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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 1  |  Issue : 3  |  Page : 157-160

Minimally invasive Approach to Restore with Porcelain Laminate Veneer on Maxillary Lateral Incisors


1 Department of Periodontology, School of Dentistry at Araraquara, São Paulo State University, Araraquara, São Paulo, Brazil
2 Department of Post Graduate Program in Integrated Dental Sciences, University of Cuiabá, Mato Grosso, Cuiabá, Brazil
3 Department of Restorative Dentistry, School of Dentistry at Araraquara, São Paulo State University, Araraquara, São Paulo, Brazil
4 Department of Post Graduate Program in Dentistry, Centro de Ensino Unificado do Maranhão University, Sao Luis, Maranhão, Brazil
5 Department of Dentistry, Ponta Grossa State University, Ponta Grossa, Paraná, Brazil

Date of Web Publication8-Dec-2014

Correspondence Address:
Mateus Rodrigues Tonetto
Department of Post Graduate Program in Integrated Dental Sciences, University of Cuiabá, Mato Grosso, Cuiabá
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2915.146499

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  Abstract 

The enhancement of indirect restorations along the advancement of adhesive systems made possible the preservation of tooth structure through the completion of minimal wear. The laminates ceramics veneers type "contact lens" are presented as a great option when compared to other restorations and excellent results can be noted in a conservative approach. The indication and proper planning are critical to the success of treatment. The present case aims to show the restoration of height and shape of lateral incisors combining the wishes of the patient to the possibilities that dentistry has to offer.

Keywords: Dental porcelain, dental veneers, restorative


How to cite this article:
Freitas de Paula LG, Tonetto MR, Lorenzetti CC, deFigueire do Pereira K, Silva MB, Bandeca MC, SouzaPinto SC, de Andrade MF. Minimally invasive Approach to Restore with Porcelain Laminate Veneer on Maxillary Lateral Incisors. J Dent Res Rev 2014;1:157-60

How to cite this URL:
Freitas de Paula LG, Tonetto MR, Lorenzetti CC, deFigueire do Pereira K, Silva MB, Bandeca MC, SouzaPinto SC, de Andrade MF. Minimally invasive Approach to Restore with Porcelain Laminate Veneer on Maxillary Lateral Incisors. J Dent Res Rev [serial online] 2014 [cited 2021 Jan 26];1:157-60. Available from: https://www.jdrr.org/text.asp?2014/1/3/157/146499


  Introduction Top


The search for anesthetically pleasing result, satisfactory, and functional is extremely importantto the patient, within the current context in which is the dental esthetic. The evolution of the techniques and restorative materials, as ceramics, has allowed professionals reinstate an oral health combined with an esthetically harmonic smile. However, to have a satisfactory result, it is necessary have knowledge about the type of materials available in the market; physicochemical and optical properties; also combining the knowledge of dental anatomy, color, limitations of materials and techniques, adhesive systems, among other essentials factors. [1]

The enhancement of indirect restorations along the advancement of adhesive systems made possible the preservation of tooth structure through the completion of minimal wear, leading to the confection of ceramic laminates extremely thin and able to solve certain cases, such as redefinition of the form, size, and color imperfections. [2],[3]

The laminates ceramics veneers type "contact lens" are presented as a great option when compared to other restorations and can be noted excellent results in a conservative approach. The indication and proper planning are critical to the success of treatment.

The current restorative esthetic treatments require a multidisciplinary approach to correct diagnosis and planning of gingival and dental alterations, including changes in color and number of teeth, shape, presence of diastema, gingival Zenith contour modified. The recognition of these changes in conjunction to knowledge related to the proportions and characteristics of the smile, ensures the final patient satisfaction. [4]

The dental proportions depend on dimensions of height and width, and the length shall be proportionately greater than the width. However, satisfactory esthetics, depends not only on the dimensions of individual teeth, but also their relation to the gingival tissue. [5]

There are many restorative systems able to promote esthetic, but what is sought is increasingly combine a high esthetic potential with high resistance, thus allowing longevity of restorations. With the advancement of restorative materials, all-ceramics restorations are capable of achieving satisfactory biological, functional, and esthetic results. [6],[7]

According to Magne and Douglas, [8] the current medical research does not involve only the evaluation of the materials individually, but also relate when they are in operation.

Besides excellent esthetic results, the indirect restorations have some advantages over other techniques for making laminate veneers, as a proper interproximal contact and marginal adaptation due to related to polymerization shrinkage control, which promotes the physical properties of the material. [9]

The present case aims to show the restoration of height and shape of lateral incisors combining the wishes of the patient to the possibilities that dentistry has to offer.


  Case Report Top


32-years old male patient who searched for restorative dental treatment due to his dissatisfaction with the esthetics of the upper lateral incisors and staining of his teeth.

Through the esthetic and functional evaluation, it was observed the smiling relationship with the patient face, from many angles. It was analyzed the characteristics of the teeth (size, shape, and adjacent teeth) with gingival tissue through photographs and study model, making it possible to observe disharmony at the height of the maxillary lateral incisors, the presence of diastema, inequality of gingival zeniths of central incisors, and the most severe staining of the teeth [Figure 1]. During the assessment and planning, there was active participation of the patient in order to obtain an esthetic and satisfactory result.

The treatment initially proposed to the patient after clinical, photographic, and study model analysisto perform a tooth whitening, gingival plasty, and fabrication of a ceramic laminate of thin thickness (called "contact lens") for the maxillary lateral right incisor (#7) and laminated ceramic slightly thicker for the maxillary lateral left incisor (#10), since this was made mostly with composite resin. However, the patient chose not to perform any surgery and just wanted corrections in lateral incisors, thus eliminating this procedure in the final planning, thereby following for making the diagnostic wax up.

Treatment was initiated with the technique of tooth whitening in office, first making a prophylaxis with brush and pumice paste with water. Then the protection of gingival tissue was taken with light-cured gingival barrier (Top Dam, FGM) and the application of the bleaching gel based on hydrogen peroxide 38% (Opalescence Boost, Ultradent).

Reached the desired color after two sessions of in-office bleaching technique, a simulation of planning in the patient was started. From the wax up in the study model, it was made a real simulation, which was installed on the patient's teeth a mock up, made in a temporary material (Protemp™ Plus, 3M ESPE) without adhesive application. In this step, the patient can see how the final result will be and talk about any changes that might be necessary for the preparation of ceramic pieces.

After approval by the patient of the result obtained with the mock up, it was started preparation for veneer porcelainofthe #10 tooth and light wear on the #7 tooth. Right after, the gingival tissue it was displaced with cord retraction to subsequently impression with vinyl polysiloxane (Express XT, 3M ESPE).

The preparation of ceramic laminates, which were made ​​of feldspathic [Figure 2], was made with hydrofluoric acid at 10% for 90 s [Figure 3] and application of the silane for 60 s [Figure 4]. On the teeth, the etching was performed with 37% phosphoric acid, application of primer and adhesive. The cementation was performed with resin cement in translucent color (RelyX™ Veneer, 3M).
Figure 1: Front view of the teeth before treatment

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Figure 2: Laminate veneer restorations made of feldspathic porcelain

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Figure 3: Feldspathic porcelain were etched with 10% hydrofluoric acid

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Figure 4: The silane coupling agent is allowed to set on the surface

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[Figure 5] and [Figure 6] shows satisfactory results with diastema closure of the lateral incisors and a harmonious relationship to other teeth, providing a beautiful and pleasant smile.
Figure 5: Intraoral final aspect with black contrast

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Figure 6: Final aspect in occlusion

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  Discussion Top


The use of ceramic laminates in the resolution of esthetic problems is an established procedure in the scientific literature, but requires careful planning and a good knowledge of materials and techniques to obtain success in the final result. [10]

The constant demand for restorative solutions that combine function and esthetics has motivated the dental market to the improvement of systems and materials. [6] There are several factors that influence a satisfactory result in the use of ceramic laminates, including the type of adhesive system and resin cement, functional and parafunctional activity of the patient, the type of tooth preparation that consequently will guide the ceramic thickness. [11]

Due to higher polishing by the glaze of ceramic materials, they have lower biofilm retention compared to direct composites, thus ensuring excellent performance of the gingival tissues. [12]

A predictable protocol made through the realization of extra- and intraoral photographs, radiographs, confection of study models, and a diagnostic wax up with ideal dimensions of width and length of the teeth is essential for the implementation of veneers.

After all these procedures, the patient can have a real predictability through restorative trial called mock up, and opine on modifications to improve the final result of esthetic treatment. [8],[13]

The literature suggests using light-cured resin cements for cementation of ceramic veneers, such as RelyX Veneer (3M ESPE), it does not have in its composition the amine as chemical activator, preventing color changes over time. The resin cements have several options of colors and opacity, and importantly do not change the final esthetic result, especially when the ceramic laminate is thin in thickness and high translucency. [14]


  Conclusion Top


A favorable and satisfactory esthetic result to the patient in a smile with ceramic laminate requires proper planning and the possibility of predictability of the outcome of treatment, allowing integrated esthetic excellence to the patient's wishes.

 
  References Top

1.
Magne P, Belser U. Bonded porcelain restorations in the anterior dentition: Biomimetic approach. Berlin: Quintessence; 2002.  Back to cited text no. 1
    
2.
Fonseca. S. Restorative Dentistry - A The art of perfection. In: Kina S, Ferreira AG. editors. Ceramic veneers. Artes Médicas; 2008. p. 159-98.  Back to cited text no. 2
    
3.
Kina S, Bruguera A. Invisible: Esthetic Ceramic Restorations, 1 st ed. Sao Paulo, Brazil: Artes Medicas; 2009. p. 420  Back to cited text no. 3
    
4.
Menezes Filho PF, Barros CH, Noronha JA, Melo Junior PC, Cardoso. RM. Avaliação crítica do sorriso. Int J Dent 2006;1:14-9.  Back to cited text no. 4
    
5.
Moro NR, Dias IC, Rossini KD. A proporcionalidade dos dentes. In: McDonald RE, Avery DR, Dean JA, editors. Dentistry for the Child and Adolescent, 8th ed. Missouri, USA: Mosby, Elseveir; 2004. p. 216-9.  Back to cited text no. 5
    
6.
Christensen GJ. Longevity versus esthetics: The great restorative debate. J Am Dent Assoc 2007;138:1013-5.  Back to cited text no. 6
[PUBMED]    
7.
Taskonak B, Sertgoz A. Two-year clinical evaluation of the lithia-dissilicate-based all-ceramic crowns and fixed partial dentures. Dent Mater 2006;22:1008-13.  Back to cited text no. 7
    
8.
Magne P, Douglas WH. Additive contour of porcelain venners: A key element in enamel preservation adhesion, and esthetics for aging dentition. J Adhes Dent 1999;1:81-92.  Back to cited text no. 8
    
9.
Cardoso PC, Decurcio RA, Almeida E Silva JS, Perillo MV, Baratieri LN. Noinvasive porcelain veneers: A comprehensive esthetic approach. Am J Esthetic Dent 2012;2:238-54.  Back to cited text no. 9
    
10.
Andrade OS, Romanini JC. Clinical protocol of ceramic veneers. R Dental Press Estet 2004;1:7-17.  Back to cited text no. 10
    
11.
Peumans M, De Munck J, Fieuws S, Lambrechts P, Vanherle G, Van Meerbeek B. A prospective ten-year clinical trial of porcelai veneers. J Adhes Dent 2004;6:65-76.  Back to cited text no. 11
    
12.
Kourkouta S, Waish TT, Davis LG. The effect of porcelain laminate veneers on gingival health and bacterial plaque characteristics. J Clin Periodontol 1994;21:638-40.  Back to cited text no. 12
    
13.
Higashi C, Reggiani RD, Kina S, Scopin O, Hirata R. Ceramic restorations in anterior teeth: Part 1. Clinical indications of ceramic systems. Revista Clínica 2009;5.  Back to cited text no. 13
    
14.
Karaagaclioglu L, Yilmaz B. Influence of cement shade and water storage on the final color of leucita - reinforced ceramics. Oper Dent 2008;33:386-91.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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