bleaching composite veneers styleitaliano style italiano white dental beauty

I bleach teeth with white composite restorations

#Whiteology is a word that Styleitaliano has given to the study area that helps restore whiter smiles in everyday practice. In the following clinical case, we gave our patient a whiter smile with predictable, repeatable and affordable smile enhancing treatments using the #Whiteology philosophy. We have used White Dental Beauty Teeth whitening gels and Professional CompoSite System. Sometimes, it could be easier for the dentist to cover the buccal area with a direct veneer than having a combination of composite and natural tooth in the buccal area, especially when multiple tooth-composite margins are present. When the previous restorations involve more than tooth in the anterior area and involve more than 1/2 of the buccal surface in two or more teeth, the dentist can propose direct veneering as a solution. Patients usually like the idea of a single-session full buccal coverage, as we can offer the possibility of improving color while we change the old restorations. The Unica matrix (Polydentia) is the game changer here: we are able to do the veneering faster, and in one visit, while retracting the tissues during construction without clamps.

smile with old yellow composite restorations

Fig.1

In the following clinical case, we had old and extensive anterior restorations to change.

old restorations and chipped teeth

Fig.2

We see a combination of problems to solve:
– Old composite restorations
– Broken incisal angles
– Old composite restorations covering more than 50% of the buccal surface in more than 1 tooth in the anterior area.

illustration outlining composite restorations on teeth

Fig.3

Old restorations digitally marked. The old composite restorations are in tooth 13 mesial and distal, 12 mesial and distal, 11 incisal and mid third buccal, mesial and distal, tooth 21 mesial, tooth 22 mesial and distal, tooth 23 mesial

contrasted photo oold composite restorations

Fig.4

Frontal view with visible old margins and higher chromaticity of the old restorations.

close up of old composite restoration on chipped central incisor

Fig.5

Lateral view we can also appreciate missing enamel on distal 13. We can also better appreciate the old composite on buccal cervical of 12.

old composite restorations on upper teeth

Fig.6

With the lateral view we can better appreciate composite going from mesial to distal on tooth number 22 covering partially the buccal enamel. Tooth 23 buccaly covered by composite.

caliper for incisor measurement

Fig.7

In order to obtain the same width for both central incisors we measure them with a caliper (digital caliper, Generic).
if the size of one central incisor is different from the other central incisor we will never achieve an optimal aesthetic result.
Tooth number 11 measured 8.47mm. Tooth number 21 measured 7.94 mm. Half millimetre difference is enough to create unpleasant aesthetics.

rubber dam isolation and teeth with old composite resin

Fig.8

Dental dam in place (Nictone, medium thickness) in the anterior area with holes from tooth 14 to tooth 24 with 2 retentive clamps W2A (Ivory).

palatal view of old composite restorations

Fig.9

The palatal view is very important in order to understand the palatal extension of the old restorations and the thickness of the teeth, which is crucial.

illustration outline of old composite restorations

Fig.10

Here’s a digital outline of the failing restorations from the palatal view.

ceramic bur for composite removal

Fig.11

Uncovering the margins of the natural tooth by removing the composite using the number 1 bur from the Direct kit from Styleitaliano. In our protocol the step number one is the detection of the margins of old restorations by means of this special ceramic bur used at low speed. The bur acts more on old composite and less on sound tooth.

multicolor wooden wedges between teeth

Fig.12

The wedges (maple wood wedges, Polydentia) are very useful to compress the papilla and to protect the dental dam. They are also easy to break, which is one of the best characteristics, instead of being cut with a diamond bur to shorten them in order to facilitate our job while removing old restorations.

teeth with multiple cavities

Fig.13

The old restorations were removed using the bur number 2 of the Direct Style bur kit: the high speed round diamond bur for quick composite removal. Then we used the number 3 bur; the low speed small round carbide bur for caries and debris removal during cavity cleaning.

unica matrix for direct composite veneering with white dental beauty composite

Fig.14

The Unica matrix (Polydentia) helps create the proximal and cervical contours of our future veneer at once. In this case, the matrix was fixed with a wedge on the mesial, and light-cured resin liquid dam (OpalDam, Ultradent) on the distal. The S1 shade from Professional CompoSite System (White Dental Beauty) was selected for coverage.

carbine bur for secondary anatomy

Fig.15

I am creating secondary texture. I mark the V sulcus with the low speed carbide multiblade round bur from the Finishing Style kit by Styleitaliano (Komet).

polished composite direct veneers

Fig.16

After polishing with rubber tips and felt wheel.

smile after direct composite coverage

Fig.17

Post operative portrait. The patient was shocked when she saw the result in the mirror, as she didn’t expect such a big change. It took 2-3 days to her to get used to the new look. During the check-up appointment, 7 days later, she was already in love with her new smile and she asked to close the diastema in the lower anterior area, so we booked her a 2-hour appointment. Sometimes it takes few hours, even 2 or 3 days to get used to a new smile.

direct veneers on upper incisors

Fig.18

1 month check-up. Close up of teeth 11, 12, 21, 22. A little chipping of mesial angle of 11. This is easily repairable.

close up on direct composite veneers

Fig.19

Close up of 11, 12, 13.

picture of direct composite veneers

Fig.20

Close up of 21, 22, 23.

palatal view after direct veneering

Fig.21

Palatal view at the check-up appointment. We can appreciate the buccal volume increase.

check up after direct diastema closure in the lower arch

Fig.22

Close up of tooth 41 and 42. Further check-ups will be made.

smile after direct veneer restoration

Fig.23

Creating a beautiful smile can really give a whole new perspective. We boosted her self-confidence. We noticed that she applies make-up daily since she has the new smile, she takes care of her hair, she loosed some weight and she smiles more. We have done something powerful. We still have some unwanted tension in the lips with every smile, to hide her teeth, but now is only on the lateral left side. The problem on the premolar area will be solven in another dental episode.

smile before and after direct composite veneering

Fig.24

Before and after.

Conclusions

Direct veneering can often be advantageous both for the dentist and for the patient. Hiding a composite-tooth transition is always a challenge, even for the highest skilled dentist. Since I have Unica matrix I feel more encouraged to do direct veneering on the day I change big old anterior restorations affecting the buccal area. Among the advantages of direct veneering I would like to mention:
-Avoiding enamel-composite margins in a visible area.
-Color improvement when needed or wanted
– Shade improvement
-Single-session technique
This is at the same time an opportunity for our patients as we can offer a predictable and affordable aesthetic results in reduced times and costs. To have a simple, white, composite with good opacity for direct veneering is a game changer. This is Professional CompoSite System (White Dental Beauty, UK)

BIBLIOGRAPHY

1) Fradeani M. Esthetic rehabilitation in fixed prosthodontics. Volume 1. Esthetic analysis. Quintessence Books, 2004.
2) Duarte S Jr., Schnider P., Lorenzon AP. The importance of width/length ratios of maxillary anterior permanent teeth in esthetic rehabilitation. Eur J Esthet Dent. 2008 Autumn;3(3):224-34.
3) Ronald E. Goldstein, Stephen J. Chu, Ernesto A. Lee, Christian F.J. Stappert. Ronald E. Goldstein’s Esthetics in Dentistry. Wiley Blackwell, 2018.
4) Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 10 Surface and polishing Quintessence Books, 2012.