Direct composite laminate veneers: three case reports

Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) Fabricated Laminate Veneers in Aesthetic Rehabilitation: A Case Report

Porcelain laminate veneers are a popular cosmetic dentistry treatment for correcting discoloured, worn, misaligned, gapped, chipped, or crooked teeth. The restorative material utilized in the indirect method can be processed using CAD/CAM (computer-aided design and computer-aided manufacturing) technology or conventional technique, which is highly sensitive. Due to its multiple benefits, digital technology is growing quickly and has opened up a lot of new opportunities for dental practitioners. These days, CAD/CAM is a helpful technique that enables the creation of monolithic restorations for ceramic materials, which is most recently utilized in the field of ceramic veneers as well as digital impression capturing and digital designing as part of treatment planning. This case study details the methodical process of creating laminate veneers for a patient who wants to enhance the look of their anterior teeth utilizing both traditional and CAD/CAM technology.

Clinical survival of No-prep indirect composite laminate veneers: a 7-year prospective case series study

BACKGROUND

The no preparation technique which is a reversible form of treatment characterized by the absence of tooth tissue preparation and preserves the soft tissue architecture while preserving all natural tooth structures is indicated in cases where the tooth structure allows material to be added. The aim of this study is to evaluate the clinical performance and survival rates of indirect composite laminate veneers with no preparation after 7 years.

MATERIALS AND METHODS

A total of 80 indirect composite veneers were placed on maxillary anterior teeth in 35 patients (n = 80). Diastema (n = 64), wedge tooth anomalies (n = 9) and re-shaping (n = 7) were the main indications for veneer treatments. All laminate veneers were fabricated with an indirect microhybrid composite material (Gradia, GC Dental). No tooth preparation was performed. Light-cured resin cement (Choice 2, Bisco) was used to lute the veneers. Composite veneers were evaluated using Modified United States Public Health Service criteria. Survival rates of the veneers were calculated using Kaplan-Meier statistics. The data containing the results of the USPHS criteria at baseline, 2 years and 7 years was statistically analyzed using Wilcoxon Signed Rank test at the 0.05 level of significance.

RESULTS

The overall survival rate was 91.3%. After 7 years, 7 absolute failures including 4 debonding (marginal adaptation, score 4) and 3 fractures (fracture of restoration, score 3) were noted. Color match was scored as 1 (n = 34) and 2 (n = 15). Slightly rough surfaces (41 of 73 laminates) and slight marginal discoloration (15 of 73 laminates) were noted. The overall scores after 84 months were significantly higher than the baseline scores for the marginal adaptation (p = 0.008), color match (p = 0.000), marginal discoloration (p = 0.000), surface roughness (p = 0.000), and fracture of restoration (p = 0.001) criteria.

CONCLUSIONS

In this study, indirect composite veneers without any preparation on maxillary anterior teeth showed acceptable performance in terms of both survival rate and quality of restorations. This procedure offers a predictable and successful treatment that ensures maximum preservation of the intact tooth.

Porcelain Laminate Veneers: A Case Report

One of the most crucial issues in modern dentistry is restoring a patient's lost dental aesthetic appearance. To do this, new therapeutic tools and techniques have been appearing on the market day by day. For anterior teeth, where aesthetics are extremely essential, the majority of dentists prefer more conservative and aesthetic treatments, such as direct and indirect laminate veneer restorations over full-ceramic crowns. The meteoric emergence of veneers has been one of dentistry's most successful innovations. It is a coating of tooth-coloured material that is put to a tooth to aesthetically restore any intrinsic discoloration or localised or generalised abnormalities. Any restoration work ought to be created using mechanical, biological, and aesthetic criteria. Patients may experience significant aesthetic issues as a result of the colour, form and structural and positional anomalies of their anterior teeth. This is a report depicting a case of porcelain laminate veneers using computer-aided design/computer-aided manufacturing (CAD/CAM).

Quantitative Measurements of the Depth of Enamel Demineralization before and after Bleach: An In Vitro Study

Objective

This study is aimed at determining two main points. First, if the Canary System™ (CS), initially used to assess caries, can measure a decalcification depth of bleached enamel quantitatively, and second, whether or not whitening has a harmful effect on enamel. This device can be considered a useful tool in the clinical assessment of the progression of demineralization after bleaching.

Materials and Methods

This study collected sixty human premolars that are in a good state recently extracted for orthodontic reason. To properly disinfect and preserve the premolars, they were stored in a saline solution and later in distilled water for a period of two weeks to allow the premolars to rehydrate. Later, 24 hours before the experiment, the premolars were introduced into a solution of artificial saliva to acquire back their minerals. The mineral content of the teeth was measured by the Canary System™ before bleaching. The teeth were bleached with 30% hydrogen peroxide (fläsh HP 30%), 30 min per week and for 3 consecutive weeks to simulate the conditions of strong bleaching in the clinic. The extent of demineralized enamel was measured by the Canary System™ at three points on the enamel surface of each tooth. The data were averaged for each application of the bleaching product. The demineralization extent of the teeth was measured by the Canary System™ before and after bleaching. The significance level was set at 0.05, and SPSS version 26 was used. The data were analyzed by using Wilcoxon's and Student's tests.

Results

Mineral loss occurred after the first bleaching session; the Canary System™ detected a decalcification in the first bleaching session (532 ± 322 μm) compared to the other sessions (p ≤ 0.05), while no significant change was detected between the second and the third sessions (p > 0.05).

Conclusion

Based on the findings of the present study, under in vitro conditions, it was possible to measure the demineralization extent of bleached enamel with the Canary System™.

Evaluation of the Sealing Ability of Direct versus Direct-Indirect Veneer Techniques: An In Vitro Study

BACKGROUNDS

Marginal discoloration, microleakage, wear, and marginal fractures are all prevalent problems with composite veneers, and this scenario leads the esthetic outcome to deteriorate with time, resulting in patient discontent. Aim of the Study. The study's goal was to determine the marginal sealing ability of composite laminate veneers when employing two types of veneer techniques: direct and direct-indirect veneers, as well as two types of composite resin: nanohybrid and microfilled composite resin restorations, using dye penetration method.

MATERIALS AND METHODS

In this study, forty extracted human teeth were utilized. Following a standardized veneer preparation on the labial surface of the teeth, they were separated into two groups of 20 teeth each, using the following composite application techniques: group A: direct veneers and group B: direct-indirect veneers. Following that, each major group was separated into two subgroups of ten teeth each, based on the type of composite employed: subgroup 1 used nanohybrid composite resin, while subgroup 2 used microfilled composite resin. All of the samples were kept in distilled water, thermocycled, and soaked in 2% basic fuchsine dye. These specimens were sectioned and examined under a stereomicroscope for dye penetration at the gingival margin. The data was analyzed using independent T-tests using SPSS 22.

RESULT

Using direct-indirect veneer technique with nanohybrid composite resin material resulted in the most negligible dye penetration at the gingival margin, while using direct veneer technique with microfilled composite resin material resulted in the maximum dye penetration. For both composite materials, gingival microleakage was lower when using the direct-indirect veneer technique than when using the direct technique, and the difference was statistically significant (P < 0.05). In both techniques, gingival microleakage was lower with nanohybrid composite than with microfilled composite, and the difference was statistically highly significant (P = 0.001).

CONCLUSION

The sealing ability of the gingival margin of tooth/composite interface is better when applying direct-indirect veneer technique with nanohybrid composite resin than that of direct veneer technique with microfilled composite resin material.

Customized composite veneers from a totally digital workflow: A case report

A treatment plan based on the use of a preview software can offer the possibility to rapidly communicate with the patient. Fully digital workflow allows for making several objects at the same time in a precise and cost-efficient manner.

Non-vital Endo Treated Tooth Bleaching with Sodium Perborate

Recently a visually pleasing smile has become a major concern for the patients; therefore, dental bleaching has gained importance due to its safety and great aesthetic results. The aim of this paper is to report a case of a non-vital, discolored, maxillary central incisor bleached by Sodium Perborate with the use of glass ionomer cement as a mechanical barrier. The patient was a 35-year-old female complaining of a discolored and unaesthetic appearance of her upper front tooth. After endodontic retreatment, the bleaching treatment was applied to the maxillary left central incisor. Following the treatment, a satisfactory aesthetic result was achieved.

Influence of thickness and incisal extension of indirect veneers on the biomechanical behavior of maxillary canine teeth

Objectives

To analyze the influence of thickness and incisal extension of indirect veneers on the stress and strain generated in maxillary canine teeth.

Materials and Methods

A 3-dimensional maxillary canine model was validated with an in vitro strain gauge and exported to computer-assisted engineering software. Materials were considered homogeneous, isotropic, and elastic. Each canine tooth was then subjected to a 0.3 and 0.8 mm reduction on the facial surface, in preparations with and without incisal covering, and restored with a lithium disilicate veneer. A 50 N load was applied at 45° to the long axis of the tooth, on the incisal third of the palatal surface of the crown.

Results

The results showed a mean of 218.16 µstrain of stress in the in vitro experiment, and 210.63 µstrain in finite element analysis (FEA). The stress concentration on prepared teeth was higher at the palatal root surface, with a mean value of 11.02 MPa and varying less than 3% between the preparation designs. The veneers concentrated higher stresses at the incisal third of the facial surface, with a mean of 3.88 MPa and a 40% increase in less-thick veneers. The incisal cover generated a new stress concentration area, with values over 48.18 MPa.

Conclusions

The mathematical model for a maxillary canine tooth was validated using FEA. The thickness (0.3 or 0.8 mm) and the incisal covering showed no difference for the tooth structure. However, the incisal covering was harmful for the veneer, of which the greatest thickness was beneficial.

Minimally Invasive Approach for Improving Anterior Dental Aesthetics: Case Report with 1-Year Follow-Up

Dental aesthetics have become highly important in recent years. Treating aesthetic demands with noninvasive or minimally invasive techniques can preserve the natural tissues. A 20-year-old female patient presented to the clinic with aesthetic concerns. After the clinical and radiographic examinations, hypomineralization was identified in the maxillary anterior teeth except the maxillary right canine. An external discoloration was also identified in the maxillary left canine tooth. Moreover, the right canine tooth was identified as a Turner's tooth according to the patient's anamnesis. The resin infiltration technique was applied to the maxillary anterior teeth except the maxillary right canine. The bleaching treatment was applied to the maxillary left canine tooth. Then, a laminate veneer restoration was applied to the upper right canine tooth with Turner's hypoplasia. Following the treatment, a satisfactory aesthetic restoration was achieved. After 1-year examination, no clinical failures were observed.

Smile makeover with direct composite veneers: A two-year follow-up report

Direct composite veneers have gained an important role in dental clinical applications following recently developed materials and techniques in adhesive and restorative dentistry. Direct application on prepared tooth surfaces or even without any preparation, with an adhesive agent and a composite resin material in a single visit is the main procedure as well as the advantage of these restorations. The main aim of this direct procedure is to create minimally invasive and long lasting restorations. As the dental materials and techniques develop, the clinicians also had the chance to mimic the natural dental tissues to create very natural alike restorations in a single appointment. But like all the other dental procedures, direct composite veneers have some indications and contra-indications. These musts have to be understood very well by the clinician before the treatment planning. But this way direct composite veneers would no longer named as 'day savior fillings' and called as minimally invasive, functional and long lasting 'direct aesthetic restorations' that perfectly emulate the natural dental tissues. This article discusses the necessities of direct composite veneers for the ultimate success and illustrates how to perform a minimally invasive, long lasting, functional and natural alike smile makeover with these restorations in a single visit.

The Effect of Polymerization and Preparation Techniques on the Microleakage of Composite Laminate Veneers

BACKGROUND

Marginal leakage is the important factor influencing the maintenance of dental esthetic.

AIM

The purpose of this study was to evaluate the relationship between the preparation techniques and type of polymerization techniques on microleakage of composite laminate veneers.

MATERIALS AND METHODS

Ninety-one same sized, caries-free human maxillary central incisors were randomly assigned to 13 groups (n = 7) and were designed with four different preparation techniques (window type, feather type, bevel type, and incisal overlap type). One group determined as control group and any preparation was applied. Nanohybrid resin composite was used for restoration. Composite laminate veneers polymerized with three different techniques (direct light curing, indirect polymerization with a combination of pressure, light and heat using a light cup and heat cup, direct polymerization, and additionally heat cured in an oven). The specimens were thermocycled, and then immersed in 5% basic fuchsine solution. Following 24 h, all specimens were immersed in 65% nitric acid solutions for volumetric dye extraction test. Samples diluted with distilled water and centrifuged and microleakage determined by a spectrophotometer.

STATISTICAL ANALYSIS USED

Data were analyzed with two-way ANOVA and Tukey honest significant difference post hoc multiple comparisons test (P < 0.05).

RESULTS

For comparing the microleakage value of preparation and polymerization techniques, Window type preparation showed a significant difference in direct polymerization + additional cured group (P < 0.05). Control group was statistically different from the other groups (P < 0.05).

CONCLUSIONS

Window type laminate preparation can be preferred in indirect polymerization technique because it caused less leakage in this present study.

Esthetic smile rehabilitation of anterior teeth by treatment with biomimetic restorative materials: a case report

BACKGROUND

In daily clinical practice, esthetics of anterior teeth is a common presenting complaint of patients.

OBJECTIVE

This case report discusses the management of asymmetric smile associated with unsatisfactory extensive composite restorations and describes a clinical protocol using the direct composite resin for smile enhancement to restore the dental harmony of anterior teeth.

METHODS

The treatment planning was based on a diagnostic wax-up and cosmetic mock-up. After clinical and patient approvals were obtained, the patient was subjected to direct and indirect restorative treatment.

CONCLUSION

Nanocomposites are an effective alternative for anterior teeth restorations. Additionally, good planning enables satisfactory esthetic results, leading to the correction of an inappropriate axial inclination of incisors.

Esthetic rehabilitation of anterior teeth with laminates composite veneers

No- or minimal-preparation veneers associated with enamel preservation offer predictable results in esthetic dentistry; indirect additive anterior composite restorations represent a quick, minimally invasive, inexpensive, and repairable option for a smile enhancement treatment plan. Current laboratory techniques associated with a strict clinical protocol satisfy patients' restorative and esthetic needs. The case report presented describes minimal invasive treatment of four upper incisors with laminate nanohybrid resin composite veneers. A step-by-step protocol is proposed for diagnostic evaluation, mock-up fabrication and trial, teeth preparation and impression, and adhesive cementation. The resolution of initial esthetic issues, patient satisfaction, and nice integration of indirect restorations confirmed the success of this anterior dentition rehabilitation.

Restoration of anterior teeth using an indirect composite technique. Case report

OBJECTIVE

This article presents a case report of restoration of anterior teeth using an indirect technique with composite veneers in order to restore the dental anatomy and to provide aesthetic and function of anterior teeth.

MATERIALS AND METHODS

A treatment of upper anterior teeth with indirect micro-hybrid composite restoration was proposed to a 40-year-old woman with old discolored and fractured ceramic veneers. Upper six anterior teeth were prepared and, after impressions with VPS of maxillary arche, the composite veneers were placed.

DISCUSSION AND RESULTS

There are several advantages offered by indirect techniques compared to direct techniques. The increased practice of veneering technique with indirect composites is due to improvement in the properties of composite materials in the last years. The results are very favourable and the patient is satisfied.

CONCLUSIONS

The restorations with composite veneers have proved durable and aesthetic, protect tooth structure and aesthetic and function is predictably re-established.