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Case Study
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Placement of Direct Composite Veneers Utilizing a Silicone Buildup Guide and Intraoral Mock-up

Cary Behle, DDS

Learning Objectives:

This case study discusses the fabrication of direct composite veneers in the anterior maxilla by utilizing an intraoral mock-up and transferring this information to the direct buildup of the veneers via a silicon putty stent. Upon reading this case study, the reader should have:
  • An understanding of the fabrication of an intraoral direct composite mock-up.
  • Knowledge of how to fabricate a silicone stent for building up the direct composite veneers.
  • An understanding of a stratification technique for layering dentin and enamel shades of composite.

The indications for direct composite materials have recently been expanded to include predictable and convenient application in the aesthetic zone. The availability of composite materials with improved physical and optical characteristics facilitates the development of enhanced aesthetics while maintaining vital function. This article presents a simplified technique that combines function with aesthetics by utilizing an intraoral composite mock-up for initial communication and the implementation of a lingual/incisal silicone stent of the mock-up to transfer the information to the definitive restorative buildup.

The direct application of composite resin has grown in importance to contemporary dentistry, and its use will continue to expand as material composition is improved by future research. Due to the variety of dentin and enamel bonding agents that are currently available, the direct application of composite resin can now be performed with success and predictability. These expanded indications for direct techniques are primarily the result of recent advances in composite resin formulation, which include enhanced strength, wear, stability, aesthetics, and ease of manipulation.

The direct application of a restorative material satisfies various considerations (eg, single appointment, direct clinician control, and reduced expense) for the patient and practitioner. While the indications for composite resins are constantly increasing, the proficiency of clinicians using direct procedures must be improved. The use of veneers to restore aesthetics in the anterior has evolved into treatment that strengthens and replaces lost or worn tooth structure (ie, biomimetics) while regaining proper function and anterior guidance. Significant improvements in the stratification of composites permit natural depth and visual effects similar to those of porcelain buildup techniques to be achieved. The use of light polymerization, incremental layering techniques, and the profusion of opaquers and tints have enabled clinicians to exercise the artistic skills that are traditionally reserved for dental technicians. Nevertheless, simplified methods are required to fabricate aesthetic restorations that reduce patient expense and chairtime.

The direct restoration of the entire arch allows an aesthetic, natural appearance to be achieved with simplified layering and color stratification, as it is not necessary to match the adjacent teeth. Once the aesthetic expectations of the patient and a comprehensive treatment plan have been determined, the sequential application of the direct resin can proceed. This article demonstrates a clinical protocol for the direct restoration of the anterior dentition utilizing composite resin, an intraoral mock-up, and buildup guide. As an alternative to the use of preliminary impressions, occlusal records, and a laboratory waxup, an intraoral composite mock-up technique was utilized to determine the correct length of the restorations.


Case Presentation

A 40-year-old male patient presented with unaesthetic teeth, which had been restored 14 years previously with direct microfilled composite resin for diastema closure. Although the material and underlying dentition had become discolored, the patient declined treatment with porcelain restorations due to the success and durability of the previous treatment and the increased expense and chairtime associated with a prosthetic solution. Clinical examination revealed Class I occlusion with evidence of bruxism and loss of cuspid guidance that resulted in group function on the left and right sides. Centric relation was within 1 mm of centric occlusion and was corrected with occlusal equilibration. Due to a lack of cuspid protection and various lateral forces, approximately 1 mm to 2 mm of gingival clefts and recession were evident on teeth #4(15), #5(14), #12(24), and #13(25). As a result of the patient's aesthetic expectations and the availability of contemporary composite materials, a treatment plan that increased the length of the 10 maxillary teeth (#4 through #13) was developed. This would establish optimal aesthetics and anterior guidance, prevent additional recession of the gingiva on the premolars, and reduce bruxism without using an appliance. Wear on the opposing dentition would be prevented, since the wear of light-cured microhybrid composites is similar to that of natural teeth.

 

Related Reading:

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  23. Baratieri LN, Berry TG. Esthetics: Direct Adhesive Restoration on Fractured Anterior Teeth. Carol Stream, IL: Quintessence Publishing; 1998:90.
 
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