Esthetic direct veneering in vital and endodontically treated anterior teeth
More than 50% of restorative procedures are direct composite resin restorations. Sound dental tissue preservation, fast workflows and repairability are only a few of the advantages offered by composite resins. Many materials of different optical and physical properties are today available, which might make the outcome very unpredictable if you don’t have deep knowledge of their usage. For example, the thickness of one of several masses may dramatically change the final outcome. That’s why many clinicians consider non-vital anterior teeth a very big challenge and they often prefer to cover them with all-ceramic restorations. This said, most patients are simply asking for a “a white smile”, because white means healthy and beautiful, as displayed in magazines, ads, and so on.
In this case report, I want to show how a direct approach could lead to a successful esthetic outcome if correct materials and techniques are used, in order to make up for the differences between vital and non-vital teeth.
Initial photos show inappropriate composite restorations for teeth 11, 21 and 22. The central incisors are also dyschromic. The patient complains of discoloration and shape of her central incisors, which, as you can see, are too short and don’t follow the lower lip-line.
The x-ray shows a pariapical lesion on tooth 11, with a poor root canal obturation.
Before isolating with the rubber dam, the correct shade was selected thanks to a customized CompoSite shade guide made with the My ShadeGuide kit (SmileLine, powered by StyleItaliano), under a light source of 5500° K.
The root canal of 11 was retreated, and filled up to 2 mm below the bone ridge, in order to allow space for a flowable composite filling to improve the esthetic outcome.
The old composite restorations were carefully removed using a cylindrical medium-grain bur (Direct Style bur kit, by Styleitaliano, Komet), because every sound enamel prism and dentin tubule is crucial to a durable restoration.
All the margins were cleaned and smoothened. A chamfer design was used to define the buccal finishing line, using a fine-grain round bur ( Finishing Style bur kit by Styleitaliano, Komet).
The cavities are now ready for the adhesive procedures.
This flowable was also spread on the buccal walls to balance dentin fluorescence loss, and to mask the dark color.
The palatal shape was built using a silicone key.
A narrow proximal space was left in order to easily accomodate the matrices.
These matrices perfectly hug the cervical and interproximal margins. They easily provide a natural emergence profile and optimize the position and fit of the contact points. This is of significant help, as it makes the final shape predictable, allowing for better time management.
CompoBrush (SmileLine) is great to help the clinician to spread and shape the composite up to the margins.
The final light curing is 60 seconds long, and is better performed using an air-blocking system (e.g. ultrasound gel). This procedure will provide the composite resins’s complete polymerization, improving surface resistance and giving better polishing performances.
To optimize the stability of the matrices while avoiding crashing them, a drop of flowable resin (My Custom Resin, Polydentia) was injected in the cervical embrasures.
No surface preparation was needed, as we are directly veneering the laterals. Enamel-specific adhesive procedures were carried out.
Surface texturing was made using different kinds of burs.
The perio bur from the StyleItaliano Finishing Style kit (Komet) is ideal when used at low speed and no irrigation, in order to obtain better light refraction and reflection to enhance the value.
Final polishing is mandatory to get esthetic success of these restorations. Furthermore, a glossy surface reduces plaque accumulation and prevents the teeth from undergoing discoloration. The polishing is performed with diamond-charged spiral wheels (Diacomp plus, EVE), and low speed under water irrigation.
Restorations completed before removing the rubber dam.
And after complete rehydration.
The x-ray shows very nice root canal and coronal fillings.
The final outcome.
Modern composite resins allow us to make restorations while staying minimally invasive. They also allow us to provide affordable solutions for our patients.
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4. Devoto W. Clinical procedures for producing aesthetic stratified composite resin restorations. PPAD 2002;14(7):541-544.