smile with discoloured upper incisor after trauma

Masking discolourations with direct veneers. A simplified protocol.

A dentist came to our clinic saying she felt a change in color a few months after she had a trauma.

An x-ray was taken and a resorption was detected. She decided to preserve her tooth some more years with an esthetic outcome.

discolored upper right central incisor

Fig.1

Intraoral picture showing discoloured 11.

lm misura instrument for enamel thickness of composite restoration

Fig.2

Trying the same composite that we will use to do the restoration, we put a button in the middle of the tooth to select the shade. Using the LM Misura instrument we calibrate the thickness of the enamel up to 0.5 mm.

composite resin white dental beauty

Fig.3

The Professional CompoSite System (White Dental Beauty, UK) E shade was used to replace enamel.

preparation for direct veneer through the mock up gallop gurel technique

Fig.4

To plan the esthetic guide we always use a wax up, digital or analogic, to create the shape. Once the mock-up is in position, we create the design of the preparations following Galip Gurel’s technique by preparing through the mock-up itself.

direct mock up removal before restoration

Fig.5

We first prepare a minimal space of 0.6 mm, to cover the discolored tooth. Then we do a veneer to immediately test the chosen shade using the same thickness in order to check the final result before actually restoring the tooth.

In this picture you can see the result with a little lower value. So we did a second test, using a whiter dentine. Then the veneer test is removed using LM Arte Fissura instrument.

acid etching and rinsing of enamel

Fig.6

After the last test, a rubber dam is placed and etching with orthophosphoric acid for 30 seconds.

microbrush with bonding agent

Fig.7

After rinsing and drying, the adhesive is applied and photo cured.

packing of composite on silicone key for direct incisor restoration

Fig.8

Using the palatal silicone key we prepared beforehand, the first layer is applied to create a better palatal surface, and incisal edge design using LM Arte Modella.

silicone key for palatal composite shell

Fig.9

The silicone guide and the composite are sit in the right position, then the excess is removed to create an incisal design.

opaque masking composite resin for dark tooth

Fig.10

In this particular case, we have to use a masking agent which is the Si M (White Dental Beauty, UK) to create a camouflage technique before the dentin layer. This layer is mandatory to cover and mask the tooth discoloration.

mamalon layering with body dentine composite resin

Fig.11

Dentin layer to reproduce the internal morphology of the tooth. On tooth 21 the dentine layer is placed only by the incisal edge to create the transition, and on tooth 11 a dentine layer is placed all over the buccal surface to improve the details under the final enamel layer.

composite enamel layering under rubber dam isolation

Fig.12

Final enamel layer. The E shade from the Professional CompoSite System (White Dental Beauty, UK) is applied on both 11 and 21 to create the shape and the texture of the buccal surface.

pop on solfex disc for shape finishing on incisor

Fig.13

To finish the surface we used sof-lex pop on discs.

spiral wheels for composite polishing

Fig.14

To polish, we use spiral wheels with water first and without water to finish.

smile after direct veneering

Fig.15

The final result using 3 layers and one masking liner from the CompoSite System with minimal preparation (only on the discolored tooth) following the simple Styleitaliano philosophy.

Conclusions

Our main goal should always be to choose the best option for our patient.

Although it may sometimes be easier to prepare invasively, we should always try to save as much sound structure as we can. When we use composite resin it is possible to work with simple protocols and less tooth reduction than with ceramic restorations. A minimal preparation always leads the choice of the restorative material.

Bibliography

1. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37(47):5-13

2. Dietschi D, Fahl JR. Shading concepts and layering techniques to master direct anterior composite restorations: an update. British Dental Journal – BDJ Aesthetic Dentistry Series, 2016;221(12): 765 – 771.

3. Fahl JR, Paravina RD. Direct Composite Restorations – The Ugly Duckling Classic. J Dent, 2013;41(5)

4. Fahl JR. Single-shaded Direct Anterior Composite Restorations: a Simplified Technique for Enhanced Results. Compend Contin Educ Dent, 2012;33(2):150-4.