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.
Intraoral picture showing discoloured 11.
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.
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.
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.
After the last test, a rubber dam is placed and etching with orthophosphoric acid for 30 seconds.
After rinsing and drying, the adhesive is applied and photo cured.
The silicone guide and the composite are sit in the right position, then the excess is removed to create an incisal design.
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.
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.
To finish the surface we used sof-lex pop on discs.
To polish, we use spiral wheels with water first and without water to finish.
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.
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4. Fahl JR. Single-shaded Direct Anterior Composite Restorations: a Simplified Technique for Enhanced Results. Compend Contin Educ Dent, 2012;33(2):150-4.