1. Prefabricated Composite Veneers Dahlia Levine & Mario Romero
Clinical Technique
Department of Restorative Sciences, Dental College of Georgia,
Augusta University, Augusta, GA USA
Dahlia Levine & Mario Romero
Co5 mm
INTRODUCTION
RESTORATIVE PROCEDURE
The advantages of veneers as an esthetic restorative solution have been well documented in the literature since their inception in the mid 1900’s1,2. The minimally invasive tooth preparation allows for maximal conservation of tooth structure and a durable long-term esthetic outcome. Recently innovations in dental materials have broadened the treatment options by introducing new alternatives for direct composite veneers3. Amongst these novel treatment options is the COMPONEER prepolymerized nano-hybrid composite veneer system by Coltene. The benefits of this system when compared to traditional porcelain veneers are evident both financially and time-wise. The potential applications of this system are far reaching as it provides an affordable highly esthetic solution for patients and a chair side-single-appointment procedure for dentists3.
In preparation for this appointment a comprehensive treatment plan was created and all disease processes controlled. A smile analysis and esthetic wax-up were completed according to the golden proportion to ensure esthetic proportionality. The patient completed bleaching three weeks prior to the veneering procedure to correct post-eruptive discoloration. Moreover, because the patient is edentulous on the mandible, occlusal rims and jaw relation records were completed prior to veneer placement to evaluate the proposed increase in incisal length using both esthetic and phonetics.
Tooth preparation: As is typical with composite veneer tooth preparations the facial enamel was reduced by 0.5 mm using a medium round diamond bur to ensure the final restoration was not over-contoured. All unsupported enamel was removed and a bevel was placed on the incisal edge sloping toward the lingual to ensure adequate bonding and prevent fracture. Additionally a mm chamfer margin was placed at the gingival crest. This created a positive stop for seating the veneer and ensured precision during placement.
Isolation: Isolation was accomplished using rubber dam envelope technique secured by two W2 retainers and block-out resin. The adjacent teeth were protected throughout the procedure by placing a Mylar strip interproximally. This also served to prevent bonding between the two veneers.
Veneer Selection: the COMPONEER contour guide was used to select the appropriate veneer size. The veneer was subsequently trimmed from the gingival portion following the contour of the positive margin stop established in the tooth preparation. In this clinical situation the patient required both diastema closure and incisal lengthening of 2.5 mm due to attrition. Thus, despite the patient’s relatively petite mouth size the large mold was selected for adequate width to close the diastema.
Etch: Etching was done for 30 seconds using Coltene’s own etchant brand (37% phosphoric acid) then thoroughly rinsed and lightly dried. This served to remove the smear layer thus maximizing resin infiltration and bond strength.
Adhesive: A thin layer of one coat bond total etch light-cured mono-component bonding agent was placed on the preparation and light cured for 20 seconds on both facially and lingually. A thin layer of adhesive was also placed on the intaglio surface of the veneer and not light cured to permit better wettability of the composite. Though pre-polymerized composite is generally sand blasted for micro-retention this step may be omitted because COMPONEER has a miro- retentive surface that is reactivated by one coat bond3.
Composite: Synergy D6 composite by Coltene was used to restore starting with tooth #8. Dentin composite A1-B1 was placed on the cervical portion of the tooth and enamel universal composite placed on the remaining facial surface. The composite was gently blended using the COMPONEER straight ended modeling instrument to ensure all surface were covered and no voids were present. A thin even layer of enamel composite was also placed on the intaglio surface of the veneer to prevent inclusion of air upon seating. The veneer was placed intraorally using the COMPONEER holder with the incisal edge parallel to the interpupillary line. The COMPONEER rubber plugger was used to place even firm pressure on the cameo surface of the veneer ensuring that excess composite flowed out around all margins. The excess facial and interproximal composite was removed using an explorer moving from gingival to incisal. The lingual excess composite was contoured to accommodate the increased incisal length. The final incisal edge thickness was trimmed to a mm for added strength. After double-checking the alignment of the incisal edge the veneer was light cured for 20 seconds on both facial and lingual surfaces. After both veneers were placed a reverse Mylar pull technique was employed on the mesial of #9 to further close the diastema and create a clinically acceptable marginal seal.
Finishing and polishing: An ET fine diamond bur was used to remove subgingival excess and establish an esthetic emergence profile. Soflex disks were subsequently used with the torque multiplier on the slow speed hand piece progressing from course to fine. The course disk was used to shorten the incisal edge to the predetermined length of 9 mm established during the jaw relation’s record appointment. Finally, phonetics were checked to ensure the restorations were functionally satisfactory.
Continued Treatment: The patient will be receiving another COMPONEER prefabricated composite veneer on #10 and at which time all finishing and polishing of #8 and 9 will be finalized. A three unit fixed partial denture with a mesial cantilever will be placed from #4-7. Upon finalization of the maxillary occlusal plane an implant retained mandibular complete denture is planned.
CLINICAL CASE PRESENTATION
Figure 1
Figure 2
Figure 1: Initial patient presentation with low smile line. Figure 2: Clinical mock-up completed using a putty matrix of diagnostic esthetic wax-up. Putty matrix trimmed to follow gingival contours and allowed to degas for 30 minutes. Mock-up placed with bis-acryl.
Figure 3
Figure 4
Figure 3: COMPONEER veneer restoration completed on #8 and #9 prepared by removing 0.5 mm of enamel from the facial surface, removing unsupported enamel and placing a bevel on the incisal edge. Figure 4: COMPONEER veneer restorations completed for both central incisors prior to finishing and polishing. Veneer size selected to provide adequate mesio-distal width to achieve a diastema closure. To establish the 9 mm inciso-gingival length pre-determined by the esthethic mock-up 2.5 mm of incisal length were added. Phonetic testing and incisal display at rest confirmed the functionality of the modification.
Figure 5
Figure 6
Figure 5: Clinical presentation after completion of bleaching. Figure 6: Immediately after placement, finishing and polishing of COMPONEER prefabricated composite veneers.
REFERENCES
Bela, Baumgarten Albert. "Porcelain-veneer dental crown." U.S. Patent No. 1,772, Aug
Meijering, A. C., et al. "Survival of three types of veneer restorations in a clinical trial: a 2.5-year interim evaluation." Journal of dentistry 26.7 (1998):
Gomes, G. and Perdigão, J. (2014), Prefabricated Composite Resin Veneers – A Clinical Review. J Esthet Restor Dent, 26: 302–313. doi: /jerd.12114