Fig.1
Intraoral photo of the original situation. You can see the porcelain veneers on teeth 11, 21.

Fig.2
The previous restoration was removed and a minimal invasive veneer preparation was obtained.

Fig.3
Then the rubber dam was placed, using the modified Hygenic Brinker clamp B6 (Coltene).

Fig.4
The entire preparation was totally etched.

Fig.5
The tooth was then meticulously rinsed with water spray and gently dried before a bonding agent (EnaBond, Micerium) was placed in two layers and polymerized.

Fig.6
A small amount of composite resin was placed onto the cervical area in order to better retain the rubber dam, and an interdental floss was attached tightly to the plastic rubber dam frame to facilitate the following composite layer placement (Img. 6, 7, 8).

Fig.7

Fig.8

Fig.9
This way the silicone guide did not interfere with the rubber dam clamp.

Fig.10
The silicone guide was partially incised (mesio-approximally to tooth 13) in order to place the piece of BlueView Varistrip (Garisson), inside the groove, and in this way to provide the optimum curvature of the proximal contact surface (Img. 10, 11).

Fig.11

Fig.12
An enamel layer of composite resin (UE2, Enamel Plus, Micerium) was placed onto the silicone matrix.

Fig.13
And then positioned on the tooth. The material was afterwards spread proximally and incisally (Img. 14), followed by 20 second light curing.

Fig.14

Fig.15
Then dentin mass was applied to mimic the mamelons (UD2, Enamel Plus, Micerium) and a very small amount of lighter dentin composite resin was placed incisally (UD1) in order to mimic the halo effect, followed by light curing (Img. 16).

Fig.16
The layer of dentin was checked before curing using the LM Arte Misura instrument in order to ensure the appropriate volume for the outer layer enamel.

Fig.17
Finally, enamel layer (UE2) was applied to the entire outer surface and polymerized.

Fig.18
The final characterization was performed by means of a periodrill shaped bur (no. 831-204-012, Komet) according to the method described in the book “Layers: An Atlas of Composite Resin Stratification” by J. Manauta and A. Salat. Final polishing was performed with a goat hair brush (RA Shiny S, Micerium) and polishing pastes (Polishing Paste Shiny Kit, Micerium).

Fig.19
The final effect of tooth 13 restored with direct composite veneer is shown (Img. 19, 20).

Fig.20

Fig.21
Before (left) and After (right) pictures, the patient’s smile.

Fig.22
Before (left) and After (right) pictures, the patient’s smile.

Conclusions

Porcelain veneers are a generally accepted and popular method for anterior tooth restoration due to the possibility of excellent aesthetics, function (anterior and canine guidance, phonetics) and biological integration of the restoration. However, in order to achieve clinical success with porcelain veneers, several conditions need to be fulfilled. These include valuable and well designed tooth preparation, precise veneer fabrication in the laboratory, and cementation with rubber dam in place according to strict adhesive procedures. When asymmetric restoration is needed, it is extremely difficult for the dental laboratory to obtain predictable aesthetics and shade. With recently introduced techniques based on quantitatively added layers (Silicone guide, Misura instrument, My Shade Guide) it is possible to achieve a direct composite restoration that is predictable in regard to aesthetics and shade selection. As it takes only one appointment and does not involve laboratory procedures, it is more economical for both the patient and the dental practice. Another advantage is reparability, which is relatively easy and usually involves only a short appointment but would be quite difficult or sometimes impossible in the case of a porcelain veneer repair. The author of this case report does not wish to assert that composite veneers are better in most cases, but they certainly can be the preferred option in many cases of contemporary dentistry.

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