smile with stained teeth with caries

Simplifying direct veneering with the right tools and materials

When restoring anterior teeth with composite, we should stay minimally invasive while meeting our patient’s needs. For a successful treatment, following a protocol is mandatory, as in aesthetic, extensive restorations, time and focus are of utmost importance. So how we can minimize chairside time while providing the patient excellent quality treatment?

stained and unhealthy teeth

Fig.1

A young lady came to the clinic complaining of bad aesthetics of her anterior teeth. The restorations she had a couple years earlier needed to be replaced due to discoloration, infiltration, and unaesthetic shape and appearance.

rubber dam isolation before removal of old fillings

Fig.2

Rubber dam isolation is mandatory to have a clean environment and to prevent contamination.

old infiltrated composite restorations

Fig.3

Right view of the defective composite restorations.

rough and discolour composite fillings

Fig.4

Left view of the defective composite restorations.

cervical structure loss after caries removal

Fig.5

After removal of the old composite restorations and of carious tissue, the enamel was selectively. Always make sure that all enamel margins surrounding the restoration are be clean and intact to obtain a perfect seal. As you can see in the picture, the shape of the teeth, especially the canines, needed an improvement. In the next few slides, you will see which instrument to use in these cases, and how to do it.

composite web and styleitaliano system

Fig.6

For this specific case the simplified CompoSite system by White Dental Beauty and Styleitaliano was used. These composites can be used both alone (generally dentin shades) or combined with enamel shades.

surface of composite after modelling with a narrow instrument

Fig.7

When recontouring a tooth or when veneering with direct composite restorations, the right instrument and movements can make the difference. Here is an example of composite layering with a narrow, commonly found instrument. As we see from the picture, a narrow active tip concentrates the pressure force on the composite underneath it during the layering, thus easily creating grooves, and, hence, an uneven surface.

lm solo intrudente modeling composite with an even surface

Fig.8

The new all-in-one SOLO Anterior instrument by LM dental, was specifically designed by the Styleitaliano team for composite veneers and anterior composite restorations. It features two wide active tips, with different angulations to facilitate spreading of composite layers.
Its wide active tip allows for a smoother spreading and and easier manipulation of the composite, while creating a very even surface requiring quick finishing and polishing only.

design of future composite restorations

Fig.9

As you can better appreciate from this side view the shape of a canine can be divided into two halves, a mesial and a distal one.

illustration of how to use solo lm styleitaliano instrument

Fig.10

With this division in mind, it’s clear how easily a nice shape can be obtained with the Solo instrument, on half at a time, adapting the composite from cervical to incisal, and toward the proximal side (distal or mesial, respectively).

picture showing motion of solo anterior instrument on upper canine

Fig.11

And here’s an illustration for the distal modeling. Gingival towards the incisal, and then distal.

modeling sequence on lateral incisor

Fig.12

And the same can be done for the laterals.

solo wide tip spreading composite on mesial canine

Fig.13

The concave shape of the tip is very useful, especially when working on the left side.

rubber dam retraction with B4 clamp on central incisors

Fig.14

After layering dentin and enamel for canines and lateral using White Dental Beauty CompoSite, B4 clamps are used for the central to retract the papilla.

gingival embrasures to be filled with the front wing technique

Fig.15

As mentioned earlier, we needed to close the black triangle between the centrals, so the Front Wing technique was chosen for a predictable and periodontally-safe contour.

composite direct veneers before finishing

Fig.16

After having eliminated the median embrasure, and having restored the small cavities, the finishing and polishing procedures can begin.

finishing and contouring of composite direct veneers

Fig.17

A simplified protocol is ideal when polishing multiple restorations. First, a diamond perio bur is used to smoothen the composite and to adjust the anatomy. Then, a pop-on disc is used to define he angle lines and for further smoothing.

polishing of composite with spiral wheel

Fig.18

As a third step, a beige spiral wheel (3M) is used to safely polish thanks to its flexible shape which adapts to all tooth surfaces.

Lucida star felt with diamond paste for composite gloss

Fig.19

As a last step, the Lucida™ Composite Gloss System by Styleitaliano was used. The disposable Lucida Star Felt is mounted on the autoclavable latch mandrel to buff the DiaShine Lucida Paste (completely water soluble).

glossy composite veneers before rubber dam removal

Fig.20

Immediately after polishing, before removal of the rubber dam.

smile with new composite veneers

Fig.21

One week follow-up.

detail of composite veneers

Fig.22

Side view at one week follow-up.

smile after direct anterior composite resin restorations

Fig.23

The patient’s satisfied smile.

Conclusions

By the introduction of new simple techniques, materials, and tools, we can simplify our daily work and make it predictable and repeatable, as in the Styleitaliano philosophy. Simple recipes can help decrease chair-time for the dentist and the patient, and make our treatments affordable and minimally invasive.

Bibliography

1. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
2. 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
3. Mangani, A. Cerutti, A. Putignano, R. Bollero, L. Madini, Clinical approach to anterior adhesive restorations using resin composite veneers, Eur. J. Esthet. Dent. Off. J. Eur. Acad. Esthet. Dent. 2 (2007) 188–209.
4. 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;23(2):73-87.