Streamlining Layered Composite Veneer Procedures
Inside Dentistry provides the latest in endodontics, implantology, periodontics, and more, with in-depth articles, expert videos, and top industry insights.
January 1, 2024
Volume 20, Issue 1, January 2024
Page(s): p. 32
Sandra Hulac, DDS
The delivery of no-preparation direct composite veneers is an immensely popular treatment approach in everyday dental practice. For younger patients, they often constitute the most singularly prudent choice to achieve an esthetic outcome. Moreover, an increasing number of adult patients are gravitating toward this noninvasive treatment, which may be a result of cautionary tales circulating online about mishaps involving porcelain veneers with excessive tooth preparations and subsequent costly corrective measures.
The execution of layered composite veneers that demonstrate the highest esthetic value demands a substantial amount of practice. Even seasoned practitioners of the technique acknowledge that, despite years of experience, a case involving ten units can still occupy a significant portion of their workday. As an alternative, a method of placing direct composite veneers using an injection molding technique with flowable composite has gained notable popularity. This approach markedly reduces the chairside time required for composite veneer procedures. Unfortunately, although the esthetic outcomes of injection-molded composite veneers are commendable, they lack the nuanced color variations exhibited by layered composite veneers. Furthermore, some practitioners have noted that certain flowable composites exhibit low color value when used in the injection molding method.
By beginning with a traditional composite layering technique and then applying the final layer to multiple teeth at once with the aid of a transparent matrix derived from a wax-up, the composite veneering process can be significantly expedited without any compromise to the esthetic result. This approach can modify zones of light reflection, manipulate and highlight lengths or widths, and ultimately yield a transformed perception of the appearance of the teeth. It is particularly advantageous in cases with difficult space distribution, where the precise placement of line angles and secondary anatomy is of paramount importance. In addition, another advantage of the procedure is the reduction of surface irregularities that often result from the freehand application of the final layer and require time-consuming corrections.
Ideally, the wax-up is created by the dentist to ensure comprehensive control over the outcome; however, a dental technician can also carry out this task using analog or digital methods. Similar to the injection molding technique, two matrices are fabricated per arch to enable a time-efficient "alternating tooth" strategy. In this strategy, the first matrix is loaded with composite to simultaneously apply the final layers to half of the treated teeth (ie, every other tooth), and then the second matrix is used to apply the final layers to the remaining teeth. These matrices are cut to permit greater ease in the "pressing on phase," facilitate easier removal of any excess composite, and to permit the placement of a split dam for moisture control.
This case demonstrates the esthetics that can be achieved using this technique, which, based on the practitioner's experience, can reduce chairside time by approximately 40%.
Sandra Hulac, DDS
Fellow
American Academy of Cosmetic Dentistry
Private Practice
Hong Kong, China
