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The #Whiteology Approach in Direct Veneering

A clinical cases by our Community member Dr. Osama Shaalan.

 

I bet all dental professionals are familiar with many areas such as implantology, cariology, periodontology.
#Whiteology is the study of beautiful and healthy smiles, divided into many specializations: anatomy, aesthetics, expression, confidence and general wellbeing. StyleItaliano developed this new approach using simple and smart techniques and materials, with the aim of providing dentists all over the world with skills to create smiles their paitents will love, while staying minimally invasive, predictable and repeatable. In this article I want to show how we can apply the #whiteology approach using White Dental Beauty CompoSite to enhance a patient’s smile in one visit.

ugly chipped teeth

Fig.1

This 25 years old young man came to the clinic complaining of bad esthetics of old composite veneers. The patient said he wanted to smile more confidently, and possibly proudly with a brand new white and attractive smile.

ugly broken and chipped incisors

Fig.2

The black background helps us highlight all the flaws of these restorations. The main flaw is that gingival embrasures were not properly considered when restoring the teeth, so the patient can’t properly floss and now has gingivitis. So, according to the patient’s request, we decided to replace the composite veneers on the upper 8 teeth.

rubber dam and ligatures isolation

Fig.3

We isolate with the rubberdam and retract the dam and papillae with floss ligatures and we removed the old composite.

enamel etching with orthophosphoric acid

Fig.4

We etched the enamel with orthophosphoric acid for 30 seconds, and then thoroughly rinsed (60 seconds).

etched chalky enamel

Fig.5

Note the chalky, frosty matte appearance of the enamel after proper etching.

brushing bonding agent on incisors

Fig.6

Bonding is applied with a brush Multiple coats of bonding agent are applied and after 20 seconds air is blown using oil-free syringe to let the solvent evaporate and polymerized perfectly for 60 seconds.

palatal composite shells

Fig.7

Palatal shells (about 0.5 mm) were built using the Enamel shade, with the aid of the silicone index.

composite contouring before layering

Fig.8

We built the proximal walls using metallic sectional matrices to layer the E shade from the White Dental Beauty CompoSite kit.

mamelon layering with dentin composite shade

Fig.9

White Dental Beauty CompoSite dentin shade Si 1 was used to layer and then shape the mamelons. The White Dental Beauty CompoSite Body shade is light cured for 40 seconds and the light output should be a minimum of 500 mW/cm2.

composite veneering before light curing

Fig.10

The final layer of Si E shade helps give the illusion of natural appearance and also for incisal characterization.

contouring composite with pop on disc

Fig.11

The finishing is a crucial part of a direct veneering treatment, to make teeth look natural, to come alive. First of all, the buccal contouring is perfected by using pop-on discs.

groove design for surface texturing of composite with diamond bur

Fig.12

Coloring and drawing the grooves can come in very handful when quickly characterizing composite veneers, here with a fine-grained diamond bur.

carbide bur to sweeten incisal grooves

Fig.13

To create the vertical macro texture, V-shaped grooves were engraved using a carbide bur, which is also great for texture.

polishing composite with rubber eve twist

Fig.14

After texturing we can remove the rubber dam. Now it’s time to sweeten the surface characterization by using a rubber Eve twist polisher.

goat-brush for composite polishing

Fig.15

Final polishing requires diamond paste. Here I used 3 and 1 micron diamond pastes with a natural goat-hair brush at 1,000 rpm dry and at 10,000 rpm with water irrigation.

felt wheel for glossiness of composite

Fig.16

A soft felt disc is used with a 1-μm aluminum oxide paste to achieve a very high gloss used at 1,000 rpm dry, and 10,000 rpm with abundant water.

finished glossy composite veneers

Fig.17

After finishing and polishing.

seamless composite veneers

Fig.18

After.

check-up of composite veneers

Fig.19

Two weeks follow up.

smile after makeover by compsite veneering whiteology approach

Fig.20

Two weeks follow up.

whiteology approach composite veneers after 4 months follow up

Fig.21

Four months follow up.

white dental beauty composite direct veneers whiteology approach

Fig.22

Four months follow up.

Conclusions

Using simple, single-shade – or two-shade – techniques, combined with the concepts of Whiteology, is the path to having satisfied patients while using a minimally invasive, predictable and repeatable approach.

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. Fahl Junior N. The direct/indirect composite resin veneer : a case report. Pract Periodontics Aesthet Dent 1996;8:627-638 .
3. Coelho-de-Souzaa FH, Gonçalves DS, Sales MP, Erhardta MC, Corrêa MB, Opdam N, Demarcoc FF. Direct anterior composite veneers in vital and non-vital teeth: A retrospective clinical evaluation. Journal of Dentistry 2015;43:13301336