The single veneer challenge. Mimicking shade and shape with composite

A clinical case by our Community member Dr. Sarmad Hijran

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

This patient came to the clinic and expressed discomfort with the over-jet of her upper left lateral. She was also concerned about the final result, since she consulted a few other dentists who proposed at least 4 anterior veneers to get a nice result because of the challenge correcting the lateral and matching it with the other teeth held. Moreover, she refused an orthodontic treatment. So, after examination, I assured her there was no need to get ceramic veneers, that I would only correct the position and shape of this single lateral with a composite restoration, without touching any other tooth, and that the result would be as natural as it should.

picture of upper lateral incisor

Fig.1
In any direct composite veneer restoration take good pictures and examine every detail of a patient’s teeth: texture, shape, color details, anomalies, etc.

polarized picture of composite button try

Fig.2
A polarized photo is the most accurate way to select composite shades. To select the correct shade, use the composite of the button that disappears under the polarizing filter.

buccal enamel preparation for direct veneer

Fig.3
The buccal surface was prepared to align the lateral to the other teeth. Always try to stay within the thickness of the enamel for optimum bonding stability.

palatal composite shell for lateral incisor

Fig.4
The palatal shell is the base for your successful completion of the following steps. It should be as thin and smooth as possible, and have the shape you wish to end up with.

lateral view of composite shell

Fig.5
Creating the outer box by building up the proximal walls makes the job much easier and predictable. The palatal shell was made of the enamel shade that was going to be used to cover the tooth labially.

raw composite dentin layering

Fig.6
Dentin layer thickness and extension should be respecting the natural anatomy of the tooth. Modeling liquid and brush is a must in layering and shaping composite layers.

finished composite veneer under rubber dam isolation

Fig.7
Final enamel layer. Two shades of enamel were used, a darker one for the cervical third, and a lighter one for the incisal, to match the neighbor teeth.

lucida paste for single-step polishing

Fig.8
Lucida polishing paste was used to give the final glistening look.

polished veneer on lateral incisor

Fig.9
Final result after polishing. You can clearly see the natural look of the restoration matching the adjacent teeth. A few white spots were added to the restoration to mimic the other teeth.
Tip: Put the color modifier beneath your final enamel layer because it will fade away if you put it on final layer surface.

texture of composite veneer

Fig.10
Detail of the mimetic micro-texture.

final smile with single tooth restoration

Fig.11
Extra oral view.

Conclusions

Composite restorations are double-edged weapon. If we know how to use them correctly, they can give us the best results, but, if don’t know how to handle them, they can ruin our day.
When I chose this title for my article, I meant to tell fellow dentists that composite restorations can be the perfect solution for many situations, especially in the anterior zone. We just need to know how to handle this material and unleash our imagination and creativity. Composite restorations can live for a long time, and give us a very natural look if we know how to exploit the features of this material. With training, focus, and knowledge we can do almost anything with it.

Bibliography

1. Devoto W, Manauta J, Paolone G. IN-OUT: a new concept in composite stratification. LABLINE. 2013;Summer: 110-127.
2. Hirata R. Shortcuts in esthetic dentistry: a new look into TIPS, 1st ed, Sao Paulo: Quintessence Editiora,2017, 358-367..
3. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 10 Surface and polishing Quintessence Books, 2012

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