a literature review. Journal of Dentistry and Oral Care Medicine, 7(1), 1020.
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