Unica frame as key to success in direct veneering

The success of any restoration involving the proximal area, such as direct veneers, strictly depends on proper matrix selection. The aim of any matrix is to produce a cleanable, anatomical restoration with a smooth convex surface, continuous with the remaining tooth structure, with the contact area at the maximum convexity of the intact adjacent tooth. Although many matrix types for direct restoration are available, we can either use a metallic sectional matrix to build the proximal walls one at a time, to frame the veneering area, or we can use the Unica anterior matrix (Polydentia). Unica anterior is the ideal matrix to perform direct class III, IV, and V cavity restorations, and aesthetic restorations, such as direct stratification of composite veneers, and shape modifications of maxillary incisors. Thanks to its contoured shape, Unica anterior facilitates the restoration of proximal and cervical margins simultaneously, even in the presence of a rubber dam or gingival retraction cords, thus reducing the time needed for the procedure. In this article, we will show how we can use Unica to frame the tooth to facilitate and enhance direct veneering in a feasible way.

style italiano styleitaliano polydentia matrix
style italiano styleitaliano polydentia matrix
style italiano styleitaliano smile with fluorosis

Fig.1
Initial photo of a young lady’s smile complaining of brown and yellow discolorations, wanting to smile confidently.

style italiano styleitaliano intraoral picture of discolored teeth

Fig.2
There was mild to moderate fluorosis on her teeth characterized by yellowish brown discoloration. The treatment of fluorosis depends on the severity of the affected enamel. A retracted view showed that the yellowish-brown discoloration was mainly related to the upper teeth. The appearance of teeth affected by moderate-to-severe fluorosis can be significantly improved by various techniques, ranging from bleaching, resin infiltrations, microabrasion, direct veneering, or indirect restorations. As the patient had limited time and budget, direct veneering suited the patient’s needs.

style italiano styleitaliano digital smile design

Fig.3
In the treatment plan goal is to mask the discolorations and do shape correction, especially incisal embrasures, to follow the curve of the smile and give the illusion of a natural-looking smile.

style italiano styleitaliano color selection with personalized shade guides

Fig.4
Shade was selected using custom shades fabricated from the White Dental Beauty CompoSIte System. Five dentine shades, and only one enamel shade. We selected a suitable shade according to the patient’s desire, and to be harmonious with her lower teeth.

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano teeth prepared for veneering

Fig.5
A little preparation here was mandatory to remove the affected enamel, and to ensure the application of universal adhesive on sound enamel as preparation of enamel improves the resin-enamel bond strength on teeth affected by fluorosis, which effectiveness is lower on unprepared teeth.

style italiano styleitaliano split dam isolation

Fig.6
Rubber dam isolation is required to have a clean environment, free from contaminants and with a clear vision. A split dam was used to facilitate the positioning of the Unica matrix to retract and seal the cervical part.

style italiano styleitaliano etching gel for bonding procedure

Fig.7
Acid etching was done for 30 seconds (3M ESPE) and then washed for 60 seconds to ensure complete removal of the etching gel.

style italiano styleitaliano frosty etched enamel

Fig.8
The frosty white appearance is a good indicator of enough etching.

style italiano styleitaliano bonding enamel surfaces

Fig.9
A universal adhesive (3M ESPE) was applied and actively rubbed against the surface to ensure complete wetting of the etched enamel.

style italiano styleitaliano ight curing with eighteenth curing pen

Fig.10
The adhesive layer was light-cured for 20 seconds using the Curing Pen (Eighteeth).

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
style italiano styleitaliano composite shade composition of direct veneer

Fig.11
Restoring using the Professional CompoSite System
One dentin shade was used to restore the entire labial surface, and one enamel shade was placed at the incisal third only. Simple, fast, and natural. In instances where a younger patient requires a little more brightness, the Si E shade (Enamel) is the perfect option, as it takes up the color of the body material for a natural appearance.
Also, when we do this, we overcome the issues related to excessive enamel thickness such as the glass effect.

style italiano styleitaliano palatal shells for anterior restoration

Fig.12
The palatal shells were built freehand using the Enamel shade (White Dental Beauty) supporting a mylar strip with a firmly positioned finger.

style italiano styleitaliano unica matrices

Fig.13
There are two types of Unica matrix, Regular and Mini deep.
Regular unica is a hard-stainless steel alloy with 30 microns designed for all anterior restorations and fits the central incisors, canines, and large teeth.
Unica mini deep is soft stainless-steel 30 microns with a malleable alloy that can easily be placed and shaped to fit small teeth like lateral incisors, lower anterior, and teeth with narrow cervical diameter.

style italiano styleitaliano polydentia matrix
style italiano styleitaliano polydentia matrix
styleitaliano style italiano simultaneous placement of tunica matrices

Fig.14
A good matrix system is key to success in direct anterior restorations, to help recreate the natural shape of the tooth with aesthetic results. If we achieve a perfect outline of the two centrals, it will be easy to copy the outlines and contour pattern to the laterals and canines. This is very important as the eye always focuses on the midline, i.e. the two centrals. For multiple anterior restorations, multiple Unica matrices can be placed simultaneously, with regular unica for centrals and mini deep for laterals. One of the advantages of using Unica is the outer shape can be easily predicted, symmetry quickly obtained, and the midline can easily be located.

styleitaliano style italiano outer composite framing for direct veneering

Fig.15
What do we mean when talking about the Unica frame? A frame is produced when building the proximal walls and cervical with the Unica matrix, which helps predict the restorations’ final shape, control the amount of composite material during layering, and subsequently decrease the time for finishing and polishing. Once the frame is outlined, the teeth are ready to receive the veneering material which can be easily layered and smoothened, while keeping good control over the amount of material. The final shape is thus easily obtained thanks to the previsualization offered by the Unica matrix.

styleitaliano style italiano critical areas of cervical and proximal contouring

Fig.16
TIP: sometimes, at this stage, we can remove the cervical overhang (red), if present. Moreover, if restorations are over-contoured, the proximal walls should be decreased to be at the same level labially. Over-contoured (yellow) walls mean layering much more composite material than needed, which might lead to overcontoured, bulky restorations, and increase the time of finishing and polishing.

styleitaliano style italiano dentin shade in direct veneering with internal characterizations

Fig.17
After layering the veneering material (SI2 dentin, White Dental Beauty) on all teeth, an incisal spacing is left for the final characterized enamel layer.

style italiano styleitaliano finished raw direct veneers

Fig.18
Layering the final enamel layer (E shade, Whie Dental Beauty) requires thorough smoothening to facilitate finishing and polishing procedures.

style italiano styleitaliano marking of the vertical inclination areas in direct veneering

Fig.19
Shaping the three facial planes using a coarse disc.

style italiano styleitaliano marking of vertical inclination areas in veneer finishing

Fig.20
Shaping the transitional lines and the curvature of the mesio-distal halves using a coarse disc at low speed.

style italiano styleitaliano surface texturization of direct composite veneers

Fig.21
We use the diamond perio bur at low speed to create the secondary anatomy. We use the body of the bur incisally, and the thinner tip towards the cervical to make the narrow part.

style italiano styleitaliano rubber twist wheel for composite prepolishing

Fig.22
A twist rubber wheel can be used to easily pre-polish all surface details, labial and proximal, at a 45 degree inclination from cervical to incisal with intermittent touches to remove all surface irregularities and sharp areas, while keeping the surface texture. The active end of the rubber is the edge, not the flat surface as compared to the disc.

style italiano styleitaliano Lucida composite gloss system with star felt

Fig.23
The Lucida™ Star and The DiaShine Lucida™ Paste allow for a single-step high-gloss polishing of composite restorations.

style italiano styleitaliano diashine lucida
style italiano styleitaliano diashine lucida
style italiano styleitaliano highly glossy composite veneers

Fig.24
Immediately after finishing and polishing.

style italiano styleitaliano composite veneers at two weeks check up

Fig.25
Two-week follow-up.

style italiano styleitaliano contrasted picture of composite veneers

Fig.26
Two-week follow-up.

style italiano styleitaliano side view of composite veneers

Fig.27
Side view.

style italiano styleitaliano side view of glory composite veneers

Fig.28
Side view.

style italiano styleitaliano smile with composite direct veneering

Fig.29
Final smile.

Conclusions

Building the outer frame is key to success in direct veneering. The Unica matrix facilitates the entire procedure and allows practitioners to overcome the challenges they face while working on multiple teeth. Its special shape helps predict and visualize the final shape, midline, and symmetry of the composite veneers, while controlling the amount of composite used, thus decreasing the time spent finishing and polishing, and that of the entire session.

Bibliography

1. Morley J, Eubank J. Macroesthetic elements of smile design. J Am Dent Assoc 2001; 132: 39-45.
2. Blitz N. Criteria for success in creating beautiful smiles. Oral Health 1997; 87: 38–42
3. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.
4. Manauta J, Salat A. Layers, An atlas of composite resin stratification., Quintessence Books, 2012.
5. Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr.Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 2011;23(2):73-87.
6. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37(47): 5-13
7. Blitz N. Criteria for success in creating beautiful smiles. Oral Health 1997; 87: 38–42
8. Hosaka K, Tichy A, Motoyama Y, Mizutani K, Lai WJ, Kanno Z, Tagami J, Nakajima M. Post-orthodontic recontouring of anterior teeth using composite injection technique with a digital workflow
9. Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr. Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 2011;23(2):73-87.
10. Heintze SD, Rousson V, Hickel R. Clinical effectiveness of direct anterior restorations-a meta-analysis. Dent Mater 2015;31(5):481-95
11.Demarco, F. F., Baldissera, R. A., Madruga, F. C., Simoes, R. C., Lund, R. G., Correa, M. B., & Cenci, M. S. (2013). Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners. Journal of Applied Oral Science, 21(6), 497-504.
12.LeSage, B. P. (2007). Aesthetic Anterior Composite Restorations: A Guide to Direct Placement. Dental Clinics of North America, 51(2), 359-378. Retrieved 7 26, 2022

style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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