Efficient aesthetics with semi-direct veneers

Ortho and Kids - Direct anteriors
5 Nov 2015

During decidous dentition, about 25% of the young patients are involved in a traumatic event. As a direct consequence of this injuries, disturbances in development or eruption of permanent teeth may occur and white yellow-brown discoloration of enamel or circular enamel hypoplasia could appear on the permanent correspondent teeth. The lesion is often sharply demarcated, stained enamel opacity could be present and they could extent from small spot to large areas. Sometimes, caused by more serious trauma, narrow horizontal groove with encircles the crown cervical to the discolored area or hypoplasia with external defect is found centrally in the coronally placed white or yellow-brown lesion.
In this type of defects, direct restoration need deep surface prep, while the dentin could also be involved. In order to reduce the enamel demolition, minimally prep must be taken into account. Also,long term marginal stability must be widely considered. Using a prepolimerized direct veenering may help in achieving good esthetic and stability, above all in medium and long term follow up. Below we post a clinical case of a young girl, aged 17, showing a severe lesion on 1.1 and minimal on 2.1, as consequence of dental trauma on 5.1 and 6.1, occurred at age 2. First time we visit Erika when she was 8, but parents decided for non intervention. 9 years later, the patient ask for improving esthetics.

Fig. 1

Because the presence of deep enamel-dentin hypoplasia, a semindirect veneering with EGR was proposed on 1.1. Due to the presence of spots on 2.1 surface, stains on the inside of EGR were performed, in order to mimic on 1.1 the same color map.

Fig. 2

Blue, White opalescence, White and Gold were used on 1.1 EGR, following the same distribution on upper central left.

Fig. 3

Before luting the shell, a minimal surface prep or enamel was made (0,5mm in thickness) without touching contact point or incised margin.

Fig. 4

After rubber dam isolation, a clump 9T and a Open Automatrix (wide regular) were used, in order to obtain a proper control of apical margin and interdental shape.

Fig. 5

1 week post op, after rehydratation. Despite a single tooth was restored, a good integration of EGR was achieved.

Fig. 6

occlusal view of the egr .

Fig. 7

One Year follow up.

Fig. 8

Three Years post EGR. A minimal Fracture on incisal edge is present.

 

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