A clinical case by our Community member Dr. Maroun Ghaleb
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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.
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.
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.
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.
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.
Each tooth was light cured for 40 seconds to ensure complete polymerization.
Four composite shades from Professional CompoSite Systemby 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.
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.
A small drop of flowable composite Multiflow (Si MP) was placed palatally and left uncured. Then a layer of Si1 paste composite was applied.
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.
When the outline was finished, it was possible to proceed to the layering steps.
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.
Si 1 was used as the body shade color. Mamelon effects on the incisal edge were done to give the restorations a natural look.
Si E (Si Enamel) was placed in the end, to give the restorations the needed translucency and opalescence.
Final result after finishing only. Notice the natural aesthetic aspect of the teeth.
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.
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