Smile makeover with direct composite veneers
A clinical cases by our Community member Dr. Osama Shaalan.
Restoring a patient’s lost dental esthetical appearance is one of the main goals of dentistry in the anterior area. New treatment materials and methods have been coming on the scene for the last few years, and have been improving our performances day after day. More and more dentists prefer conservative and aesthetic approaches, such as direct veneering, instead other treatment options. In this article we will use new composite system credited by the Styleitaliano team, the White Dental Beauty CompoSite.
This 32 years old young man came to the clinic complaining of bad esthetics. The patient said he wished to smile more confidently, and that he was looking forward to get a brighter, whiter and more attractive smile.
Caries was found on teeth 11 and 21, due to restoration failure. Because the patient had multiple defective composite restroations in the other upper anterior teeth, we decided to do composite veneers for the upper anteriors.
Rubber dam is placed for isolating the teeth with floss ligatures, to have maximum retraction to better manage the cervical seal, which is also a critical area in this type of restoration.
After removing the caries and the old defective restorations.
It is mandatory that the subgingival enamel margins are exposed after isolation, in order to create a perfect seal. One of the most critical issues for a successful composite restoration, is obtaining and maintaining isolation of the preparation during the entire process of cleansing, treating the enamel and dentinal surfaces, and placing of the composite.
Selective etching technique (only enamel etch for 30 seconds) was used, followed by water rinsing for 60 seconds.
Multiple coats of bonding agent are applied and after 20 seconds air is blown using oil-free syringe to let the solvent evaporate. Light curing for 60 seconds.
What is White Dental Beauty CompoSite?
The White Dental Beauty CompoSite System consists of the following:
• Si0, Si0.5, Si1, Si2 & Si3 – Known as the ‘five shades of white’, these shades are designed for whitening and restorative cases, assisting with the perfect color match for bleached or naturally white teeth. These multi-functional shades can be used for mono layering in full direct veneer cases, or in conjunction with the Enamel for a two-layer technique.
• SiM & SiMP – These two flowable shades each provide different benefits. SiM uses an opaque light resin, instantly camouflaging the shade of the tooth and providing a neutral base for immediate restorative work. SiMP is a multipurpose flowable, which can be used as a base/liner and to cement veneers or overlays.
• SiE – This enamel shade has been designed to blend flawlessly with all the Si universal shades, featuring a calibrated translucency. It is ideal for a two-layer technique and for simply characterizing the incisal edge.
• SiP – This posterior bulk fill has a high filler content and is designed specifically to work easily with the ‘Fast Modelling Technique’, minimizing shrinkage or fracture.
A 0.3-0.5 palatal shell was built with the Enamel shade, free hand using transparent strips supported by placing a finger on the palatal side.
Proximal walls were built using a metallic sectional matrix with E White Dental Beauty CompoSite and multipurpose flowable material ideally used as a base between walls (White Dental Beauty CompoSite M,).
This is an important step: if we control the outer shape we can control layering of inside dentin shade perfectly and also facilitate finishing and polishing procedures.
White Dental Beauty CompoSite dentin shade Si 2 is used to fill the small proximal spaces.
Two White Dental Beauty CompoSite dentin shades are used :Si 1 cervically and Si 0.5 incisally before placing the final layer. The White Dental Beauty CompoSite Body shade Si should be cured for 40 seconds with a 500 mW/cm2 minimum light source.
To make the restoration look more natural I also used:
1 – CE Filtek Z350 XT in between mamellons to get an opalescent effect
2 – A white opaque tint at the incisal edge to create the illusion of incisal halo
The final layer, Si E is used to create the illusion of a natural tooth.
The first finishing step requires correction of the angle lines with a fine needle diamond bur.
Correction of the labial contour following the three thirds of the natural labial surface with a fine long taper diamond bur or with finishing discs.
To create the vertical macro texture, V-shape grooves we can use a carbide bur, for detailed finishing and texturizing of surface anatomy.
After having created the texture details we should soften the surface of the composite resin with a rubber Eve twist polisher.
On the second appointment, final polishing is carried out. A 3 and 1 micron grain diamond paste (Micerium) with a natural goat hair brush at 1,000 rpm (Shiny G, Micerium) are used with no water, then at 10,000 rpm with abundant irrigation.
A soft felt disc (Shiny F, Micerium) is used with a 1 μm aluminum oxide paste to achieve a very high gloss. I use it at 1,000 rpm with no water, and at 10,000 rpm with abundant water.
Immediatley after final finishing and polishing
Final situation after finishing and polishing, waiting for complete gingival healing.
Final situation after finishing and polishing, waiting for the gums to heal completely.
Before and after.
Direct Composite veneers can be a suitable solution for patients who want a whiter and more appealing smile, especially for thouse who want it quickly. The direct veneering technique allows us to sculpt and create beautiful and natural looking smiles in one visit, while being minimally invasive; this technique is also a financially attractive procedure for the patient.
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3. Dietschi D. Layering concepts in anterior composite restorations. J Adhesive Dent 2001;3:71-80.
4. Fahl Junior N.The direct/indirect composite resin veneers : a case report. Pract Periodontics Aesthet Dent 1996 ;8:627-638