Looking at the past, the most frequent concerns related to dentistry were healthy teeth and a correct smile.
The demand for aesthetics and conservative dentistry has increased significantly in the last decade due to patient desires. Nowadays aesthetics matters, perfect smiles are a must and it is proven that they influence the patient’s self-esteem and psychosocial wellbeing .
Based on scientific statistics and clinical data, direct stratification composite veneers offer a valid solution for aesthetics rehabilitation in the anterior region.
Less expensive than a traditional ceramic solution, direct stratification of composite veneers can be performed in a single session treatment and can be modified during the stratification process to meet patients’ needs.
Additionally, the evolution of standard and nano-filled composites leads to improved mechanical properties and wear resistance .
A recent meta-analysis of prospective studies on anterior composite restorations showed a median overall estimated survival of 84.6% after 5 years of clinical service .
Most common complications related to direct stratification composite veneers are fracturing, caries, staining, colour deterioration and change of surface roughness . However, the easy repairing properties of composite materials may solve these complications. Furthermore, direct restorations do not need enamel roughening, as etching with phosphoric acid is enough to improve bond strength.
Direct stratification composite veneers consist in the direct application of one or more layers of composite resin directly on the tooth structure. The composite is then sculpted to correct colour and shape defects, allowing aesthetics restoration to be generally accomplished in a single appointment .
Different tools can be used to restore the correct shape and the emergency profiles of anterior teeth. Until today, the most common procedure for restorations with direct stratification composite veneers consisted in the restoration of interproximal and cervical margins in two different steps, using respectively two posterior matrices for the interproximal margins and a matrix band cut to a specific shape for the restoration of the cervical area.
In this case study, we decided to use the new anterior matrix Unica anterior from Polydentia, as it simplifies the procedure allowing to directly restore the whole emerge profile, cervical and interproximal margins, in a single step.
Employing this new matrix, the tooth’s surfaces are first prepared and cleaned to accommodate the composite veneer.
The matrix is then positioned on the teeth and fixed in place. Usually, plastic or wooden wedges can be used to ensure a proper fixing of the matrix. As an alternative, e.g. in case of wide class III restorations where the wedge placement could compromise the interproximal profile by collapsing the matrix into the cavity, a liquid dam (e.g. Polydentia myCustom Resin) can be a valid alternative to hold the matrix in place.
Composite stratification is then performed: first of all, the emergency profile is restored followed by palatal walls modelling. A rough tooth morphology is then reconstructed with the application and sculptured with one or more layers of composite.
The final shape of the tooth is then contoured using burs, abrasive discs and polishing appliances.
The patient, 52 years old woman, came to our attention discontent with her smile.
She presented maxillary anterior teeth with an inadequate anatomy and a fractured on incisor 11.
The clinical examination revealed caries free teeth and satisfactory oral hygiene.
After anamneses and clinical examination, we decided to proceed with 4 direct composite veneers on all central and lateral incisors using a fully adhesive and additive technique with minimal preparation.
The following case studies illustrate the direct composite veneering procedure using the new matrix Unica anterior from Polydentia.
Thanks to the evolution of composites materials, direct stratification composite veneers are nowadays a valid, quick and less expensive solution for aesthetics rehabilitation in the anterior region. Successful aesthetics and functional results are nevertheless strongly dependent on the operators understanding of adhesive processes and sculpting ability.
Different tool and procedures can help the clinician correctly restoring the emergency profile; among these, the new Unica anterior matrix stands out because of its simplicity and versatility, allowing to quickly and easily restore both cervical and interproximal profiles at the same time, strongly reducing the chair time, and bringing aesthetics restorations within everyone’s reach.