Simple direct veneers

With the development of modern composite materials, it is possible to make natural-looking direct veneers without resorting to difficult layering strategies. The advantage to this approach is we do not have to select many different shades ,and then pay meticulous attention to their layering thickness. This decreases the chance for errors and mismatches, hence we can concentrate on creating a natural shape and polishing.
This simple technique is also indicated in the case of large defects. As the thickness of the body material is decreasing, the material appears less chromatic and more translucent, making it suitable to replace dentin, and also palatal and approximal parts of the tooth with the same shade.
If however, there is insufficient space for this kind of materials, they can become too translucent in the dentin area and drop the value of the restoration.

styleitaliano style italiano old composite veneers

Fig.1
Initial situation of this young female patient, who presented with improper old composite restorations on teeth 11 and 21.

styleitaliano style italiano initial patient status

Fig.2
Full status of the patient.

styleitaliano style italiano wax up of incisor veneers

Fig.3
After discussing all possibilities and initial periodontal and conservative therapy, we decided to replace the restorations with composite resin. We took an impression and have a conventional wax-up fabricated for the two central incisors.
Tip No.1: Make sure to remove all vestibular and palatal overhangs of old restorations before the actual impression. This makes it possible for the lab technician to create proper shapes and gives you better fitting silicone keys. Furthermore, it lets the gingival inflammation heal, and you will be able to make the new restorations in better conditions.

styleitaliano style italiano color try before removing old composite

Fig.4
Try-in of the selected body and enamel shades on the adjacent teeth before dehydration of the teeth, right after anesthesia.

styleitaliano style italiano rubber dam isolation and class IV cavity preparation

Fig.5
Placement of rubber dam, removal of old restorations and creating a 1.5 mm long bevel on the vestibular side for an invisible transition between tooth and restoration. In cases where you cover the whole buccal surface of the tooth with composite, it is easier to create a nice transition.

styleitaliano style italiano silicone index fitting

Fig.6
Make sure to try the silicone key with the rubber dam in place, to ensure a perfect fit without interferences.

styleitaliano style italiano marking palatal extent of restoration on silicone key

Fig.7
Marking the finish line with the LM Arte Fissura instrument.

style italiano styleitaliano lm arte anterior instrument
style italiano styleitaliano lm arte anterior instrument
styleitaliano style italiano showing composite area marked onto silicone index

Fig.8
This makes the extent of the missing palatal side evident.

styleitaliano style italiano floss ligatures for rubberdam retraction

Fig.9
In case of a medium scalloped gingival architecture, you can achieve sufficient retraction with floss ligatures. After this, the surface was sandblasted with 30micron Al2O3 (AquaCare).

styleitaliano style italiano acid etching of enamel surfaces

Fig.10
Etching of the enamel for 30 seconds.

styleitaliano style italiano palatal composite shells

Fig.11
Creation of the palatals shells.
Tip No.2: Body shade material was used for both the palatal and interproximal layers due to its good handling and optical properties.

styleitaliano style italiano unica matrix for direct composite veneering

Fig.12
For the creation of the approximal walls, Unica matrix was used. You can also use this matrix for gingival retraction and support for cervical composite layer.

style italiano styleitaliano polydentia matrix
style italiano styleitaliano polydentia matrix
styleitaliano style italiano outer frame for veneer restorations

Fig.13
Approximal walls in situ. As we use the same material for the dentinal body, thickness of the material is not important here.

styleitaliano style italiano layering mamelon anatomy

Fig.14
Placement of the dentine body with body shade. The mamelon architecture is extended almost to the incisal edge, as there is not much incisal translucency in the adjacent teeth. Towards the gingival side, the material is extended to the whole bevel, to ensure even thickness of enamel material.

styleitaliano style italiano placement of opalescent shade at the incisal edge

Fig.15
A flowable opalescent effect material is placed in the incisal part.

styleitaliano style italiano fully layered veneer restorations before finishing

Fig.16
The enamel layer is placed on the whole labial surface.

styleitaliano style italiano air-blocking gel for final polymerization

Fig.17
Final polymerization with Liquid strip (Ivoclar), to prevent the formation of the oxygen-inhibition layer.

style italiano syleitaliano marked line angles

Fig.18
The transition lines define basic shape and symmetry of the teeth.

styleitaliano style italiano polished composite veneers

Fig.19
After polishing.

styleitaliano style italiano direct composite veneers after rehydration

Fig.20
Final restorations after rehydration. For direct restorations, light bouncers or softboxes can hide the real appearance, so a regular twin flash will give a more realistic picture of the end result.

styleitaliano style italiano composite veneers at check-up

Fig.21

Conclusions

Great results can be achieved with composite resin, even with a simplified layering technique, if the proper indications are respected.

Bibliography

1. Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr. Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent. 2011 Apr;23(2):73-87. doi:10.1111/ j.1708-8240.2010.00392.x. Epub 2011 Feb 25. PMID: 21477031.
2. Manauta J, Salat A, Putignano A, Devoto W, Villares CF, Hardan LS. Natural, polarized light and the choice of composite: a key to success in shade matching of direct anterior restorations- Part I. Odontostomatol Trop. 2016 Sep;39(155):11-9. PMID: 30239179.
3. Ferraris F, Diamantopoulou S, Acunzo R, Alcidi R. Influence of enamel composite thickness on value, chroma and translucency of a high and a nonhigh refractive index resin composite. Int J Esthet Dent. 2014 Autumn;9(3):382-401. PMID: 25126618.
4. Korkut B, Ünal T, Can E. Two-year retrospective evaluation of monoshade universal composites in direct veneer and diastema closure restorations. J Esthet Restor Dent. 2022 Dec 7. doi:10.1111/jerd.12992. Epub ahead of print. PMID: 36478098.
5. Lempel E, Lovász BV, Bihari E, Krajczár K, Jeges S, Tóth Á, Szalma J. Long-term clinical evaluation of direct resin composite restorations in vital vs. endodontically treated posterior teeth – Retrospective study up to 13 years. Dent Mater. 2019 Sep;35(9):1308-1318. doi:10.1016/j.dental.2019.06.002. Epub 2019 Jul 2. PMID: 31278018.

style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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