Don't miss a digital issue! Renew/subscribe for FREE today.
×
Inside Dentistry
September 2021
Volume 17, Issue 9
Peer-Reviewed

Treating Anterior Wear With Composite Veneers

A cost-effective, minimally invasive option to restore esthetics and balance occlusion

Zachary S. Sisler, DDS

Composite resin lends itself to being one of the most minimally invasive treatment options in a clinician's armamentarium. It can be utilized in a whole gamut of procedures, from routine general dentistry to high-end esthetic cases and fine-tuning occlusal relationships. Although composite can facilitate a wide array of treatment modalities, this article focuses on its use for the placement of composite resin veneers coupled with bonded incisal edges to ensure optimal occlusion.

A 50-year-old male patient presented to the practice unhappy with his smile due to the uneven edges of his maxillary anterior teeth. A thorough exam was performed, which revealed that the patient exhibited moderate wear on his maxillary and mandibular anterior teeth with minimal wear facets in the posterior region. This was deemed to be associated with a parafunctional bruxism habit related to an underlying diagnosis of sleep apnea. The patient reported that he was being successfully treated for his underlying sleep apnea condition through the use of a continuous positive airway pressure (CPAP) machine.

With treatment options presented that included both porcelain and composite veneers, the patient ultimately chose to take the composite route for teeth Nos. 5 through 12. The primary factors behind his decision were the minimally invasive nature of the treatment, the lower cost, and that the composite could be more easily repaired.

The occlusal scheme would include the creation of stable centric stops with posterior disclusion by way of anterior guidance. For this particular patient, the goal was to create smooth transitions in laterotrusive movements that would allow for less damaging forces to be applied to the teeth. These movements were established and fine-tuned through equilibration that involved the use of composite resin on the mandibular incisal edges.

About the Author

Zachary S. Sisler, DDS
Accredited Member
American Academy of Cosmetic Dentistry
Private Practice
Shippensburg, Pennsylvania

Pretreatment retracted photograph with teeth apart displaying the wear on the maxillary and mandibular anterior teeth.

Fig. 1

Diagnostic casts mounted in centric relation to develop a treatment plan and wax-up for the case.

Fig. 2

The mandibular anterior teeth were waxed to visualize the proposed changes needed to establish the new occlusal scheme.

Fig. 3

Occlusal markings on the cast indicated smooth transitions in laterotrusive movements on the articulator.

Fig. 4

At the first appointment, the deteriorated composite on tooth No. 9 was removed, and the rest of the maxillary teeth were roughened with a fine grit diamond finishing bur prior to bonding.

Fig. 5

Composite was layered from the lingual aspect to the facial aspect of tooth No. 8 using a putty matrix to transfer the newly proposed wax-up contours. First, a translucent composite (Filtek™ Supreme Ultra [CT], 3M) was placed, then dentinal lobes were created with a dentin shade composite (Filtek™ Supreme Ultra [B1B], 3M). Maverick color was then added for detail in the incisal edge, followed by an enamel layer of composite (Filtek™ Supreme Ultra [B1E], 3M).

Fig. 6

The full contour buildup of tooth No. 8 would act as a guide for the restoration of the remaining maxillary teeth to be treated.

Fig. 7

Pretreatment close-up photograph of the mandibular anterior teeth prior to establishing the new bonded incisal edges.

Fig. 8

A small groove was placed in the incisal edge of each tooth to be restored, as well as a beveled exterior edge, to enhance the bond strength and finishing ability.

Fig. 9

Once the teeth were prepared, an etchant (Select HV® Etch w/BAC, BISCO, Inc) was applied.

Fig. 10

A chlorhexidine solution (Consepsis™, Ultradent) was then applied to the preparations to help prevent hydrolysis degradation of the bonding agent.

Fig. 11

Next, a bonding agent (Prime & Bond® NT, Dentsply) was applied and cured.

Fig. 12

Composite (Filtek™ Supreme Ultra [B1B], 3M) was then carefully placed into the preparations and sculpted.

Fig. 13

A serrated saw (QwikStrip™, Qwikstrip) was used to adjust the proximal contacts and provide a clean path for flossing.

Fig. 14

Finally, the occlusion was checked, and the teeth were polished with a cup (Enhance® Dentsply Sirona).

Fig. 15

Maxillary occlusal view demonstrating the establishment of stable centric stops.

Fig. 16

Maxillary occlusal view demonstrating smooth transitions for laterotrusive and protrusive movements.

Fig. 17

At the end of the first appointment, the maxillary anterior composite veneers had the rough shape and form required, but the patient was instructed to test the newly proposed esthetic design and return for any necessary adjustments before final finishing.

Fig. 18

At the second appointment, the tertiary anatomy and line angles were further developed using finishing discs (Sof-Lex™, 3M), and a high shine polish was executed using polishing discs (Flexibuff®, Cosmedent) and paste (Enamelize™, Cosmedent).

Fig. 19

Posttreatment smile photograph of the completed minimally invasive smile transformation with composite resin demonstrating a stable occlusal scheme.

Fig. 20

© 2024 Conexiant | Privacy Policy