Superior Aesthetics
Composite Layering vs Composite
Veneers
Munther Sulieman

• Smile analysis
• Recontouring
• Whitening
• Micro/macro-abrasion
• Composite bonding
• Veneers
• Crowns

• Degree of polish
• Thickness of enamel
• Enamel morphology
• Fluorescence and translucency
• Dehydration
• Recession and dentinal exposure
• Intrinsic, extrinsic or internalised stain

• Intrinsic Discolouration
• Extrinsic Discolouration
• Internalised Discolouration

• METABOLIC
• Alkaptonuria
• Congenital erythropoietic porphyria
• Congenital hyperbilirubinaemia
• Rickets, Ehlers- Danlos syndrome
• etc.

• INHERITED
• Amelogenesis imperfecta
• Dentinogenesis imperfecta
• Dentinal dysplasias

• IATROGENIC
• Tetracycline stains
• Fluorosis

 Caused by an interference with the calcification process of the enamel matrix which results in incomplete maturation accompanied with opacity and or porosity
 Wide range of severity: mottled teeth- minor
(intermittent white flecking or spots) to severe manifestation that involves pitting and brownish surface stains
 Only affects superficial enamel thickness usually

• TRAUMATIC
• Enamel hypoplasia
• Pulpal haemorrhage products
• Root resorption
• AGEING
• Teeth become darker, more yellow and slightly more red

 Rupture of blood vessels and extravasation of erythrocytes into the dentinal tubules which gives the tooth a pink hue but the tooth may still remain vital
 Majority of post endo discoloration is caused by failure to completely remove blood or other organic material from the pulp chamber.
 Pastes/ restorations: corrosion products from silver amalgam in dentinal tubules, silver in sealing pastes or zinc oxide eugenol- blue grey discoloration at cervical area

 Developmental disturbance in the formation of the inorganic component of enamel during amelogenesis- results in brown enamel, white opacities or enamel coloration defects of various hues.
 Defects can be localised to one section or an entire surface of the tooth with coloured streaks, multiple spots or other patterns

• Idiopathic
• MIH: Molar Incisor
Hypomineralisation

• Tobacco products
• Tea, coffee and red wine
• Spices
• Vegetables
• Medicines
• Plaque

• CATIONIC ANTISEPTICS
• Chlorhexidine
• CPC
• Hexetidine
• OTHERS eg. Listerine

• TRAUMA
• cracks
• loss of enamel
• recession
• CARIES
• RESTORATIONS

 Lesions are acquired: occur when dental plaque persists undisturbed on enamel surface producing organic acids that etch the mineral content out of the enamel surface
 Left undisturbed further leads to dental decay
 If intercepted early, there is no need for restorations
 Common sites for these lesions are cervical margins of teeth or around orthodontic brackets with poor
OH.

• Regardless of the nature of the discolouration
 Must decide whether the discolouration is confined to the superficial enamel thickness or in the deep dentine layers
 This determines the complexity and extent of treatment as well as the absolute choice of treatment

Treatment Options
1. Bleaching: Vital and Non-vital
2.
Enamel microabrasion
3. Direct composite veneers
4.
Indirect veneers (Porcelain/ Composite)
5.
Bleaching with indirect or direct veneers

• Vital
• Home
 CP / HP -trays
• In-surgery
 15-50% HP ± heat / light activation
 35% CP waiting room
• OTC
 Strips / Paint-on
• Other
 Toothpaste Mouthrinse Chewing gum
• Non-Vital
 Walking
 HP,Perborate/HP, CP
 Inside / Outside
 CP
 In-surgery
 35% HP

• Generalised staining
• Ageing
• Smoking and dietary stains
• Fluorosis
• Tetracycline staining
• Traumatic pulpal changes
• Aesthetics pre or post restorative

 Patients high expectations
 Decay and periapical lesions
 Patient can’t tolerate taste
 Pre existing Conditions
 Crowns
 Extensive restorative dentistry: Composite and porcelain restorations
 Major cracks
 Exposed dentine
 Pre existing problem sensitivity
 Highly translucent tooth
 Pregnancy
 No scientific evidence against bleaching but there may be a psychological effect on mother
 Bleaching may exacerbate pregnancy gingivitis

 Intensity, Location and Depth of lesion will determine Tx
 Bleaching of background (reduce contrast between white spot and rest of tooth)
 Micro-abrasion of foreground with or without bleaching
 Bleaching/abrasion and composites
 Composite Veneers

Where Why and When Does
Composite Work?
• Biocompatibility
• Adhesion to Enamel and Dentine
• Colour Perception Optical Effects
• Harmonious Blending with Tooth structure
• Multiple Uses
27

Main problems in handling composite
• Stickiness
• Surface wetting
• Surface smoothness
• Homogeneity
• Adaptation
• Individualization of texture and shape
• Internal air bubbles and wetting defects
28

Freehand technique - problems
•
Aesthetic impression/expression
•
Anatomical form
2
•
Modelling incisal edges 3
•
Surface texture 4
•
Mammelons
5
•
Ridgeline contour
• layer
6
Control thickness of enamel
1
7
7
4
5
3
2
1
6
© Mario Besek

Primary indications
 White spot lesions
 Severe fluorosis
 Severe hypoplasia
All these discolorations are usually confined entirely to the enamel thickness and never extend into the dentine
 Heavily restored stained anterior teeth

• Advantages
• More conservative- no enamel removal!
• One session no lab costs
• Easier shade match compared to single porcelain veneer involving a lab especially if mock-up is used

 Only cut tooth tissue if absolutely necessary and then only into enamel
 Consider air abrasion and bonding composite to reshape teeth
 Mock-up may be needed to check contour and shade if patient agreement is deemed necessary
 Shade match prior to tooth dehydration
 Matching adjacent tooth roughness and texture greatly enhances appearance

• For small class IV and III cavities- centripetal approach (build up from inside to outside)
• For large class IV and incisal build up- buccolingual approach used in conjunction with silicone index

Natural Layering Technique
“The Clinical Procedure”
• Finishing & Polishing- aim is to re-create texture and gloss.
• Surface re-contouring with fine diamonds while discs are best for plane and convex surfaces.
• Smooth out concavities/uneven surfaces with fine diamonds or silicone points
• Fine shine best with hard polishing brushes

• PC- Proximal contact
• BLP- Bucco-lingual profile
• TL- Transitional lines
• SM- Surface morphology
• IE- Incisal edge

● are polymerized, prefabricated enamel shaded composite laminates
● is a direct Composite-Veneering-System
● simplify the freehand technique
● increases the quality of front teeth restorations
● is an economical system
36

Componeer thickness
● Minimal or no preparation due to the minimal thickness of composit laminates of 0.3 mm.
● Ceramic veneers have a minimum thickness of 0.5 – 0.8 mm

Contour guide
● Optimal form selection using the translucent, high-contrast contour guide
38

Properties & advantages
● High opalescence and natural blue effect of the enamel
● High flexure strength E-modulus similar to tooth
39

Form - shape - texture - surface - gloss
40

Properties & advantages
● Highest adhesion composite - composite, optimized by the microretentive surface (2 µm)
©
Componeer erosion 2µm
© Mario Besek

Properties & advantages
• Soaked for 1 week in water at 37 ° C
• 240‘000 cycles, 49N
• 600 x 5 ° / 55 °
• Cresylblue, 24h
• 80 specimen
• 74 showed no penetration
• 6 showed some slight discoloration
Prof.Dr. Ivo Krejci, University of Geneva

Simple individualization
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Properties & advantages
● Optimized marginal quality - less polymerization stress
44

• Extended indications
• Less objective & subjective limits
• Conservative Procedure
• Good Longevity /Repair
• Cost effectiveness
45

• Choose correct size
• Choose correct shade
• Isolation of teeth
• Preparation small shallow chamfer/interporoximal conditioning
• Re check size and adjust componeer with possible try in
• Etch Bond Cure tooth

• Place and adapt composite on tooth
• Bond but don’t cure Componeer, place composite and adapt on Componeer
• Fit first Componeer on tooth and firmly push into position
• Clean excess before curing
• Trim and polish

Indirect Porcelain or Composite Veneers
Indicated for conservative treatment of anterior teeth that are;
• Relatively intact
• Worn
• Discoloured
• Misaligned
• Malformed

Indirect Porcelain or Composite Veneers
• Porcelain
• High aesthetics
• Excellent gingival tissue response
• Relatively minimal labial reduction
• Durable and fracture resistant
• Shine through problem
(Blue grey)
• Composite
• High aesthetics
• Excellent gingival response
• More conservative
• Can be repaired if fractured
• Shine through problem
(Blue grey)

 Types of preparation: depends on shade of discoloured tooth, its position and alignment and presence of restorations
 Minimal: surface reduction just to bond to enamel
 Conventional: 0.3mm reduction cervically, 0.5mm centrally within enamel and retain incisal edge or reduce by 1mm. Keep contacts!
 Deep: 0.6mm reduction into dentine and removal of contact points