Journal of Conservative Dentistry
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Year : 2006  |  Volume : 9  |  Issue : 3  |  Page : 87-92
Direct composite veneering technique producing a smile design with a customised matrix


Department of Conservative Dentistry and Endodontics, RV Dental College, Bangalore, India

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   Abstract 

A recent trend in dentistry has been to conservatively and esthetically restore anterior teeth. This is evident by the growing use of composite resins and other tooth colored restorative systems. Today with trend towards minimum intervention in dentistry, composite veneers have become an answer to discolored anterior teeth. Direct placement of composite veneers has greater control, require a conservative removal of tooth structure and can be easily repaired and modified at any stage. However chair side direct placement of composite veneers is time consuming procedure and is technique sensitive. A new technique for placement of composite in single visit using the modified customized matrix has been proposed.
This paper illustrates two case reports of direct composite veneering using a new modified customized matrix technique for treatment of discolored teeth after bleaching.

How to cite this article:
Lal SM, Jagadish S. Direct composite veneering technique producing a smile design with a customised matrix. J Conserv Dent 2006;9:87-92

How to cite this URL:
Lal SM, Jagadish S. Direct composite veneering technique producing a smile design with a customised matrix. J Conserv Dent [serial online] 2006 [cited 2020 Aug 5];9:87-92. Available from: http://www.jcd.org.in/text.asp?2006/9/3/87/42328

   Introduction Top


Esthetic dentistry has become an integral part of every day practice in dental clinic. With increasing patient demand, it has also become a challenging job for our profession.

There are many treatment alternatives for the conservative clinical management of non carious enamel defects such as enamel hypoplasia, enamel hypocalcification, localized enamel malformations and wear, rotations and simple malalignment, fluorosis, and discoloration of teeth due to trauma or tetracycline staining [11] . These modalities may involve the placement of labial composite veneers, or composite veneering following vital and nonvital bleaching as tooth bleaching as the sole treatment for discolored teeth may not provide a complete permanent esthetic satisfaction. [11]

Veneering using ceramics is also a treatment modality but requires more removal of tooth stricture. Though improved properties of indirect composite restorations have provided an added advantage, but they require a tooth preparation more invasive with two appointments and higher cost. [4]

Chair side composite restorations have emerged to provide the operator with greater control over the restorative process by sculpting the final restoration to the desired morphology and color. Due to remarkable improvements in composite resin formulation a new technical and artistic level has been reached. [3]

The emergence of a new breed of composite resins comprising very small-sized particle technology enables dentists to provide both strong and life-like aesthetic restorations. These new breeds of composite resins, termed "nanofilled composites", promise better polish longevity of luster, better handling and high strength. [2]

Direct placement of composite for veneering is a laborious process particularly for multiple teeth. Simpler techniques using matrix have been advocated to make the procedure less technique sensitive [3],[4],[9],[10] . Use of matrix in placing composite simplifies the chair side treatment procedure.

This paper proposes a new simplified direct composite veneering using a modified matrix to achieve desirable esthetics in single visit.


   Materials and Methods Top
The patients selected for the study were referred to Department of Conservative Dentistry and Endodontic RV dental college, Bangalore who had hypoplastic teeth and wanted its correction to obtain good esthetic.

Impressions were made and models prepared prior to bleaching which will aid in future in fabricating modified matrix for direct composite veneering.

All patients who had hypoplastic teeth were bleached with McInnes solution till the discoloration was minimized prior to composite veneering.

Modified Matrix fabrication:

Models were modified and finished to predictable esthetics for the patient accordingly. [Figure 1]

The matrix material selected was copyplast 1 mm [Figure 2]. Once the cast were modified they were placed in Biostar machine on the lead beads [Figure 3] and the matrix fixed in the rim. The temperature and pressure were set accordingly and the matrix was fabricated trimmed to be used in the patient's mouth. [Figure 4],[Figure 5]

The composite resin system chosen for this article was Ceram X nano duo ceramic Restorative by Dentsply Caulk. Shade selection was done.

After tooth reduction of approx 0.3-0.5 mm with a chamfer [Figure 7] the teeth were etched [Figure 8], bonded [Figure 9] and composite was placed on the teeth followed by placement of matrix [Figure 10] and cured for 40 seconds per tooth.[Figure 11]

The matrix was removed and excess composite was removed using no 11 scalpel blade [Figure 12]. The veneers were polished using the enhance system Ceram X. [Figure 13].


   Case report 1 Top
A 24 year male patient presented with darkened teeth, with midline diastema. Pre restorative considerations included prophylaxis, oral hygiene instruction and correction of gingival asymmetry.

Bleaching:

The teeth were bleached for three weeks in three sessions. This lightened his teeth enough so that he was pleased with the resulting shade. [Figure 15] Bleaching allowed more conservative restorations.

Shade Selection and Color Mapping:

The shade selection was done at the beginning of the appointment before the teeth could dehydrate.

During the period of bleaching appointments the cast were modified to obtain predictable esthetics and matrix was fabricated. [Figure 1], [Figure 6]


   Case report 2 Top


A 29 year male patient presented with pitting and discoloration of upper anterior teeth. After three sessions of vital bleaching the cast was modified, matrix fabricated direct composite veneering was done. [Figure 19]

After composite placement using the matrix the teeth were polishing using enhance polishing system. [Figure 21]


   Discussion Top


Today with trend towards minimal intervention in dentistry, direct composite veneering after bleaching of discolored teeth has provided clinician with added advantage of achieving predictable esthetic results with minimized trauma to the teeth.

Bleaching as a sole treatment for discolored teeth may not provide a complete satisfaction for permanently achievable esthetics. Direct or indirect ceramic or composite veneering of teeth has been suggested as additional permanent alternative in treatment of discolored teeth. [10]

Ceramic veneering requires more removal of tooth structure. Improved properties of indirect composite restorations have provided an added advantage, but require a more invasive tooth preparation, a good lab support color matching maybe subjective-may not be perfect, Special surface treatments for bonding and more than one appointment for veneering and preparing temporaries. [4]

Today's composite resins are remarkable materials that when handled properly will provide years of attractive service and wear resistance. They provide greater control, require a conservative removal of tooth structure and can be easily repaired and modified at any stage [11] .

While no one will argue that the porcelain veneer is king, most will admit that there are times when they are inappropriate and of course can be priced too high for their intended recipient.

To simplify composite placement -customized matrix for individual patients can be made which is less technique sensitive and provides greater opportunity and freedom to deliver optimized esthetic goals.

A modified matrix technique for placement of newer formulations of direct composites has been proposed which provide the clinician with ease in fabricating multiple composite veneers in single visit. In this technique Copyplast (1 mm) material [Figure 2]has been used for fabricating the matrix in the Biostar machine.

However, similar results could be obtained with use of thicker 0.5-Inlm of polyester film sheets which is more economical.

This modified matrix technique can also be used to Rebuild fractured teeth, Malformed teeth, Spacing/ Diastema and Malposed teeth.

Through use of Resin Replicas and their associated templates (matrix) which ultimately stem from accurate digital imaging and simulation, even those who just skimmed by Dental Anatomy can become direct bonded veneer all-stars.


   Conclusion Top


This innovative simplified technique can be used as an alternative to direct placement of composite since it has the following advantages.

  • A final restoration is predictable and easily achievable
  • Direct bonding to the tooth material.
  • Easily repairable.
  • Can be used in Diastema closure, crown lengthening to achieve a smile design.
  • Smooth and finished surface easily achievable
  • Esthetic & Economical.


Considering these advantages this simple technique can be used as an alternative to direct placement of composite providing good esthetics and function.[Figure 14],[Figure 16],[Figure 17],[Figure 18],[Figure 20],[Figure 22]

 
   References Top

1.Baratieri I.N.: Aesthetics: Direct Adhesive Restoration on Fractured Anterior Teeth. Carol Stream, IL, Quintessence Publishing. 1998.44.  Back to cited text no. 1    
2.Christopher Ck Ho; Composite artistry using Premise - The new breed of nanofiller Den- tal PracticeSeptember/October-1392004  Back to cited text no. 2    
3.Miller M.: Reality; The Techniques. Vol. 1. 2003, "Veneers-Direct Resin", p 207-232.  Back to cited text no. 3    
4.Peyton J.H.: Direct Restoration of Anterior Teeth: Review of the Clinical Technique and Case Presentation. Pract. Periodont. Aesthet. Dent. 2002;14(3)p203-212.  Back to cited text no. 4    
5.Behle C.: Placement of Direct Composite Veneers Utilizing a Silicone Build-up Guide and Intraoral Mock-up. Pract. Periodont. Aesthet. Dent. 2000; 12(3): p 259-266.  Back to cited text no. 5    
6.Fahl N.J.: Achieving Ultimate Anterior Esthetics with a New Microhybrid Composite. Compendium. Vol. 21, 2000. (Suppl. No. 26) p413.  Back to cited text no. 6    
7.Fahl N.J.: Predictable Aesthetic Reconstruction of Fractured Anterior Teeth with Composite Resins: A Case Report.Pract. Periodont. Aesthet. Dent. 1996, Vol. 8, No. 1, p 17-30.  Back to cited text no. 7    
8.Newton fahl; The esthetic composite anterior single crown restoration, The Esthetic Chroincal vol 9 no. 1 59-701997  Back to cited text no. 8    
9.Martin B. Goldstein; Alternative Approaches to Building Beautiful Smiles Dentistry Today Volume 24 NO.7 July 2005  Back to cited text no. 9    
10.Jordon R.E.: Esthetic Composite Bonding: Techniques and Materials. St. Louis, MO; 1993: p 106-109.  Back to cited text no. 10    
11.Crispin, B.J.: Contemporary Esthetic Dentistry: Practice Fundamentals. Carol Stream, IL: Quintessence Publishing; 1994: p 241-266.  Back to cited text no. 11    

Top
Correspondence Address:
Suhas Mohan Lal
Department of Conservative Dentistry and Endodontics, RV Dental College, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0707.42328

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21], [Figure 22]



 

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    Abstract
    Introduction
    Materials and Me...
    Case report 1
    Case report 2
    Discussion
    Conclusion
    References
    Article Figures

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