Based on clinical and scientiﬁc data, direct composite veneers, which are a cheaper solution compared to traditional ceramic, offer a valid option for aesthetic rehabilitation, and can be performed in a single session and modiﬁed during the layering process to meet patients’ needs. The evolution of standard and nano-ﬁlled composites has led to better mechanical and wear resistance  with an overall estimated survival of 84.6% after 5 years of clinical service . The most common complications are fracture, caries, staining, colour deterioration and change of surface roughness . However, the easy repair properties, and the minimal invasiveness (no enamel roughening needed for adhesion) of composite restorations often make up for these complications. The patient, 52, came to our attention complaining about her smile. Clinical examination revealed caries free teeth and satisfactory oral hygiene. All incisors had an inadequate anatomy and one central was fractured. We decided to proceed with 4 direct composite veneers on all central and lateral incisors using a fully adhesive and additive technique.
The isolated ﬁeld after cleaning, disinfection and polishing of all surfaces. Emergency proﬁles of anterior teeth can be restored in many ways. Until today, the most common procedure for restorations with direct stratiﬁcation composite veneers consisted in the restoration of interproximal and cervical margins in two different steps, using respectively two posterior matrices for the interproximal margins and a matrix band cut to a speciﬁc shape for the restoration of the cervical area.
Unica anterior matrix by Polydentia simpliﬁes the procedure allowing to directly restore the whole emergence proﬁle, namely cervical and interproximal walls, in a single step. Unica is placed on the teeth and ﬁxed in place. Usually, plastic or wooden wedges can be used to ensure a proper ﬁxing of the matrix. In this case, the intrinsic rigidity of the steel matrices and the presence of intact contact points ensured a good stability and so no wedges or resin were needed to hold the matrices in place. As an alternative, e.g. in case of wide class III restorations where the wedge placement could compromise the interproximal proﬁle by collapsing the matrix into the cavity, a liquid dam (e.g. Polydentia myCustom Resin) can be a valid alternative to hold the matrix in place.
A bottom view of the central incisors highlighting the surface preparation. See how the convex shape of the matrices makes it possible to position the rubber dam more e!ectively in the cervical area, guaranteeing better isolation of the operating ﬁeld. Direct stratiﬁcation composite veneers consists in the direct application of one or more layers of composite resin directly on the tooth structure. The composite is then sculpted to correct colour and shape defects, allowing aesthetics restoration to be generally accomplished in a single appointment .
The clinical situation after proximal walls build-up on incisor 21. A universal system adhesive was used to increase the bond strength before proceeding with the direct stratiﬁcation of both mesial and distal walls using enamel composite. The same procedure was then repeated on the second central incisor.
After the proximal build up, the palatal walls were modelled in order to imitate the angulation of the tooth, using a slight amount of enamel composite placed on the ﬁnger. The enamel composite was then pressed onto the palatal surface and the previously modelled proximal guides, and light-cured.
Composite veneers stratiﬁcation: at ﬁrst, a layer of dentin was placed.
A second layer of enamel was placed to mimic the shades of the tooth and modelled to the ﬁnal shape using a spatula and brushes. The picture shows the composite veneers on central incisors before contouring ad pre-ﬁnishing.
After contouring the central incisors, using the same methodology described before, we proceeded with the direct stratiﬁcation of the composite veneers on the lateral incisors.
Unica matrix in place and plastic wedge.
Emergency proﬁle build up on incisor 22. Once the material is light cured, the matrix is separated and pulled of for better view.
The image shows the composite veneers on both lateral incisor 12 and 22 before contouring, ﬁnishing and polishing. The contouring and ﬁnishing were performed with a low speed diamond bur to better motion control surface smoothness, even in case of coarse grit size. Pre-polishing was then performed using brown spiral wheel (3M, Germany) and polishing paste (premier, Diamond twist SCL), while extra gloss ﬁnishing can be achieved using a buff wheel.
The immediate outcome after rubber dam removal.
The clinical situation after ﬁnal polishing and texturing of the restoration. This image was taken at the 30 day check-up after restoration.
Polarized picture shows perfect integration of the composite veneers.
The ﬁnal outcome of the restoration.
Clinical situation 3 months after restoration.
Thanks to the evolution of composites materials, direct stratiﬁcation composite veneers are nowadays a valid, quick and less expensive solution for aesthetics rehabilitation in the anterior region. Successful aesthetics and functional results are nevertheless strongly dependent on the operators understanding of adhesive processes and sculpting ability. Different tool and procedures can help the clinician correctly restoring the emergency proﬁle; among these, the new Unica anterior matrix stands out because of its simplicity and versatility, allowing to quickly and easily restore both cervical and interproximal proﬁles at the same time, strongly reducing the chair time, and bringing aesthetics restorations within everyone’s reach.
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