Composite Veneers

Background
A pleasant 8 year old girl was referred to my service to replace resin bonding on tooth 21 (#9) that continually has been a debonding problem for the last 3 years since the accident happened. At that time, the patient dived into a neighbor’s pool and realized it was too deep for her, lunging up instinctively, and impacting her tooth against the lateral aspect of the pool wall. Clinically, there are remnants of resin bonding on the fracture margin, and it is noted that the tooth is more chromatic relative to tooth 11 (#8). On discussion of the color map, the patient did not desire the white intensive noted in the mid-incisal region of 11 to be reproduced in tooth 21.

Procedure
Prior to local anesthetic, the color map was noted and the shade button technique employed using various shades of Ultradent Vit-l-escence. Shades tested in the enamel/incisal region: Pearl Neutral, Pearl Frost (L to R), Shades tested in the cervical/dentin region: A2, A1 (L to R). The shades Pearl Neutral, A1 and Trans (T) (Permaflo, Ultradent) were selected as the colors to employ, with a touch of white tint in the incisal region. The A1 shade would have enough optical density to help lift the value and reduce the chroma of the tooth simultaneously. The patient was anesthetized, and a split rubber dam attached, however on slightly mobile D’s would not be tolerated. The tooth was prepared and an infinity bevel established in the usual way, micro air abrasion using 27 micron aluminum oxide was utilized to ensure no residual composite and to increase the micromechanical retention form of the tooth prior to a total etch technique using Peak Universal Bond.

The lingual shelf was freehanded using a pre-crimped Mylar strip to parallel the linguoaxial wall of tooth 11 (#8). The join line was opaqued and the dentin volume rebuilt using A1 (Dentin) (Vit-l-escence). The incisal aspect was characterized to exhibit dentin lobule irregularity, and the interposing spaces filled with a light layer of translucent composite (T, Permaflo, Ultradent). Light white tint clouds were painted in the incisal window region to increase the biomimetic character of the tooth. The final enamel layer was sculped with Pearl Neutral, and imparted a realistic depth of translucency to the entire composition. Finishing of Primary and Secondary anatomy was completed before polishing with the final luster achieved using a 0.5 micron diamond paste (Diamond Polish Mint, Ultradent). The occlusion was checked to ensure the restoration did not interfere with her envelope of function.
Final reassessment exhibits excellent esthetic integration displaying incisal window details visible from the oblique view that match that of adjacent teeth. A fantastic finish for a fantastic patient with a fantastic material.