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Inside Dentistry
December 2021
Volume 17, Issue 12
Peer-Reviewed

Replacing Worn Composite Restorations With Porcelain

Conservative approach maintains tooth structure while improving dentofacial esthetics

Amanda Seay, DDS

Finding appropriate treatment options that fulfill patients' functional and esthetic goals while working within their personal budgets is a challenge that clinicians face every day.

The young female patient who presented in this case had suffered from undiagnosed acid reflux for many years, which resulted in the development of erosive facial lesions on her maxillary teeth. More than 10 years prior, they had been covered with composite. Although the composite maintained her risk prognosis and prevented further loss of enamel, the material displayed some pitting from chemical and mechanical wear that had occurred over the years. After presenting treatment options, the decision was made to replace the composite material with porcelain in a manner that would avoid any further preparation. The erosive lesions on the patient's lower arch would be covered with composite utilizing the injection mold technique in a transitional bonding approach.

First, a smile design was completed to determine where the teeth belonged within the framework of the face and lips. The centrals would need to be lengthened in order to create a more pleasing smile curve. To fill the buccal corridor, it would have been ideal to extend the span of porcelain restorations to the second premolar or first molar; however, to meet the financial treatment goals of the patient, the decision was made to work with only the teeth that had suffered significant loss of enamel volume. The resulting treatment plan involved placing porcelain restorations on teeth Nos. 5 through 12 with the goal of filling the buccal corridor as much as possible until she was ready to add prepless veneers to her second premolars and molars in the future.

Although the patient demonstrated acceptable function, over the years, the chemical wear had outpaced the mechanical wear, which created areas of deep dentin exposure.

About the Author

Amanda Seay, DDS
Fellow
American Academy of Cosmetic Dentistry

Director of Outreach and Engagement
Seattle Study Club

Clinical Instructor
Kois Center
Seattle, Washington

Private Practice
Mount Pleasant, South Carolina

Pretreatment smile photograph showing composite veneers that were placed more than 10 years ago to cover facial erosive lesions.

Fig. 1

Retracted maxillary view showing the pitting of the composite surfaces that had developed in the presence of low pH and abrasion over time.

Fig. 2

Pretreatment full-face photograph with teeth apart showing how the chemical and mechanical wear of the teeth resulted in a loss of central incisor length and, subsequently, a reverse smile curve.

Fig. 3

A template of the new smile design against the existing dentition reveals the additive approach that will be used.

Fig. 4

A series of burs (KS1 Diamond, Brasseler; ET6 Carbide, Brasseler) was used to remove the composite restorations while maintaining the structural integrity of the teeth. The natural color of the maxillary teeth is the same as the opposing teeth because no additional tooth structure was removed.

Fig. 5

Provisional restorations (Luxatemp®, DMG America), which were designed to fill the buccal corridor, were fabricated and luted to teeth Nos. 5 through 12 with a flowable composite (LuxaFlow™, DMG America).

Fig. 6

Floss indentation was used to evaluate and verify the esthetics of the tissue levels.

Fig. 7

Acquiring a full-face smile photograph with the provisional restorations in place is essential to evaluate the dentofacial esthetics.

Fig. 8

A 12 o’clock view permits analysis of any transverse discrepancies and the incisal edge position within the framework of the lips.

Fig. 9

Rubber dam isolation (Dental Dam, Nic Tone; HYGENIC® Brinker Clamps, Coltene) was achieved for the insertion of two restorations at a time.

Fig. 10

Protecting the adjacent teeth from the etching (Select HV® Etch, BISCO) and bonding (Adhese® Universal VivaPen, Ivoclar Vivadent) protocol was accomplished with Tofflemire matrix bands (HO Bands™, HO Dental Company), but PTFE tape can also be used.

Fig. 11

Each time that two restorations (Amber® Press, HASS BIO America) were seated, all of the excess cement (Variolink® Esthetic [Neutral], Ivoclar Vivadent) was removed, and the next pair of restorations was tried in to verify complete seating.

Fig. 12

After all of the restorations were delivered, the interproximal areas of the dam were cut to convert it into a split dam and allow for the final cleanup of the margins.

Fig. 13

Note the amount of crevicular fluid that was present once the interproximal areas of the dam were released.

Fig. 14

Posttreatment smile photograph of the porcelain restorations achieving a more natural smile curve and fuller buccal corridors.

Fig. 15

Posttreatment right lateral photograph showing how the teeth now fill the framework of the lips much better than before.

Fig. 16

In this posttreatment left lateral photograph, the amount of buccal volume added can be visualized by the difference between tooth No. 13, which is untreated, and tooth No. 12, which has the veneer.

Fig. 17

It is important to maintain the tissue levels to achieve appropriate pink and white esthetics.

Fig. 18

Final full-face portraits capturing unrestrained facial expressions that demonstrate the lip dynamics and the impact of the treatment on the dentofacial esthetics. After the patient had waited 15 years for the smile of her dreams, we were able to fulfill her esthetic and functional goals.

Fig. 19

Final full-face portraits capturing unrestrained facial expressions that demonstrate the lip dynamics and the impact of the treatment on the dentofacial esthetics. After the patient had waited 15 years for the smile of her dreams, we were able to fulfill her esthetic and functional goals.

Fig. 20

Amanda Seay, DDS

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