direct veneers incisor

Direct veneers, the single incisor challenge

This case is very special to me, as the patient is both my mentor and my brother, who’s a great dentist and professor. So you’ll understand how it felt when he called me up one day, asking me to restore his tooth because he wasn’t satisfied with his smile.

dental photography and polarisation

Fig.1

So this very special patient needed me to treat his central incisor, which he broke when he was young. Back in the day he had the fragment reattached.

cast and wax up

Fig.2

After evaluating color shades, I fabricated a wax-up to pre-perform and pre-visualize the morphology and texture, and to memorise all the details.

composite button try for shade selection

Fig.3

After this morphological planning, we need to train our own eyes to see colors, so I performed a composite button try to select the exact composite shade.

unica matrix for dental sandblasting

Fig.4

In order to preserve the most enamel, I used Aquacare to sandblast the old composite resin in between the fragments.

fourth class cavity on central incisor

Fig.5

Afterwards, I removed the old composite, so the tooth is now ready to start restoring.

direct composite veneer on central incisor

Fig.6

Before placing the rubber dam, I perform a last chromatic test, using the same composite shade and thickness to create some kind of a “test veneer”, in order to assess shade selection was correct.

teflon tape during acid etching

Fig.7

After this last test I isolate with the rubber dam and protect the contiguous teeth with teflon tape before etching with orthophosphoric acid for 30 seconds.

microbrush bonding on tooth

Fig.8

After having dried the whole surface, it’s time to bond. I also apply the adhesive to the palatal surface.

silicone index for composite palatal shell

Fig.9

I mark the limit of the restoration on the silicone index with the LM Fissura instrument before applying the composite mass, in order to minimise material residue.

composite palatal shell

Fig.10

The first layering step is very important, as it’s the time you create the contour for the whole restoration. You set the incisal line and the shape of the embrasures. To build the palatal wall I used a chromatic enamel mass (WE, Filtek Supreme, 3M).

unica matrix and wedges for direct veneer

Fig.11

After building the palatal wall, I placed the UNICA matrix to create the full contour and to easily control the contact point. For this layer I used the MW Estelite Omega (Tokuyama Dental).

anatomical composite layering

Fig.12

After the first layer, I needed to create the internal morphology and to reposition the transition line.

composite resin layering and transparent matrix

Fig.13

For the final layer of the veneer I used a high value enamel mass to even the appearance of the restoration.

composite resin proximal layering with matrix

Fig.14

To easily access the proximal areas I always use the LM Arte Modella and Applica Twist.

light curing central incisor

Fig.15

The last light-curing cycle is 40 seconds, to get full conversion.

rubber dam isolation and floss ligature

Fig.16

After layering is finishes, we can remove the rubber dam before polishing.

composite resin veneer before polishing

Fig.17

The restoration, right after rubber dam removal.

rubber cups for composite polishing

Fig.18

To polish the buccal surface I use silicone tips and polishing paste.

brush and felt for composite resin polishing

Fig.19

Followed by brush and felt discs.

invisible composite resin veneer

Fig.20

This is the final result using 3 composite shades and absolutely no dental preparation.

before and after composite resin veneer restoration

Fig.21

The Before and After.

Conclusions

With minimal invasiveness in mind, today’s composites are a better option compared to ceramic restorations, so I choose composite veneers for all my patients when a restorative, non-invasive treatment is needed. Always put preservation of your patients’ teeth first.

Bibliography

1. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37(47):5-13

2. Bazos P2. Bazos P, Magne P. Bio-Emulation: biomimetically emulating nature utilizing a histoanatomic approach; visual synthesis. Int J Esthet Dent, 2014;9:330-352.
3. Franco EB, Francischone CE, Medina-Valdivia JR, Baseggio W. Reproducing the natural aspects of dental tissues with resin composites in proximal restorations. Quintessence Int. 2007;38(6):505-10.
4. Ottoboni TDO, Falacho RI. The importance of diagnostic wax-up to make predictable composite resin aesthetic restorations in anterior dentition. J Clin Dent Res. 2016;13(3):54-60.