Fractured incisors: a judicious restorative approach--part 1

AIM: To consider different conservative options in the literature to restore fractured anterior teeth. MATERIALS AND METHODS: Only anterior tooth fractures not involving the pulp were considered, without limitation on age. Treatment options were chosen depending on the clinical situation of patients at first visit. The authors considered 15 cases each of: reattachment; porcelain veneers; direct composites. RESULTS AND CONCLUSIONS: The techniques analysed were revealed to be valid during the period of observation. No failures were recorded with vital teeth keeping their vitality and no radiographic signs of apical or root pathology. With reattachment, two cases have shown the visibility of fracture line after 2 years, depending on the angle of light incidence on the tooth surface. For direct restorations, three adult cases have shown partial discolouration at 24, 28 and 40 months. No fractures or debonding have occurred among porcelain veneers. The authors suggest, whenever possible, to utilise the reattachment technique. Direct restorations are suitable for young patients: they have a higher chance of sustaining further trauma than adults, and composites have a favourable failure mode compared to ceramics. In adults, where long-lasting restorations are needed, restoration with porcelain veneers is the treatment of choice.     

Fractured incisors: a judicious restorative approach--Part 2

AIM: To consider different conservative options in the literature to restore fractured anterior teeth. MATERIALS AND METHODS: Only anterior tooth fractures not involving the pulp were considered, without limitation on age. Treatment options were chosen depending on the clinical situation of patients at first visit. The authors considered 15 cases each of: reattachment; porcelain veneers; direct composites. RESULTS AND CONCLUSIONS: The techniques analysed were revealed to be valid during the period of observation. No failures were recorded with vital teeth keeping their vitality and no radiographic signs of apical or root pathology. With reattachment, two cases have shown the visibility of fracture line after two years, depending on the angle of light incidence on the tooth surface. For direct restorations, three adult cases have shown partial discolouration at 24, 28 and 40 months. No fractures or debonding have occurred among porcelain veneers. The authors suggest, whenever possible, to utilise the reattachment technique. Direct restorations are suitable for young patients: they have a higher chance of sustaining further trauma than adults, and composites have a favourable failure mode compared to ceramics. In adults, where long-lasting restorations are needed, restoration with porcelain veneers is the treatment of choice.     

Bonding porcelain laminate veneer provisional restorations: An experimental study.

STATEMENT OF PROBLEM: Minimal tooth preparation is required for porcelain laminate veneers, but an interim restoration is anticipated by patients to protect their teeth against thermal insult, chemical irritation, and to provide esthetics. Cement remaining after the removal of the provisional restoration can impair the etching quality of the tooth surface and the fit and final bonding of the porcelain laminate veneer. PURPOSE: This in vitro study inspected the tooth surface for remaining debris from cement after removal of a provisional restoration. MATERIAL AND METHODS: Seventy-two extracted natural anterior teeth were prepared for porcelain laminate veneers. For half of the teeth, the smear layer was removed before luting provisional restorations. Veneer provisional restorations were fabricated and luted to teeth with 3 bonding methods: temporary eugenol-free cement, spot etching combined with dual-curing luting cement, and polyurethane adhesive combined with dual-curing luting cement. After removal of provisional restorations 1 week later, the tooth surface was examined for residual luting material with an SEM. RESULTS: Traces of cement debris were found on provisionally prepared teeth for all 3 material methods. CONCLUSION: The use of polyurethane adhesive combined with the dual-curing cement revealed significantly less teeth with debris than the other methods. This difference was less distinct when the smear layer was removed.     

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.     

Minimally invasive porcelain veneers: indications for a conservative esthetic dentistry treatment modality

Patients have many restorative options for changing the appearance of their teeth. The most conservative restorative treatments for changing the appearance of teeth include tooth bleaching, direct composite resin veneers, and porcelain veneers. Patients seeking esthetic treatment should undergo a comprehensive clinical examination that includes an esthetic evaluation. When selecting a conservative treatment modality, the use of minimally invasive or no-preparation porcelain veneers should be considered. As with any treatment decision, the indications and contraindications must be considered before a definitive treatment plan is made. Long-term research has demonstrated a 94% survival rate for minimally invasive porcelain veneers. While conservation of tooth structure is important, so is selecting the right treatment modality for each patient based on clinical findings.     

Integration of composite and ceramic restorations in tetracycline-bleached teeth: a case report

The success of an esthetic rehabilitation depends on the understanding of the patient's need and expectation. The management of patients with moderate to severe tetracycline-stained teeth is very challenging. Tooth whitening may be a valid alternative to more aggressive treatments; however, patients should be aware of the limitations of tooth whitening therapy. Clinicians may select differing treatment plans; tooth whitening can improve intrinsic discoloration in a way so that no further treatment is required. Once tooth whitening is completed, direct or indirect restorative procedures may be afforded to match the existing restoration with the bleached tooth structure. This article describes a conservative clinical approach to rehabilitate the smile of a patient with moderate to severe tetracycline-stained teeth using a combination of tooth whitening and direct composite and indirect porcelain restorations in the maxillary anterior segment. CLINICAL SIGNIFICANCE: The combination of tooth whitening and adhesive restorations allows clinicians a significantly more conservative approach to intrinsically stained teeth; tooth preparation for porcelain veneers and porcelain-fused-to-metal and full-ceramic crowns can be restricted to conditions in which persistent tooth discoloration or significant loss of both dentin and enamel exists.     

小瓷贴面在上前牙切角缺损修复中的应用

目的:采用小瓷贴面修复上前牙切角的小面积牙体缺损,对其治疗效果进行评估。方法:上切牙切角小面积牙体缺损患者9例,涉及患牙9颗,其中上中切牙8颗,上侧切牙1颗,根据个体牙体缺损的大小进行牙体预备,要求牙体预备的范围达缺损区域以外约2mm,常规制作IPS-EmpressII小瓷贴面,常规粘结。修复治疗完成后进行了12-24个月的临床追踪观察,检查基牙与贴面边缘密合度、边缘着色、修复体颜色、解剖形态、有无修复体周围龋及修复体有无折裂。结果:在12-24个月的观察期中,全部修复体各项检查指标都未发现异常,修复效果良好。结论:在严格选择适应证的前提下,小瓷贴面可以做为上切牙小面积切角缺损的有效治疗方法。     

Cumulative effects of successive restorative procedures on anterior crown flexure: intact versus veneered incisors.

OBJECTIVE: When successive restorative procedures (e.g., porcelain veneers, interdental resin composite restorations, and endodontic treatment) are carried out on the same tooth, significant effects on crown flexure can be expected. METHOD AND MATERIALS: Dentin-bonded porcelain veneers (experimental group) were assessed in vitro using functional and cyclic thermal loads. They were compared to natural teeth (control group) with respect to 2 parameters: coronal flexure (investigated using experimental strain gauges) and morphology of the tooth-restoration interface (scanning electron microscopic evaluation). For both veneered and natural teeth, crown deformation was recorded at 5 sequential experimental steps: intact tooth (baseline), Class III cavities, Class III resin composite restorations, endodontic treatment, and endodontic restoration (without posts). RESULTS: No significant differences in crown flexure were found between natural and veneered incisors when compared across experimental steps. The main effect for experimental steps was highly significant. When averaged across all specimens (natural and veneered teeth), the endodontic treatment step resulted in the highest crown flexure (1.55x the baseline value). The unrestored Class III cavities and the endodontic restoration were next highest (1.30x and 1.28x the baseline value, respectively). The lowest crown flexures were found after restoration of the Class III cavities (1.13x the baseline value). No measurable microleakage or gaps were detected at the ceramic-resin, resin-enamel, or resin-dentin interfaces (Optibond FL, Kerr). CONCLUSION: Each subsequent reduction in tooth structure resulted in a substantial increase in crown flexibility, even after restoration. Endodontic procedures were responsible for most of the loss in crown stiffness. Extensive proximal cutting and restorations seemed to minimally affect crown flexure. Porcelain veneers showed perfect biomimetic behavior, because cumulated restoration procedures had the same effect on natural and veneered incisors.     

Porcelain veneers: a review of the literature

OBJECTIVES: Porcelain veneers are steadily increasing in popularity among today's dental practitioners for conservative restoration of unaesthetic anterior teeth. As with any new procedure, in vitro and in vivo investigations are required to assess the ultimate clinical efficacy of these restorations. The current literature was therefore reviewed in search for the most important parameters determining the long-term success of porcelain veneers. DATA SOURCES: Laboratory studies focusing on parameters in prediction of the clinical efficacy of porcelain veneers such as the tooth preparation for porcelain veneers, the selection and type of the adhesive system, the quality of marginal adaptation, the resistance against microleakage, the periodontal response, and the aesthetic characteristics of the restorations have been reviewed. The clinical relevance of these parameters was then determined by reviewing the results of short and medium to long-term in vivo studies involving porcelain veneers performed during the last 10 years. CONCLUSIONS: The adhesive porcelain veneer complex has been proven to be a very strong complex in vitro and in vivo. An optimal bonded restoration was achieved especially if the preparation was located completely in enamel, if correct adhesive treatment procedures were carried out and if a suitable luting composite was selected. The maintenance of aesthetics of porcelain veneers in the medium to long term was excellent, patient satisfaction was high and porcelain veneers had no adverse effects on gingival health inpatients with an optimal oral hygiene. Major shortcomings of the porcelain veneer system were described as a relatively large marginal discrepancy, and an insufficient wear resistance of the luting composite. Although these shortcomings had no direct impact on the clinical success of porcelain veneers in the medium term, their influence on the overall clinical performance in the long term is still unknown and therefore needs further study.     

An indirect veneer technique for simple and esthetic treatment of anterior hypoplastic teeth

This study describes a technique for treating anterior hypoplastic teeth using indirect nanocomposite veneer restoration. The prime advantage of an indirect veneer technique is that it provides an esthetic and conservative result. One of the most frequent reasons that patients seek dental care is discolored anterior teeth. Although treatment options such as removal of surface stains, bleaching, microabrasion or macroabrasion, veneering, and placement of porcelain crowns are available, conservative approach such as veneer preserves the natural tooth as much as possible. Full veneers are recommended for the restoration of localized defects or areas of intrinsic discoloration, which are caused by deeper internal stains or enamel defects. Indirectly fabricated veneers are much less sensitive compared to a operator's technique and if multiple teeth are to be veneered, indirect veneers can be usually placed much more expeditiously. Indirect veneers last much longer than the direct veneers. Therefore, indirectly fabricated veneers are more advantageous than directly fabricated veneers in many cases.     

Clinical and scanning electron microscopic assessments of porcelain and ceromer resin veneers.

PURPOSE: Recently available Ceromer resin materials are promising for fabrication of esthetic anterior laminates and provices an alternative, cost effective treament modality to porcelain laminates for discolored anterior anterior teeth. It was proposed to study the esthetic quality and surface finish of veneers fbricated from ceromer resin and compare it with the standard porcelain veneers, both clinically as well as by scanning electron microscope (SEM) at baseline and at 12 months. If found comparable, ceromer resin veneer could provide an alternative to porcelain veneers which is an expensive technique for a developing country like India. MATERIALS AND METHODS: Seventy-two veneers, 36 porcelain and 36 ceromer were placed in 12 subjects who were studied at 0, 6 and 12 months for clinical acceptability, and at 0 and 12 months for SEM assessment. The restorations were luted with Opal luting composite and Scotchbond multipurpose system; polyvinyl siloxane was used as the impression material. The clinical assessment was made using modified United Public Health Services criteria, whereas the SEM assessment was made by quantitative analysis of the marginal fit and surface characteristics of the two veneering materials. RESULTS: Ceromer exhibited good anatomical form during the study period, but depicted changes in color, surface appearance, marginal adaptation, increased marginal discoloration, and tissue response. Inability to achieve a good finish with high gloss was a major drawback of the ceromer. Porcelain exhibited better esthetics, marginal adaptation, finish qualities, and tissue response. The SEM showed good to excellent marginal fit at baselinne in ceromer and porcelain veneers, but loss of luting resin at the margins was evident in both the materials after 12 months, leading to visible gaps in a number of veneer restorations. Ceromer veneers exhibited poor surface characteristics in several restorations, which further degraded in an oral conditions over 12 months. CONCLUSION: Veneering is an effective mode of treating discolored teeth. Ceromer veneers exhibited deterioration of surface finish and increased marginal discolouration over a period of 12 months. Clinically ceromer veneers were less acceptable to the patients than porcelain veneers. Porcelain out-scored ceromer as a permanent mode of treatment for discolored teeth, as over a period of 12 months it yielded good clinical results in comparison to ceromer.     

Indirect Porcelain Veneer Technique for Restoring Intrinsically Stained Teeth

Indirect porcelain veneers are often the ideal restoration for intrinsically stained teeth. This article details a step-by-step procedure for esthetically restoring discolored teeth. Porcelain laminate veneers are often indicated when teeth bleaching or direct composite bonding procedures cannot provide the desired esthetic result. Veneers are more appealing to many patients than full coverage crowns because of the more conservative tooth preparation required. If technique details are followed meticulously and cases are appropriately selected, porcelain veneers are not only durable but also promote marvelous gingival health and may be the most esthetic anterior dental restoration.     

Indirect porcelain veneer technique for restoring intrinsically stained teeth.

Indirect porcelain veneers are often the ideal restoration for intrinsically stained teeth. This article details a step-by-step procedure for esthetically restoring discolored teeth. Porcelain laminate veneers are often indicated when teeth bleaching or direct composite bonding procedures cannot provide the desired esthetic result. Veneers are more appealing to many patients than full coverage crowns because of the more conservative tooth preparation required. If technique details are followed meticulously and cases are appropriately selected, porcelain veneers are not only durable but also promote marvelous gingival health and may be the most esthetic anterior dental restoration.     

A Study on Provisional Cements,Cementation Techniques,and Their Effects on Bonding of Porcelain Laminate Veneers

Minimal tooth preparation is required for porcelain laminate veneers, but interim restorations are a must to protect their teeth against thermal insult, chemical irritation, and to provide aesthetics. Cement remaining after the removal of the provisional restoration can impair the etching quality of the tooth surface and fit and final bonding of the porcelain laminate veneer. This in vitro study examined the tooth surface for remaining debris of cement after removal of a provisional restoration. Determine the presence of cement debris on prepared tooth surface subsequent to the removal of provisional restoration. Determine the cement with the least residue following the cleansing procedures. Determine the effect of smear layer on the amount of residual luting cement. Eighty-four extracted natural anterior teeth were prepared for porcelain laminate veneers. For half of the teeth, the smear layer was removed before luting provisional restorations. Veneer provisional restorations were fabricated and luted to teeth with six bonding methods: varnish combined with glass ionomer cement (GIC), varnish combined with resin modified GIC, varnish, spot etching combined with dual-cure luting cement, adhesive combined with GIC, adhesive combined with resin modified GIC, and adhesive, spot etching combined with dual-cure luting cement. After removal of provisional restorations 1 week later, the tooth surface was examined for residual luting material with SEM. Traces of cement debris were found on all the prepared teeth surfaces for all six groups which were cemented with different methods. Cement debris was seen on teeth subsequent to the removal of provisional’s. Dual-cure cement had the least residue following the cleansing procedures. Presence of smear layer had no statistical significance in comparison with cement residue. With the use of adhesive the cement debris was always found to be more than with the use of varnish. GIC showed maximum residual cement followed by dual-cure.     

IPS Empress铸瓷贴面修复上颌年轻恒切牙冠折的临床观察

目的:评价IPSEmpress铸瓷贴面修复上颌年轻恒切牙冠折的临床效果。方法:对冠折未露髓的上颌年轻恒切牙采用IPSEmpress铸瓷贴面修复后的临床效果观察2～3年。结果:31例患者共35颗牙齿瓷贴面修复,在观察期间瓷贴面完整无缺损,无边缘及表面着色,无继发龋,2颗与邻牙颜色有轻度颜色不调,3颗轻中度的牙龈炎症,其余与邻牙颜色协调,边缘适合性好,没有继发牙髓炎症。结论:用IPSEmpress铸瓷贴面修复年轻恒切牙冠折,可以快速恢复其外形和美观,最大可能地保护了牙体牙髓组织,不需待成年后二次修复。     

Longevity of composite restorations of traumatically injured teeth

PURPOSE: To evaluate clinically the long-term (7-year) behavior of resin-based composite restorations and original fragment reattachments. METHODS: From an initial number of 130 young subjects (8-18 years old), only 60 fulfilled the inclusion criteria and consented to the evaluation of long-term follow-up of their restorations. Out of a total of 90 injured teeth, 70 were treated with direct composite restorations, and 20 with the original fragment reattachment technique. These 90 teeth were divided according to traditional (Andreasen, Ellis) classifications and according to a new classification (Spinas-Piroddi). Then the restorations were examined according to a modified version of USPHS method during the 7-year follow-up. RESULTS: Three-year old composite restorations needed some kind of treatment (ranging from polishing to the replacement of the restoration); in the period between 3-5 years, all the restorations (belonging to all of the injury types) needed a complete replacement. The results indicated that a restoration can probably be replaced three or four times before the tooth shows severe reduction of its adhesive properties. Composites cannot be used for long-term restorations; if the subject has completed his growth, the mandatory therapeutic alternatives are prosthetic restorations (crowns, porcelain veneers).     

Porcelain laminate veneers. A retrospective evaluation after 1 to 10 years of service: Part I--Clinical procedure

PURPOSE: Currently available clinical studies on porcelain laminate veneers seem to support their use as a standard treatment method in modern restorative dentistry. The purpose of this study, which comprises 3 parts, was to evaluate the clinical applicability and the survival probability of porcelain laminate veneers for an observation period of up to 10 years. This first part of the study describes the step-by-step clinical procedure. MATERIALS AND METHODS: The reasons for provision of porcelain laminate veneers were mainly for the treatment of worn anterior teeth, surface enamel defects, intrinsic discolorations, and hypoplasia. As the treatment time for try-in, cementation, and finishing of veneers differs significantly from that needed for conventional restorations, the total time required for veneer treatment was evaluated. RESULTS: A total of 205 porcelain laminate veneers, 117 in the maxilla and 88 in the mandible, was placed in 72 patients (43 females and 29 males). Mean cementation time was 38.7 minutes, which increased significantly to 43.9 minutes if single discolored teeth were being restored. Clinical experience and a familiarity with the strict step-by-step procedure followed throughout the study reduced the mean treatment time from 40.8 minutes during the first 5 years to 36.7 minutes in the following years. CONCLUSION: The porcelain laminate veneer concept provides excellent esthetic and conservative restorations, but it should be stated that the cementation and finishing procedure is highly time consuming.     

The Use of Fragments of Thin Veneers as a Restorative Therapy for Anterior Teeth Disharmony: A Case Report with 3 Years of Follow-up

Aim: The present case report described the use of contact lens of thin porcelain veneers as a restorative therapy to solve anterior teeth disharmony. Background: Fragments of thin veneers are minimally invasive restorations with little or no dental preparation and present thickness ranging from 0.2 to 0.5 mm. They are used in case of diastema closure, small changes of teeth, color and restoration of teeth with small fractures. Case report: A 25-year-old man was admitted at a dental clinic complaining about the diastema presence on the upper anterior teeth. Patient was referred to an orthodontic treatment in order to provide better distribution of the diastemas and harmonious proportion of the teeth. Afterwards, contact lens of thin porcelain veneers were fabricated on the six upper anterior teeth. Conclusion: Based on the outcomes of this clinical report, we considered the use of fragments of thin veneers as a successful treatment option after 3 years of follow-up. Clinical significance: The fragments of thin veneers have been established to be an interesting alternative to esthetically restore the anterior teeth with minimal invasiveness. However, since it is a new treatment modality, longitudinal studies are necessary to understand the material's behavior. Keywords: Porcelain, Dental contact lens, Diastema, Oral rehabilitation, Dental esthetic, Clinical case. How to cite this article: Okida RC, Filho AJV, Barao VAR, dos Santos DM, Goiato MC. The Use of Fragments of Thin Veneers as a Restorative Therapy for Anterior Teeth Disharmony: A Case Report with 3 Years of Follow-up. J Contemp Dent Pract 2012;13(3):416-420. Source of support: Nil Conflict of interest: None declared.     

Removal of Porcelain Veneers Aided by a Fluorescing Luting Cement

Purpose: Porcelain veneers are a safe and effective treatment modality for selected teeth that have poor esthetics. However, removal of porcelain veneers that have failed may be time‐consuming and involve considerable removal of sound tooth structure adjacent to the veneer. The aim of this study was to evaluate a novel method of porcelain laminate veneer removal by incorporating a fluorescent dye into the luting cement that allows the practitioner to visualize the cement on the tooth and remove the veneer without causing residual damage to the adjacent tooth substance. Materials and Methods: Porcelain veneers were luted on extracted teeth with a luting cement modified with a fluorescing agent. Faculty teaching staff and final year dental undergraduates were asked to remove the veneers with the aid of a curing light to render the luting cement visible by fluorescing. They were then asked to compare the removal of comparable veneers without this visual aid and to complete a standard questionnaire. The depth of cure of the conventional and modified cements was measured using a penetrometer. Results: Results of the questionnaire indicated that the operators found removing the veneer cemented with the modified (fluorescing) cement considerably easier than removing the veneer cemented with the conventional cement. Microscopy indicated that more damage was caused to the underlying tooth during removal of conventionally cemented veneers. The incorporation of the dye into the cement reduced the depth of cure from 4.238 mm (SD = 0.025) to 3.761 mm (SD = 0.096). CLINICAL SIGNIFICANCE The fluorescent cement was considered to be superior to conventional cements in its ease of visibility, and as a consequence, veneers cemented with the fluorescing cement are easier to remove. The fluorescing dye significantly reduced the depth of cure, but this may not be clinically significant, because of the small thickness of cement employed when luting adhesive restorations. The use of such fluorescing materials may not be restricted to a luting cement for veneers but may also be incorporated into bases and lining materials so they can be visualized on removal of tooth‐colored restorations, to prevent further tooth destruction.