A clinical cases by our Community member Dr Osama Shaalan.

As patient demand for a white, bright smile increases, using a composite system that’s designed for whitened teeth is a must for restorative work on bleached or naturally white teeth. The CompoSite System was specifically designed for composite veneers, as in this kind of restoration we can only use one or two shades to restore a whole smile. In this article we will demonstrate how we can use the whiteology approach with the aid of the Unica matrix for composite veneers, to make a smile makeover procedure simpler and more predictable.

Fig.1

This 25 years old young woman came to the clinic complaining of bad esthetics. The patient wished to smile more confidently, and she was looking forward to get a brighter, whiter and more attractive smile.

Fig.2

Her upper teeth presented diffuse decay, mainly due to the fact she couldn’t maintain a proper oral hygiene during the two-year orthodontic treatment. As she had multiple defective composite restorations in the other upper anterior teeth, we decided to go for composite veneers for the upper anteriors as a minimally invasive approach.

Fig.3

Rubber dam is placed, and floss ligatures are used to retract the dam in order to better manage the cervical seal, and to have more control over the emergence profile, which is also a critical area in this type of restoration.

Fig.4

After removing the caries and the old defective restorations.

Fig.5

A selective etching technique was used, and the bonding agent was rubbed for 20 seconds and then gently air blown to let the solvent evaporate. Light curing is carried out for 60 seconds.

Fig.6

A thin palatal shell was built with the Enamel shade, freehand using transparent strips supported by placing a finger on the palatal side (White Dental Beauty CompoSite Enamel).

Fig.7

Unica is the ideal matrix for anterior restorations such as class III, IV, V, and for direct veneering as well. Its two wings allow for easy placement, and the contouring shape perfectly adapts to all anterior teeth. You can use this matrix to both restore proximal and cervical margins at once, even with the rubber dam, thus reducing chair time significantly.

Fig.8

The shape of Unica also helps visualise the final shape of the restoration before starting the layering. For an increased stability, plastic or wooden wedges can be used. As an alternative, e.g. in case of wide class III restorations where the wedge could crash the matrix, liquid dam an be a viable option to hold the matrix in place.

Fig.9

Proximal walls were built using E White Dental Beauty CompoSite. This is an important step: if we control the outer shape we can control layering of inside dentin shade perfectly, and also facilitate finishing and polishing procedures.

Fig.10

The White Dental Beauty CompoSite dentin shade used before placing the final layer and shaping mamelons is Si 2. Light curing for 40 seconds with a 500 mW/cm2 minimum light source.

Fig.11

To make the restoration look more natural, the enamel E shade was used as a final layer, and a white opaque stain SiM was used to create the illusion of an incisal halo.

Fig.12

The first finishing step requires correction of the angle lines with a fine needle diamond bur.

Fig.13

Right after rubber dam removal and before the polishing procedures.

Fig.14

After having created the texture details we should soften the surface of the composite resin with a rubber Eve twist polishing tip.

Fig.15

For the final polishing 3 and 1 micron diamond pastes with natural goat-hair brush are used at 1,000 rpm with no water and at 10,000 rpm with abundant water.

Fig.16

After finishing and polishing.

Fig.17

One week follow up.

Fig.18

The patient’s new smile.

Fig.19

Before and after.

Conclusions

Direct composite veneers can be a suitable solution for patients who want a whiter and more appealing smile, especially for those who want it quickly. The direct veneering technique allows us to sculpt and create beautiful and natural looking smiles in one visit, while being minimally invasive; this technique is also a financially attractive procedure for the patient.

Bibliography

1. Devoto W1, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.

2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. , Quintessence Books, 2012.

3. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.

4. Fahl Junior N, The direct/indirect composite resin veneers : a case report. Pract Periodontics Aesthet Dent 1996 ; 8 : 627-638 .