Aesthetic dentistry courses
Additive Composite Veneers
The final esthetic outcome of an anterior restoration depends on the combination of the final form of the restoration with the color selection, tooth anatomy and the thickness of each composite shade.
Clinicians should have a precise idea of the form of the final restoration in their mind before starting color selection and composite layering (Deliperi, 2011).
Three mandatory steps are recommended when placing direct anterior composite restorations:
1-pre-op mock and/or wax-up to determine the final form of the restoration
2-shade selection and optical characteristic reproduction based on tooth age
3-evaluation of tooth thickness to manage the three-dimensional layering of dentin and enamel shades
Once the correct final form has been determined, the clinician should proceed with an accurate shade selection. Shade selection starts with dentin shade selection. Dentin represents the most important layer for the integration of the restoration with the surrounding tooth structure. The color of the tooth is derived from the dentin, whereas enamel only works as modifier of the dentin color.
Once tooth form has been determined and shade has been selected, clinicians need to manage the three-dimensional thickness of dentin and enamel shades. This last step may be the most difficult. By managing the quantity of composite dentin and enamel shades, it is possible to reproduce the fluorescence and opalescence of natural teeth at the three different dental ages: young, adult and old patients. This goal can be achieved using few dentin shades and only one enamel shade most of the time.
Meticulous choice of the quantity of composite shade applied and placement of small increments (Deli-bits) may help to overcome this issue and reduce the stress in structurally compromised teeth (Stress-reduced Direct Composite Restorations) – Deliperi PPAD 2003.
Prepless direct composite veneers may be very challenging for the clinicians in terms of shade matching and a learning curve is required for sure. However, additive composite veneers are the only minimally invasive procedures able to protect and conserve 100% of the remaining sound tooth structure in the anterior area.
The goal of biomimetic dentistry to continually preserve the patient’s teeth during each dental procedure is then achieved!
The following case presentations will demonstrate how a Stress-reduced Direct Composite Restorations (SRDC) protocol can guarantee success in different clinical scenarios.
Slide 1- Class IV direct composite restoration
Tooth fracture of the left central incisor; the existing Class IV restoration failed. A mock-up was completed and layering of the composite resin was planned to mimic the fluorescence and opalescence of a young tooth. The final restoration matches the shade and anatomy of the adjacent tooth.
Slide 2- Prepless direct composite veneers following orthodontic treatment
Patient undergoing orthodontic treatment, rejected a post-orthodontic crown lengthening procedure. Indeed, intrusion of the left central incisor was approved to match the gingival levels of the two central incisors. Following tooth whitening procedures, additive composite veneers were completed to improve the final form of the four anterior teeth. Accurate composite layering of dentin and enamel shades was completed; the micro and macro texture were also reproduced to totally match the anatomy and shade of the adjacent teeth.
Slide 3- Additive direct composite veneers for diastema closure
Complete smile make-over with no tooth preparation at all! Following Dr Deliperi’s three mandatory steps is the key for success when placing anterior additive composite restorations.
The post-op photopolarized smile picture shows the details of the layering protocol that was selected to match the anatomy of the the lower anterior teeth of an adult patient. The reproduction of the value, the incisal halo and the incisal translucency are priorities in shade matching.
Slide 4- Post-orthodontic additive direct composite veneers for tooth wear treatment
Following orthodontic treatment, the four upper incisors teeth appeared too short due to tooth wear from parafunction. Gingival recession treatment was delayed by the patients.
Four direct composite veneers were planned in an attempt to eliminate the appearance of an old patient teeth. The correct composite resin layering was guided by the use of silicone matrix obtained from the wax-up. The wax-up also served as a tool for patient approval of the final shape of the restoration via a composite mock-up.
Shade matching was achieved selecting high chroma, low value dentin and enamel shades.
Slide 5- Additive full crown composite restorations in a full-mouth rehabilitation
The Deliperi protocol for biomimetic dentistry does not require the use of any post or traditional dental crowns even in the most challenging clinical scenario. Aesthetic and function may be established using a minimally invasive approach.
A night guard was fabricated to find a position of the mandible comfortable enough to avoid both muscle and joint symptoms and the new position of the mandible was recorded via an acrylic jig.
Both the anterior and posterior teeth were restored using a stress-reduced direct composite protocol at the established vertical dimension of occlusion. An additive layering technique of composite resin allowed the full crown reconstruction of the mutilated dentition.
Slide 6- Combination of additive direct composite veneers and porcelain laminate veneers
Meticulous choice of the quantity of composite resin shade applied and particular care on the finishing and polishing steps may help clinician to match the aesthetic of porcelain veneers by using composite resin veneers.
Being less rigid than porcelain veneers, direct composite veneers may be more indicated for canine reconstruction in case of parafunction. Even though wearing a night guard is mandatory in a similar clinical scenario, composite resin may forgive more during masticatory function due its superior elasticity and repairability.
