Direct composite veneers

Direct veneering for everyday aesthetic solutions

A clinical case by our Community member Dr. Maroun Ghaleb

 

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.

 

In minimally invasive aesthetic dentistry, several treatment options are available and vary in techniques: direct, indirect or direct-indirect; and in materials: composite or ceramic.
The optimal treatment selected for each case is based on the indications, the required chair time and the patient’s financial status. Therefore, when a patient cannot afford to have ceramic veneers, the composite veneers are proposed as a cheaper alternative. In addition, when the chair time is problematic, composite veneers can also be presented as a time saving alternative by adopting the direct approach that gives the patient the final result in one session, as opposed to the ceramic veneers process which requires additional appointments.
The rising breakthroughs in dental materials are aiming to offer better clinical outcomes. In fact, the evolution in resin composites and adhesives, enhanced the clinical performance and the longevity of Laminate composite veneers.
Practitioners using composite resins are then able to mimic with high precision the optical and the colorimetric characteristics of the dentin and the enamel, in order to get a natural looking result.
White Dental Beauty’s Professional CompoSite System has been developed with optimum viscosity, resulting in excellent handling and a non-sticky consistency that is ideal for modelling and shaping. The system also boasts high polishability, allowing restorations to become invisible with natural fluorescence and high colour stability resulting in beautiful long-term aesthetics.

old defective composite restorations on upper teeth

Fig.1

A sixty-years-old woman came to my clinic complaining about her anterior teeth. She suffered from hypersensitivity in the left area, bleeding when brushing, fractures and bad esthetics. As seen in the picture, many problems are to be solved:
– Chipping on tooth 12;
– Multiple cervical abrasions;
– Inadequate composite restorations: over-hanging restorations and the teeth are bonded together, which explains the bleeding when brushing;
– Unaesthetic color and shape of the teeth;
– Caries, especially on tooth 23.

prepared incisors after removing old restorations

Fig.2

After cleaning the caries and removing the old defective composite restorations, a rubber dam was placed. Large areas of enamel are still present, allowing the future restorations to bond perfectly to the teeth.

etching of enamel surfaces

Fig.3

The surface was etched by applying 35% phosphoric acid (Scotchbond, 3M/ESPE, St. Paul, MN, USA) for 30 seconds, and then rinsing it thoroughly for 30 seconds with distilled water.

bonding of central incisors

Fig.4

Afterwards, the adhesive single bond 2 (3M/ESPE, St. Paul, MN, USA) was applied in two consecutive layers, using a microbrush. A 5-second air-spray was performed after each layer to evaporate the solvent.

light curing during composite restoration

Fig.5

Each tooth was light cured for 40 seconds to ensure complete polymerization.

Si White Dental Beauty CompoSite by StyleItaliano style italiano

Fig.6

Four composite shades from Professional CompoSite System by White Dental Beauty were used:
Si 1, equivalent to A1, is the final shade desired by the patient.
Si E (Si Enamel), is used to give translucency and good opalescence properties to the restoration.
Si M (Si masque), is used to instantly have a camouflage of the tooth’s shade. It is an opaque light resin considered as an ideal tool for dyschromia and masking dark teeth in one layer.
Si MP (Si multipurpose) is a flowable composite used in the interproximal areas to ensure perfect adaptation.

Composite palatal walls and outline

Fig.7

The Front Wing Technique was used to close all the diastemas; the mesial and distal frontal wings, and the palatal wall of the two centrals were done freehand. This technique makes it easier to achieve a good shaping and contouring of the teeth and to obtain harmonious dimensions. Si 1 was applied on the interproximal regions and Si E on the palatal wall.

sectional matrices for anterior restoration

Fig.8

Two anterior matrices and a wedge (Polydentia) were placed to ensure a tight contact point and a good marginal seal.

detail of backfilling in the front wing technique

Fig.9

A small drop of flowable composite Multiflow (Si MP) was placed palatally and left uncured. Then a layer of Si1 paste composite was applied.

composite backfilling

Fig.10

The paste composite was packed using a microbrush, until the uncured flowable came out on the buccal side. Excess material was removed bucally and palatally before polymerization. The same procedure was done for the second tooth after removing the matrix of the first one.

shape outlined with composite resin

Fig.11

When the outline was finished, it was possible to proceed to the layering steps.

layering of composite resin in anterior veneering

Fig.12

Si M (Si Masque) was first used to cover and masque the discolored parts of the teeth, and to give a natural final color to the restorations.

shaping mamelons with composite

Fig.13

Si 1 was used as the body shade color. Mamelon effects on the incisal edge were done to give the restorations a natural look.

layering enamel with web composite

Fig.14

Si E (Si Enamel) was placed in the end, to give the restorations the needed translucency and opalescence.

direct composite veneers

Fig.15

Final result after finishing only. Notice the natural aesthetic aspect of the teeth.

Lucida star felt for polishing of composite

Fig.16

Final polishing using the Lucida system.

composite veneers before and after

Fig.17

1-year follow-up.

Conclusions

In conclusion, direct composite veneers are a suitable solution for patients who desire to enhance their smile aesthetics. This treatment presents several advantages such as the lower cost, the lesser number of appointments and the possibility to repeatedly repair any inconvenient result and to polish. The longevity of direct composite veneers is affected by various factors such as the chosen material (good choice of the composite and the adhesive system), the operator’s dexterity and clinical skills, and the patient’s compliance (good hygiene, regular check-ups…). When meticulously selected and properly used, these materials can yield excellent and long-lasting results.

Bibliography

1. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. The European journal of esthetic dentistry 2010;5:102-124.
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012
3. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
4. Fahl N. Jr, Ritter A. Composite veneers: the direct-indirect technique: Quintessence Publishing Co; 2020.
5. Dietschi D, Shahidi C, Krejci I. Clinical performance of direct anterior composite restorations: a systematic literature review and critical appraisal. The International Journal of Esthetic Dentistry 2019;14:252–270.
6. Spaveras A, Vjero O, Anagnostou M, Antoniadou M. Masking the Discolored Enamel Surface with Opaquers before Direct Composite Veneering. Journal of Dentistry, Oral Disorders & Therapy 2015;3(2):1-8.