Proportions matter: direct composite veneers

A clinical case by our Community member Dr Ani Vasileva

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

In the field of restorative dentistry, direct composite veneers have emerged as a popular and minimally invasive option for enhancing dental aesthetics. These veneers, created directly on the tooth using composite resin materials, offer significant advantages in terms of esthetics, cost-effectiveness, and conservation of tooth structure. A critical aspect of achieving successful outcomes with direct composite veneers is the precise proportioning of the composite material. The proportions of the composite not only influence the aesthetic results but also affect the mechanical properties and longevity of the veneers. Proper proportioning ensures that the veneers blend seamlessly with the natural dentition, mimicking the color, translucency, and texture of the surrounding teeth.

styleitaliano style italiano initial situation direct composite veneers

Fig.1
A 28-year-old patient visited the clinic seeking aesthetic enhancement of her smile. Upon examination, restorations on her upper front teeth were found to be discolored and cracked, with secondary caries lesions, gingival asymmetry, suboptimal proportions, and a deviated midline.

styleitaliano style italiano initial situation direct composite veneers

Fig.2
Proportions close to 100%.

styleitaliano style italiano initial situation direct composite veneers

Fig.3
Managing the proportions issue involved elongating the incisal edge and correcting the gum line. The goal was to achieve proportions close to 80%.

styleitaliano style italiano initial situation direct composite veneers

Fig.4
Proportions close to 100%.

styleitaliano style italiano initial situation direct composite veneers

Fig.5
To manage the proportions issue, the incisal edge was elongated and the gum was corrected. The width was adjusted on both sides with the aim to achieve proportions close to 80%.

styleitaliano style italiano occlusal view direct composite veneers

Fig.6
Occlusal view.

styleitaliano style italiano direct composite veneers two-dimensional design 2D design

Fig.7
In creating a two-dimensional (2D) design using Affinity Photo on an iPad with a pen, the process starts by envisioning the end result. First, the contour of each tooth is outlined, followed by filling in colors and applying finishing touches. If necessary, corrections are made to the gum area. This approach allows for planning the case and determining solutions, while facilitating clear explanations and discussions with the patient.

styleitaliano style italiano bleeding points direct composite veneers

Fig.8
Bleeding points.

styleitaliano style italiano gingivectomy

Fig.9
For crown lengthening procedures, an electrosurgical device is used. Before cutting, marking the area to be removed with a black marker enhances visibility and operational ease. In this case, only gingivectomy was performed, without the need for osteotomy or osteoplasty due to considerations of the biological width.

styleitaliano style italiano after gum removal

Fig.10
Immediately after crown lengthening, electrosurgery is preferred for its clarity in the procedure’s outcome, comfort for the patient, and minimal post-operative pain or discomfort.

styleitaliano style italiano direct composite veneers three-dimensional design 3D design

Fig.11
In three-dimensional (3D) design for wax-ups, both additive and subtractive methods are employed. This involves not only adding wax to build up desired structures but also removing excess wax to refine and shape the final product.

styleitaliano style italiano direct composite veneers mock-up

Fig.12
Mock-up.

styleitaliano style italiano removal of old composites direct composite veneers

Fig.13
The process involves removing old composite restorations and preparing for an adhesive protocol using the KaVo RONDOflex 27 μm.

styleitaliano style italiano etching and bonding direct composite veneers

Fig.14
Etching and bonding (OptiBond Prime and Adhesive) by Kerr Corporation, California, USA.

styleitaliano style italiano palatal walls direct composite veneers

Fig.15
Restoring the palatal surface with the silicone index involves using ESTELITE ASTERIA WE (Tokuyama Dental Corporation, Tokyo, Japan).

styleitaliano style italiano chroma application direct composite veneers

Fig.16
Applying a thin layer of ESTELITE with medium chroma opacity (Tokuyama Dental Corporation, Tokyo, Japan) effectively blocks light.

styleitaliano style italiano proximal wall creation direct composite veneers

Fig.17
Using matrices to restore the approximal areas involves utilizing ESTELITE ASTERIA, WE (Tokuyama Dental Corporation, Tokyo, Japan).

styleitaliano style italiano proximal wall creation direct composite veneers

Fig.18
Using matrices to restore the approximal areas involves utilizing ESTELITE ASTERIA, WE (Tokuyama Dental Corporation, Tokyo, Japan).

styleitaliano style italiano approximal areas restored direct composite veneers

Fig.19
The approximal areas and cervical part are restored too.

styleitaliano style italiano direct composite veneers mamelons creation

Fig.20
Forming the mamelones using the ESTELITE ASTERIA A2B (Tokuyama Dental Corporation, Tokyo, Japan).

styleitaliano style italiano direct composite veneers vestibular enamel layer

Fig.21
Vestibular enamel layer was created using the ESTELITE ASTERIA, WE (Tokuyama Dental Corporation, Tokyo, Japan).

styleitaliano style italiano direct composite veneers finishing

Fig.22
Finishing.

styleitaliano style italiano direct composite veneers polishing

Fig.23
Polishing using the DIACOMP PLUS TWIST (EVE Ernst Vetter GmbH, Pforzheim, Germany).

styleitaliano style italiano direct composite veneers 3 weeks check-up

Fig.24
3 weeks check-up.

styleitaliano style italiano direct composite veneers 3 weeks check-up

Fig.25
3 weeks check-up.

styleitaliano style italiano direct composite veneers 3 weeks check-up

Fig.26
3 weeks check-up.

styleitaliano style italiano direct composite veneers 3 weeks check-up occlusal view

Fig.27
Occlusal view (3 weeks check-up).

styleitaliano style italiano before and after direct composite veneers

Fig.28
Before and after.

Conclusions

Following the 2D and 3D designs, the contour is improved, the tooth proportions are enhanced, and the midline is corrected, resulting in the overall harmony of the smile.

Bibliography

  1. Esthetic Rehabilitation In Fixed Prosthodontics: Esthetic Analysis: A Systematic Approach To Prosthetic Treatment.
  2. Interdisciplinary Esthetic Dentistry.
  3. Biomimetic Restorative Dentistry.
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