Veneer Aesthetics – Direct Composite Vs Porcelain
A 30-year-old female patient with porcelain veneers on teeth 11 and 21 came to the office wishing to improve the shape and color of tooth 13 (Img. 1). The patient had right maxillary lateral incisor agenesis, and therefore her canine had been transformed with composite resin into a lateral incisor. However, the restoration had undergone discoloration over the years, and seemed to be too big as the aim of the previous restoration was to close a diastema.
The issue consisted in the type of material to propose to the patient: would porcelain veneer be the best choice?
Of course it is possible, but it would be very demanding for the dental technician to make a single, asymmetrically positioned porcelain veneer. He would have to spend many hours, probably remaking it many times in order to obtain a similar shade to the neighboring teeth. It is also challenging to make the tooth look smaller and close the diastema at the same time, as in many cases porcelain restorations may make teeth appear bigger.
Treatment Plan: direct composite veneer was planned and a silicone guide was made from a mock-up.
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.
1. Devoto W. Clinical procedure for producing aesthetic stratified composite resin restorations. Pract Proced Aesth Dent. 2002 Sep; 14(7):541-3.
2. Zarow M, D´Arcangelo C, D´Amario M, Marzo G. Conservative approach for the management of congenital bilateral agenesis of permanent mandibular incisors: case report and literature review. Eur J Paediatr Dent. 2015 Jun;16(2):154-8.
3. Zarow M, D´Arcangelo C, Paolone G, Paniz G, Felipe L. EndoProsthodontics – Guidelines for the clinical practice. Quintessence Int, Chicago 2016.
4. 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 Sep;37(147):5-13.
5. Paolone G, Ordini G, Manauta J, Devoto W, Putignano A. Composite shade guides and color matching. Int J Esthet Dent, 2014 Summer;9(2):164-82.
6. Manauta J, Salat A. Layers: And Atlas of Composite Resin Stratification. Quintessence Int, Chicago 2012.