Anterior Aesthetic Restoration Using a Direct Resin Veneer Technique
John Roberts, DDS
female patient presented for smile enhancement (Figure 1). A clinical examination
with necessary radiographs and a professional cleaning indicated that no soft
or hard tissue pathology was evident. Although the patient had previously
undergone orthodontic treatment in addition to esthetic crown placement,
fillings, and routine care, Class I occlusion and Class III tendencies remained
evident (Figure 2). Minimal, if any, wear patterns existed in the enamel. Functionally,
the patient guided well on right, left, and protrusive excursions. No balancing
or working interferences were noted in the posterior region.1,2 No
history or complaint of temporomandibular disorder, pain, popping or crepitis
upon maximum opening, or lateral, or protrusive excursions were noted (Figure 3).
symmetry was evident, with no midline shift. A mild cant was present on the
left side, with low tissue evident in the gingival architecture. Short central
and lateral incisors resulted in a reversed smile line and poor esthetic
proportions (Figure 4). The buccal corridor appeared satisfactory (Figure 5). The
patient did not feel comfortable with the white and brown spots visible on the
anterior dentition, and desired greater incisal length, improved phonetics, and
periodontal health was excellent. Tooth #13 was restored with a provisional
crown and required replacement with a definitive porcelain restoration. Adequate
composite restorations were present on teeth #2 through #5, and #9, #12, #15, #18
through #23, and #26 through #31. Teeth #1, #16, #17, and #32 were missing. Minor
gingival tissue correction would also be required to improve the cant.3
multiple treatment options were discussed with the patient, direct veneers
to restore teeth #5 through #12, to alter the smile line as well as the shade. Tooth
#13 was also scheduled for crown replacement. The following steps would be
followed in the treatment plan:
periodontal maintenance and good home care was expected, as it was already
habit for this patient.
- Teeth #5
through 12 would be prepared for veneers or veneer onlays.
- A hybrid
composite would be placed as a base for the dentin shade and strength in the
- Because the
dentin structures were more opaque and contain a more saturated chroma, the use
of a layered restorative technique with calibrated translucencies was selected
to allow development of exceptional esthetics and an accurate shade match.
- An enamel-shaded
microfill would be placed over the dentin layer to be polished to a natural
- Occlusal adjustments
would ensure that the new composite veneers would last in the new length and
tooth length and the removal of the brown spots were of primary importance
because these were, essentially, the patient’s primary concerns. Each tooth was
prepared and rebuilt individually so that tooth form and position would not be
lost (Figure 6). Tooth depth cuts were placed at 0.5 mm in the facial tooth
structure.4 The tooth preparation design was maintained in a simple
manner, with margins maintained supragingivally, and the incisal third of each
tooth prepared more aggressively to allow space for the development of incisal shade
and translucency. Care was taken to extend the preparations into the
interproximal area far enough to eliminate interproximal shadowing.5
Following rubber dam isolation, a clear
plastic strip was placed between each preparation to maintain optimal
interproximal contacts. Using the total-etch technique, the dentition were
etched with a 35% phosphoric acid material for 15 seconds and rinsed
thoroughly. A micro brush was used to absorb the excess water on the bonding
surface. An adhesive material was generously agitated on the preparations for
20 seconds and air dried to evaporate any alcohol carrier in the bonding agent.6
This layer was light cured for 20 seconds per tooth.
Shade B1 Dentin was placed on the
cervical aspect and tapered towards the insisal to establish the body color and
to provide strength to the addition in incisal length.7 This also
helped eliminate a transition in color between the dentin body of the prepared
tooth and the desired length. This layer became the functional surface on the
lingual aspect. Developmental lobes were subsequently formed in this layer and
then stained. Internal characterizations were then added to give warmth and help
decrease the natural tendency of teeth to become too gray when increased in
brightness. Translucency was instilled along the incisal edge to encourage
recognition of the underlining characteristic colors. Beveling back the incisal
edge at the proper angle to create a line of light being refracted created the
incisal halo effect. Several layers of the final resin layer were removed and
replaced in an attempt to create proper tooth contour (Figure 7). Canine
guidance was then developed on the lingual aspect.8 The Bennet shift
was induced with mild pressure on the balancing side of the mandible to ensure
the new canine guidance cleared all balancing and working interferences.9
Protrusive occlusion was verified prior to definitive finishing and polishing.
resin was removed with finishing strips and fine-fluted carbide burs under
copious water irrigation. Although the facial surfaces were polished using
disks with varying grits, care was taken not to remove all surface texture created
during placement of the enamel layer of composite resin (Figure 8).10
1. Okeson JP.
Management of Temporomandibular Disorders and Occlusion. Fourth Edition. St. Louis, MO:
2. Dawson PE.
Evaluation, Diagnosis, and Treatment of Occlusal Problems. Second Edition. St. Louis, MO:
3. Chiche GJ, Pinault
A. Esthetics of Anterior Fixed Prosthodontics. Carol Stream, IL:
Quintessence Publishing, 1994.
4. Heymann HO. The
artistry of conservative esthetic dentistry. J Am Dent
Assoc 1987;Spec No:14E-23E.
5. Beagle JR. Surgical
reconstruction of the interdental papilla: Case report. Int J Periodont Rest
6. Heymann HO, Bayne
SC. Current concepts in dentin bonding: Focusing on dentinal adhesion factors.
J Am Dent Assoc 1993;124(5):26-36.
7. Albers HF. Tooth
Colored Restoratives. 7th ed. Hamilton,
Ontario; BC Decker, Inc, Alto
8. Manns A, Chan C,
Miralles R. Influence of group function and canine guidance on
electromyographic activity of elevator muscles. J Prosthet Dent
9. Rufenacht CR.
Fundamentals of Esthetics. Carol
Quintessence Publishing, 1990.
10. Miller MB, Castellanos
IR. Reality. Houston, TX: Reality Publishing, 2001.
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