Direct veneers through a simplified method combined with DSD – simple guidelines for single shade restoration

Community - Direct anteriors
15 Jun 2017
Fig. 1

Img. 1 – Initial situation

Fig. 2

Img. 2 – Initial situation, Retracted Photo

Fig. 3

Img. 3 – Initial situation, Retracted Photo

Fig. 4

Img. 4 – Scaling, polishing and finishing of old restorations and composites after Orthodontic treatment. The photo shows how the teeth are affected by previous treatments.

Fig. 5

Img. 5 – Digital smile Design was done to see the areas needed for addition of the composite.

Fig. 6

Img. 6 – Isolation is always the first step in a procedure. Moisture control is an important step for extending the life expectancy of our direct restorations.

Fig. 7

Img. 7 – Extra Retraction and inverting of the rubber dam.

Fig. 8

Img. 8 – Conditioning of the enamel surface with phosphoric acid.

Fig. 9

Img. 9 – Dryness and removal of excess water.

Fig. 10

Img. 10 – Bonding was done before placing the matrices. The easiest way to start in such cases, in which there is no need to change the position of the midline, is to place two appropriate sectional matrices vertically with a wedge to establish the place of the contact area in the midpoint. Composite body shade was used to close the diastema on one of the centrals in the begining. Care and focusing on good adaptation where the composite has to extend palatally to prevent over-hanging and have initial good contours to minimize our finishing time later on.

Fig. 11

Img. 11 – After finishing the proximal area of the first central incisor we remove the first sectional band to have an appropriate contact. Then we proceed with the adaptation of the composites in the same manner.

Fig. 12

Img. 12 – The initial situation after removing of both matrices. Now we can start adaptation of composite on the buccal surface of the two central incisors.

Fig. 13

Img. 13 – A photo showing how the composite is anatomically adapted, right from the beginning. It becomes easier to finish the restoration as we spend more time adapting the composite.

Fig. 14

Img. 14 – Sectional matrix is again used, but this time without a wedge. The wedging action of the rubber dam was used to secure the band in place to give a maximum contour for the tooth proximally.

Fig. 15

Img. 15 – Lateral incisor, proximal area done correctly.

Fig. 16

Img. 16 – Buccal surface done anatomically again.

Fig. 17

Img. 17 – The opposing lateral incisor and both of the canines were done with the same protocol, always starting with doing a correct proximal contour followed by mimetic buccal contours.

Fig. 18

Img. 18 – Immediate result after finishing and polishing. Finishing of the proximal area was done using soflex discs for a minimal adjusment. The buccal surface was finished using a alow speed medium grit dimond bur. The polishing was done following the recipe of J. Manauta and A. Salat in their "Layers" book.

Fig. 19

Img. 19 – Immediate result.

Fig. 20

Img. 20 – The smile of the patient.

Fig. 21

Img. 21 – Notice the fine and natural anatomy.

Fig. 22

Img. 22 – Good facial integration with the smile is what we want to reach.

 

Conclusions

The use of a single shade composite was the first step to simplify our restoration. After that, the way we start our work, and some specific guidelines can always provide the key to success. However, the need for extra steps of pre-planning is always essential and this is where the simplified digital smile design concept by Christian Coachman takes place.

Bibliography