Assessing aesthetic composite veneer placement via digital photography.

Restoring teeth using direct composite veneers can be quite challenging for a clinician. Achieving natural color blending, masking dark teeth, removing decay, and providing a natural finish require meticulous placement with various composite opacities and shades. Critical self-evaluation using digital photography, documentation, and follow-up visits to perform veneer enhancements are critical to ensure an aesthetic outcome. This article will demonstrate how digital photography is used to achieve an aesthetic result in the placement of eight direct resin veneers.     

Direct resin composite veneers: masking the dark prepared enamel surface.

A technique for manufacturing direct resin composite veneers is presented. Described are the advantages of using an acrylic resin matrix, made before the preparation is begun, to copy anatomic details. An additional step to mask previously prepared dark enamel with opaquers is also described. The advantages and limitations of the procedures are discussed.     

Treatment of an amelogenesis imperfecta with restorations prepared using a modified clear matrix technique

The rehabilitation of a patient with amelogenesis imperfecta (AI) from both functional and esthetic standpoints represents a challenge. A number of treatment options have been proposed. Recently, the use of adhesive restorations has gained popularity because of the improved physical properties of these materials. This article describes a treatment with direct resin composite for the restoration of teeth affected by the hypomature type of AI. A modified clear matrix technique was used during the preparation and restoration process. The use of the technique provides clinicians with reduced chair time, and the matrix can be repeated when needed; restorations can be performed relatively quickly with a minimal post‐operative finishing process. This article highlights the use of direct‐bonded resin composites providing satisfactory esthetics and function in restoring AI‐affected teeth.     

Esthetic rehabilitation of avulsed–replanted anterior teeth: a case report

Abstract –  Avulsion is a complex injury affecting the pulp, periodontal ligament and the alveolar bone. Avulsed permanent teeth can survive following replantation. However, post-traumatic external root resorption eventually resulting in loss of the traumatized tooth is a frequent finding. After replantation of the avulsed teeth, esthetic requirements can be needed. Treatment options include porcelain laminate veneers, metal-ceramic restorations and all-ceramic crowns as well as minimally invasive procedures such as direct resin composite bonding. This article describes the restoration of avulsed and replanted teeth with direct resin composite laminate veneers. Because of the fact that lost fragments were recovered with the loss of anterior esthetic, and bearing in mind the patient's psychologically affected, we considered direct resin composite laminate veneer restoration of the avulsed and replanted teeth as the best therapeutic option. The patient was satisfied with the final result.     

Direct placement restorative materials for use in posterior teeth: the current options

The purpose of this paper is to provide guidelines to assist in the selection of dental materials for restoring posterior teeth in adolescents. Currently, amalgam is still the best plastic restorative material for some Class I cavities, and for Class II cavities and all multi-surface restorations. Tooth-coloured materials are preferred by some patients and dentists, however these alternatives are more technique sensitive than amalgam. Composite resin is the most common direct placement alternative to dental amalgam, providing patients with relatively low cost, tooth-coloured restorations. However, composite resins have limited indication, their placement is more time-consuming than for amalgam, cost-benefit considerations are a concern, difficulty in obtaining a marginal seal persists and there are few long-term studies published in the peer reviewed scientific literature. The literature currently supports the use of composite resin for the restoration of a limited range of Class I and Class II cavities. Composite resin restorations are not recommended for MOD or other multi-surface restorations. In selected clinical situations, fissure sealants, preventive resin restorations and glass ionomer cement are also appropriate materials to use to restore posterior teeth. Fissure sealants, when properly maintained, can play a significant role in the prevention and control of dental caries in pits and fissures in primary and permanent teeth. Preventive resin restorations should be placed to restore deep pits and fissures with incipient caries and/or developmental defects in primary and permanent teeth. Glass ionomer cement may be used for restoring Class V cavities where appearance is not the primary concern, for conservative Class III cavities, and as a provisional restorative material. It is not recommended for Class II or IV restorations.     

A single-appointment,definitive post-crown restoration: a case report

The marked advances made in restorative materials have allowed dentists to explore new techniques in restoring teeth. This paper describes a method of restoring extensively damaged endodontically treated teeth that are using the LightPost system and composite resin to build-up the broken crown directly. The treatment was completed in a single visit. Applying this direct technique in selected cases can simplify treatment planning and result in an acceptable restoration with pleasing aesthetics.     

A simplified technique for fabricating esthetic cast metal occlusal surfaces for dentures

This article describes a simplified method for making esthetic cast metal occlusal surfaces. Monoplane posterior acrylic resin block teeth, cast in a nickel-chrome alloy, are coated with silane and an esthetic composite resin veneer is applied to the buccal surface. These veneered posterior metal teeth are incorporated in the wax setup and the dentures are processed and finished. The dentist's routine technique for delivering dentures to the patient can be followed.     

Direct posterior composite resin restorations: A review. 1. Factors influencing case selection

The principal factors that influence case selection for direct composite resin restorations in posterior teeth are discussed. These include the perceived preference for tooth-coloured aesthetics, survival rate and replacement of posterior composites, clinical problems and concerns such as occlusal surface defects and the numerous effects of the material's polymerization contraction, and the availability of alternative tooth-coloured techniques for restoring posterior teeth. Specific guidelines in case selection are suggested. A subsequent paper reviews controversial aspects of the restorative technique for posterior composites and, on this basis, defines important principles in the clinical technique.     

Surface resistance to abrasion of preformed laminate resin veneers

Preformed laminate resin veneers should be adapted closely to the teeth to reduce the thickness of the composite layer. Minimal voids at the composite, veneer, and tooth junctional margin will result. Composite resins are difficult to finish, but laminate veneer can be highly polished. Poorly finished veneer surfaces appear to abrade to a smoother surface with toothbrushing while poorly finished composite surfaces remain rough. To reduce material loss from abrasion, the veneer restoration should be highly polished. Polishing the veneer at the gingival margin is particularly important to gingival health. Only rough veneer surfaces will be improved by toothbrushing abrasion. Special instructions should be given to patients with laminated veneers to reinforce proper oral hygiene and to discourage use of highly abrasive dentifrices. Continued monitoring of plaque accumulation should minimize problems related to oral hygiene.     

Techniques for achieving realistic color distribution in large composite resin restorations

A technique of using macrofilled and microfilled composite resins in conjunction with tints and opaquers has been described. The technique achieves a more realistic color distribution in large composite resin restorations, such as Class IV restorations, diastema closures, veneers, and large Class III restorations. In placing more natural distributions of color in composite resin restorations, a more pleasing appearance can be achieved.     

不同树脂粘结剂对ZrO_2瓷贴面修复模拟四环素牙颜色的实验研究

目的：研究不同颜色的树脂粘结剂对ZrO2瓷贴面修复两种程度的四环素牙颜色的影响,为临床提供依据。方法：使用CM700d/600d分光测色计测量不同颜色的树脂粘结剂对ZrO2瓷贴面修复两种四环素牙颜色的影响,采用国际照明委员会（CIE）1976L＊a＊b标准色度系统进行评价。结果：使用不同颜色树脂水门汀粘接瓷贴面修复模拟四环素基牙,粘接后黏结前后瓷贴面试件表面的L＊、a＊、b＊值之间有统计学差异（P〈0.05）。深灰色背景的四环素牙用Kerr NX3白色光固化树脂水门汀对修复体的色彩的效果较好,而浅灰背景的四环素牙用SDI A1双固化树脂水门汀能更好的体现修复体的最终的修复效果。结论：ZrO2全瓷贴面可以改善四环素牙的颜色,但修复后最终的颜色易受基牙影响,所以应根据四环素牙的不同程度来选择合适的的树脂粘结剂。     

Comparison of microleakage between direct placement technics and direct inlay technics

Laboratory studies have indicated that improvements in the physical properties of composite restorations, especially for posterior teeth, may be obtained if these materials underwent heat treatment prior to insertion. The purpose of this study was to compare the microleakage in Class II restorations ending on cementum/dentine when these preparations were restored by a direct placement composite resin as opposed to a direct inlay composite resin. Thirty-six human posterior mandibular teeth were used in this study and randomly divided into three equal groups; Group I was prepared and restored with the composite Ful-fil in a direct placement technique. Groups II and III were prepared and restored using a direct composite resin inlay technique. The material used in Group II was Brillant D.I.; that of Group III, Ful-ful. All preparations terminated 1.0 mm apical to the CEJ. The composite resin patterns of Groups II and III were oven-tempered before cementing with D.I. Duo Cement. Specimens were thermocycled 125 times between 5-55 C. Microleakage was noted cervically on a scale of 0 to 5. The composite Ful-fil, used as a direct placement material, exhibited less leakage (P less than 0.05) than either the Brillant D.I. composite or Ful-fil composite when these materials were placed as direct composite inlays.     

Clinical management of non-carious enamel defects

Enamel defects not caused by decay may occur singly or may be generalized over the entire tooth surface. In the past, treatment of these aesthetic problems required large cavity preparations or full crown coverage of the affected teeth. Now, with the advent of various resin restorative materials capable of bonding to enamel, new techniques are being developed which are less radical. By etching the surface of the enamel with varying concentrations of dilute phosphoric acid, sufficient porosity is produced to allow the resin to adhere to it. Thus, by removing a minimal amount of tooth structure, the affected area can be masked with a thin layer of resin material after the surface has been properly prepared. If the fault in the enamel is generalized, the whole surface of the tooth may be restored using this technique, effectively covering the tooth with an aesthetic veneer. The new resin filling materials offer good colour stability as well as resistance to abrasive wear. Tests have revealed that this mode of treatment has a successful retention rate of over 92 per cent after 5 years. Lightly discoloured or stained defects of the enamel may be treated by bleaching the affected area with no adverse effect on the pulp tissue. Those teeth not improved by bleaching can be conservatively managed by veneering their surfaces with smooth finishing plastic materials.     

Composite or amalgam? Not a black or white decision

Amalgam as a restorative material in dentistry is discussed because of believed toxic properties of the material, yet there is no scientific prove for the assumption. Adhesive restorations are a possible alternative for amalgam in restoring posterior teeth. For treatment of primary caries, the direct composite resin restoration has many advantages. When greater defects are to be restored, adhesive composite resin restorations become less favourable. At this moment no long term results are available for indirect adhesive techniques. For the time being it seems necessary to use composite resin as well as amalgam for the restoration of posterior teeth.     

A polychromatic composite layering approach for solving a complex Class IV/direct veneer/diastema combination: Part II.

Restoration of a Class IV defect in the aesthetic zone in combination with a direct resin veneer can be a considerable challenge for clinicians, especially when striving to emulate the natural dentition. Shade-matching is a particular concern in achieving a natural-looking aesthetic result. Value enamels can also be used over selective areas of a Class IV restoration as needed to modify the perception of the chroma of underlying layers of artificial dentin and body enamel. This second and concluding part provides a discussion of how an advanced polychromatic composite layering technique can be used to meet the patient's aesthetic expectations.     

The use of a direct bonded microfilled composite resin veneer

This technique creates a direct bonded microfilled composite resin veneer that replicates the complex color distribution and surface texture of the natural tooth structure. Duplicating the complexity of natural tooth color can be repeated by recording the different layers of color used in their sequence of placement.     

Maximizing esthetic results in posterior restorations using composite opaquers

After removal of caries or a faulty existing restoration in a posterior tooth, frequently the pulpal floor is a dark substrate. Composites are translucent by nature, and even the more opaque shades transmit nearly 60% of visible light, meaning that composites require a certain thickness to maintain their intended shade, especially if the underlying substrate is particularly dark. Depending on the intensity of the dark substrate, even relatively thick composite restorations may not be capable of disguising the discolored dentin underneath. The substrate absorbs a significant part of the light that would otherwise reflect toward the occlusal surface, and the restoration has a nonvital monochromatic grayish color. Opaquers and tints (color modifiers) may be extremely useful to overcome this situation. In this study, composite restorations were placed in extracted teeth to demonstrate that the final esthetic results rely upon the optical properties of the background as well as those of the composite material itself. Preparations with simulated dark pulpal floors were restored without the use of opaquers and tint modifiers. After tooth hydration, the final shade was recorded with photographs. The restoration was removed and a new restoration was placed, but this time with a technique involving opaquer and tints. This article compares and discusses the outcomes of these two procedures.
CLINICAL SIGNIFICANCE
This demonstration shows a simple technique that can help dentists obtain predictable esthetic results in their daily practice with posterior composite restorations.     

Human enamel veneer restoration: an alternative technique to restore anterior primary teeth

Restoration of severely decayed primary teeth is a clinical challenge in Pediatric Dentistry. Among the restorative treatment options, the use of prefabricated crowns and resin composite restorations, either by means of direct or indirect techniques is mentioned in the literature. The purpose of this article is to describe the rehabilitation of primary anterior teeth in a 5-year-old patient. Dental treatment consisted on an anterior space maintainer prosthesis made with natural primary teeth, plus human dental enamel veneer (facet) restorations. The advantages of this technique are better esthetics and the natural enamel has physiologic wear and offers superficial smoothness and cervical adaptation compatible with those of the surrounding teeth.     

The effectiveness of opaquer and color-modifier materials: a laboratory study

New, direct bonding composite resin products are available for esthetic and restorative dentistry. As in vitro study was conducted to evaluate the stain-masking effectiveness of 57 opaquers or color modifiers. Results of the testing on 265 specimens are reported, ranging from minimal to excellent masking.     

An innovative direct technique for resin composite veneers for teeth with color alterations.

An alternative technique for fabricating resin composite veneers for teeth with color alterations is presented. The technique is based on research carried out with a silica derivative (coesite). The veneer is applied directly to the mouth. The objective of the technique is to provide greater translucence to the teeth, resulting in a better imitation of the natural appearance.