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.
Fig.1
Initial situation of this young female patient, who presented with improper old composite restorations on teeth 11 and 21.
Fig.2
Full status of the patient.
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.
Fig.4
Try-in of the selected body and enamel shades on the adjacent teeth before dehydration of the teeth, right after anesthesia.
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.
Fig.6
Make sure to try the silicone key with the rubber dam in place, to ensure a perfect fit without interferences.
Fig.7
Marking the finish line with the LM Arte Fissura instrument.
Fig.8
This makes the extent of the missing palatal side evident.
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).
Fig.10
Etching of the enamel for 30 seconds.
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.
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.
Fig.13
Approximal walls in situ. As we use the same material for the dentinal body, thickness of the material is not important here.
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.
Fig.15
A flowable opalescent effect material is placed in the incisal part.
Fig.16
The enamel layer is placed on the whole labial surface.
Fig.17
Final polymerization with Liquid strip (Ivoclar), to prevent the formation of the oxygen-inhibition layer.
Fig.18
The transition lines define basic shape and symmetry of the teeth.
Fig.19
After polishing.
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.
Fig.21
Conclusions
Great results can be achieved with composite resin, even with a simplified layering technique, if the proper indications are respected.
Bibliography
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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.
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