old composite restoration and chipped incisor

The perfect matrix for direct composite resin veneers

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 [1][2] with an overall estimated survival of 84.6% after 5 years of clinical service [2]. The most common complications are fracture, caries, staining, colour deterioration and change of surface roughness [3][4][5][2][6]. 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.

Fig.1

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.

Fig.2

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.

Fig.3

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 [8].

Fig.4

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.

upper incisor direct composite layering and incisor matrix

Fig.5

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 shape modification of upper teeth

Fig.6

Composite veneers stratification: at first, a layer of dentin was placed.

composite restorations on central incisors

Fig.7

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.

lateral incisor isolation for direct composite

Fig.8

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.

lateral incisor isolation with matrix and wedge

Fig.9

Unica matrix in place and plastic wedge.

restoring with unica anterior matrix and composite

Fig.10

Emergency profile build up on incisor 22. Once the material is light cured, the matrix is separated and pulled of for better view.

rough composite restorations on upper incisors

Fig.11

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.

composite resin veneers after polishing

Fig.12

The immediate outcome after rubber dam removal.

upper composite resin veneers after finishing and polishing

Fig.13

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 for composite veneer check

Fig.14

Polarized picture shows perfect integration of the composite veneers.

surface texture of composite resin restorations

Fig.15

The final outcome of the restoration.

: direct composite resin veneers style italiano

Fig.16

Clinical situation 3 months after restoration.

Conclusions

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.

References

[1] JANUS, J.; FAUXPOINT, G.; ARNTZ, Y.; PELLETIER, H.; ETIENNE, O. Surface roughness and morphology of three nanocomposites after two different polishing treatments by a multitechnique approach. Dent Mater, Copenhagen, v. 26, n. 5, p. 416-425, 2010.

[2] FRESE, C.; SCHILLER, P.; STAEHLE, H. J.; WOLFF, D. Recontouring teeth and closing diastemas with direct composite buildups: a 5-year follow-up. J Dent, Bristol, v. 41, n. 11, p. 979-985, 2013.

[3] SILVA, M. A.; VITTI, R. P.; SINHORETI, M. A.; CONSANI, R. L.; JUNIOR, J. G.; TONHOLO, J. Evaluation of the Surface Roughness and Microleakage of Dental Composites Exposed to Different Beverages. J Contemp Dent Pract, New Delhi, v. 16, n. 10, p. 800-804, 2015

[4] GRESNIGT, M. M.; KALK, W.; OZCAN, M. Randomized controlled split-mouth clinical trial of direct

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