Fig.1
This patient required aesthetic improvement; restorations with a minimal invasive approach were chosen. After he was informed that he already had invasive restorations, we decided together to improve the aesthetics with composite restorations in one session.

Fig.2
This is the aspect of the teeth after isolation, when the composite in excess can be observed most of the times.

Fig.3
The first thing we do is to remove the old composite restorations and to clean the proximal area – old composite, adhesive in excess, calculus, plaque. Also the width of the central incisors was slightly different and we always should take this into consideration during our restorative procedures.

Fig.4
The main challenge in these situations is to evenly split the space between the centrals. Mylar strips are not very helpful in this step, but two metal matrices (MyCustomRings Kit, Polydentia) can help the dental practitioner to better see where the midline is placed.

Fig.5
With both matrices in place I have restored 11.

Fig.6
After applying the composite on the mesial part of 11, I removed both matrices and started contouring the restoration. For a nice outcome, it is critical that the mesial part of 11 has the right shape.

Fig.7
Then, the mesial wall of 21 was restored using only one metal matrix and, after that, both distal walls were built. To check the width of the central, we can use a periodontal probe to measure. In this step, I am not focusing on the vestibular part yet.

Fig.8
Now, my concern is to have the proximal walls in the right position and to have as much as possible the equal width.

Fig.9
Next, I have restored the laterals just the proximal walls.

Fig.10
After this step, in order to have a better control over the limits of the restorations on the cervical area, I prefer to do a split of the rubber dam and to place a continuous retraction cord. Then I prepared the vestibular part of the teeth leaving enough space for the composite.

Fig.11
Starting all over the adhesive procedure, I restored the vestibular part of the teeth one by one, beginning with the centrals.

Fig.12
After each reconstruction, I prefer to adjust it as a reference for the next one. Also at this moment you can adjust the length and the morphology of the incisal margin.

Fig.13
If the proximal limits of the veneer are placed in an area where the spatula or the instruments have no access, the metal matrices can be used again.

Fig.14
All four veneers were reconstructed. As a composite material I used Brilliant OA2 for proximal and for the last composite layer A2 Brilliant Ever Glow, Coltene.

Fig.15
After rubber dam was removed, I performed an initial finishing and polishing of the reconstructions. This session took 2.5 hours: anesthesia, isolation, cavity preparation, proximal reconstruction, vestibular reconstruction, and initial finishing procedure.

Fig.16
During the next session, I checked the colour and the composite integration and after that I did the final finishing and polishing procedure.

Fig.17
The main step at this stage is to work with the transition lines. If this step is properly carried out, the composite veneers will have a visual appearance that will please the patient.

Fig.18
The final aspect after finishing and polishing. Also we can see the nice improvement of the gingival aspect only after a few days.

Fig.19
This second appointment was about 1 hour, so the whole procedure took 3.5 hours, divided in two sessions.

Fig.20
Final outcome.

Fig.21

Conclusions

1. Composite veneers can be a nice option for vital and non vital teeth.
2. Composite veneers are the less invasive procedures.
3. In case we have to restore both proximal and vestibular parts of a tooth, starting with the proximal walls may prove to be more efficient.

Bibliography