Pre-operative view of the from region, showing old composites and several caries to be removed.

Universal Smile

The direct composite veneers approach to restore a patient smile is convenient and economic compared to the ceramic indirect approach. The composite gives always the possibility to modify, repair or easily reshape a restoration directly in the mouth. Since composites are not an inconvenient and offer the advantage of a minimal invasive preparation, the subsequent indirect approach will be also possible in a near future.

universal smile direct composite veneers approach

Fig.1

This clinical case presents Julia, 65 years old, that came to improve the aesthetics of her smile.

Pre-operative view of the from region, showing old composites and several caries to be removed.

Fig.2

Pre-operative view of the from region, showing old composites and several caries to be removed.

After cavity preparation and rubber dam isolation

Fig.3

After cavity preparation and rubber dam isolation, the etching step on tooth 1.3, consisting on selective enamel etching using 3M ESPE™ Scotchbond™ Universal Etchant for 20 seconds.

Bonding step

Fig.4

Bonding step: application of 2 layers of 3M™ Scotchbond™ Universal Adhesive to ensure a great interdigitation into the etched enamel and an ideal penetration into the dentinal substrate, which is also increased using a gentle blow air before light-curing.

Using one mass of Filtek Universal Restorative (3M, ESPE) composite it was possible to perfectly follow the cervical margin anatomy

Fig.5

Using one mass of Filtek Universal Restorative (3M, ESPE) composite it was possible to perfectly follow the cervical margin anatomy.

Post-operative result prior to finishing and polishing procedures

Fig.6

Post-operative result prior to finishing and polishing procedures.

old mesial class III composite of 1.2 was removed and after etching step

Fig.7

After the old mesial class III composite of 1.2 was removed and the etching step consisted always on the selective enamel etching using 3M ESPE™ Scotchbond™ Universal Etchant for 20/30 seconds.

Bonding of the surface

Fig.8

Bonding of the surface with the application of 2 layers of 3M™ Scotchbond™ Universal Adhesive.

Final result prior to finishing and polishing

Fig.9

Final result prior to finishing and polishing.

Contouring, finishing and polishing

Fig.10

Contouring, finishing and polishing are critical, important steps. The Sof-LexTM Diamond Polishing System (3M, ESPE) can offer to the clinician the best solution for a simple and also satisfactory finishing and polishing technique. The beige Spiral Wheel offers the best solution for the first step of the finishing procedure.

Contouring, finishing and polishing

Fig.11

Then, pink Spiral Wheel was used to obtain an adequate and appreciable polished surface.

Post-operative view of the polished teeth

Fig.12

Post-operative view of the polished teeth.

Palatal view of 1.3 after caries removal and cavity preparation

Fig.13

Palatal view of 1.3 after caries removal and cavity preparation.

Buccal view

Fig.14

Buccal view.

After cavity preparation, the etching step on tooth 2.3

Fig.15

After cavity preparation, the etching step on tooth 2.3, consisting on selective enamel etching using 3M ESPE™ Scotchbond™ Universal Etchant for 20 seconds.

Application of 2 layers bonding

Fig.16

Application of 2 layers of 3M™ Scotchbond™ Universal Adhesive, which is a crucial step to obtain a strong and durable adhesion between dental hard tissues and composites.

Application of one mass of Filtek Universal Restorative composite

Fig.17

Application of one mass of Filtek Universal Restorative composite; the restoration of cervical margin was performed.

Final result before the finishing and polishing procedures

Fig.18

Final result before the finishing and polishing procedures.

Selective enamel etching

Fig.19

Selective enamel etching using 3M ESPE™ Scotchbond™ Universal Etchant for 20 seconds.

Application of 2 layers bonding

Fig.20

Application of 2 layers of 3M™ Scotchbond™ Universal Adhesive.

Wetting well all the surface and drying gently ensure the best interdigitation into the etched enamel and an ideal penetration into dentinal substrate.

Application of one mass of Filtek Universal Restorative composite

Fig.21

Application of one mass of Filtek Universal Restorative composite following the cervical margin anatomy.

Post-operative view after the composite modeling, before the polishing procedure

Fig.22

Post-operative view after the composite modeling, before the polishing procedure.

Intra-operative views of each step during 1.1 restoration

Fig.23

Intra-operative views of each step during 1.1 restoration. The etching Step (A); the typical surface aspect after etching (B); the bonding step (C), and the composite application (D) to realize the restoration.

Final result before the rubber dam removal and finishing and polishing procedures

Fig.24

Final result before the rubber dam removal and finishing and polishing procedures.

Post-operative final result right after the rubber dam removal

Fig.25

Post-operative final result right after the rubber dam removal.

Post-operative view at one week of follow-up

Fig.26

Post-operative view at one week of follow-up.

Conclusions

Using a single layer approach, a proper tooth-restoration matching and an easy but effective modeling and shaping have been achieved. With the natural match and chameleon-like properties, Filtek Universal Restorative (3M, ESPE) creates adequate restorations with less shades. Modeling, finishing and polishing the composite material with the right instruments is crucial to realize the right restoration. A simple system like The Sof-Lex™ Diamond Polishing System (3M, ESPE) gives a good solution to realize a smooth and glossy restoration.

Bibliography

1. Kim J-H, Cho J, Lee Y, Cho B-H. The Survival of Class V Composite Restorations and Analysis of Marginal Discoloration. Oper Dent. 2017 Jun; 42(3):E93–101.

2. Benetti AR, Havndrup-Pedersen C, Honoré D, Pedersen MK, Pallesen U. Bulk- fill resin composites: polymerization contraction, depth of cure, and gap formation. Oper Dent. 2015 Apr;40(2):190–200.

3. Fronza BM, Rueggeberg FA, Braga RR, Mogilevych B, Soares LES, Martin AA, et al. Monomer conversion, microhardness, internal marginal adaptation, and shrinkage stress of bulk-fill resin composites. Dent Mater. 2015 Dec; 31(12):1542–51.