Workflow: Composite veneering on non vital teeth
Regardless of the type of the clinical situation, major flaws can strongly impact on the quality of life of a person.
The use of direct composite veneering as a treatment option should be considered the first choice in order to recover the aesthetic appearance of damaged teeth, especially because indirect techniques have a higher biological and economical cost. Composite direct veneering is also the first choice when we think in a minimal invasive way.
A large number of studies have demonstrated long lasting good results for composite restorations in posterior teeth. A recent meta-analysis of prospective studies on anterior composite restorations showed a median overall estimated survival of 95% for class III and 90% for class IV, after 10 years.
When composite veneering was used, the studies showed a satisfactory clinical performance and the survival rate of 80.1% after 3.5 years. Direct composite veneers performed in vital teeth showed a better performance compared to those in non-vital teeth for colour match, fracture and retention outcomes. The same retrospective clinical evaluation (1) showed that veneers in non-vital teeth have two times higher risk of failure than the veneers placed in vital teeth and that was no difference in survival rate between veneers placed with micro-filled or universal composites.
Based on scientific statistics and clinical data, composite veneers could be an option to enhance the aesthetic appearance of our patients’ smiles. Of course composite veneers do not exclude the use of indirect restorations such as crowns or ceramic veneers.
In this article, three non vital teeth and one vital tooth were restored with composite to improve the aesthetic appearance. In my clinical practice I call this an “aesthetic emergency” before a long lasting treatment option will be done.
Also, I would like to demonstrate a workflow option that we can use when we want to restore both proximal and vestibular parts of the teeth in the same session. As a basic guideline to follow each time, at first we should concentrate on the restoration of the “frame” of the tooth (proximal and incisal) and after that, we can better focus on the facial aspect of the tooth. Regarding this hypothesis, the steps that are presented in this article have the purpose of enhancing the efficiency of the procedure and spending less time chair side with more predictable aesthetic outcome for the patient.
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.
Fábio Herrmann Coelho-de-Souzaa, Daiana Silveira Gonçalvesb, Michele Peres Salesb ,Maria Carolina Guilherme Erhardta, Marcos Britto Corrêac, Niek J.M. Opdamd ,Flávio Fernando Demarcoc. Direct anterior composite veneers in vital and non-vital teeth: A
retrospective clinical evaluation. Journal of Dentistry 43 (2015) 13301336
R. Da, Rosa, P.Aodolpho, T.A. Donassollo, M.S. Cenci, A.D. Loguércio, R.R. Moraes, E.M. Bronkhorst, N.J. Opdam, F.F. Demarco, 22-year clinical evaluation of the performance of two posterior composites with different filler characteristics, Dent. Mater. 27 (2011) 955963.
F.H. Van de Sande, N.J. Opdam, P.A. Rodolpho, M.B. Correa, F.F. Demarco, M.S. Cenci, Patient risk factors influence on survival of posterior composites, J. Dent. Res. 92 (2013) 78S83S Suppl.
N.J. Opdam, F.H. Van de Sande, E. Bronkhorst, M.S. Cenci, P. Bottenberg, U. Pallesen, P. Gaengler, A. Lindberg, M.C. Huysmans, J.W. Van Dijken, Longevity of posterior composite restorations: a systematic review and meta-analysis, J. Dent. Res. 93 (2014) 943949.