Aesthetic and stress-free in a single session

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Direct restoration with prefabricated composite veneers

Aesthetic and stress-free - in a single session The use of prefabricated composite veneers is an attractive alternative to elaborate, indirect fabrication processes. Ulf Krueger-Janson describes first user experiences with a direct composite veneer system, which is integrated into the daily practice routine and not only saves the patient the insertion appointment, but also impression taking and a temporary restoration.

Author: Ulf Krueger-Janson

The use of prefabricated veneer shells facilitates the work of the practice team, as it eliminates the need for impressions and the fabrication of temporaries, as well as the stress of the unspoken but ever-

She greatly appreciated being able to go home with beautiful anterior aesthetics.

substance is also blasted interdentally with a powder blasting unit (Fig.4).

Preparatory measures Selecting

the

veneer

However, this can also be performed

dummy:

the

present worry of whether the provisionally luted veneers will "stay attached" until the

product

appointment for adhesive luting. In the documented case, we therefore opted for

shapes (dummies) for selecting the veneer shells. This enables selecting the

a "direct variant" (Fig. 1). Restoration was performed using the Brilliant Componeer

appropriate size in length and width. Once the size and shape have been

Veneering System from Coltène. The system includes prefabricated composite

determined, the individual veneers can be applied (Fig. 2). This also allows a first

veneers for aesthetic anterior restorations

colour match to be made.

in a single session. This method of immediate restoration was perceived by

Conditioning the gingiva and tooth structure: placement of a Strength II

the patient as being convenient, timesaving and aesthetically appealing.

retraction cord to facilitate retraction of the gingiva.

range

includes

The gingiva is then isolated with OpalDam (Ultradent) (Fig.3) and the tooth

transparent

sufficient

before placing the cord. This is followed by preparation with a conical grinding tool.

Preparation For corrections in colour and shape, as well as for simple functional corrections, the natural enamel substance must be abraded. Depending on the indication, the amount of substance to be abraded from the natural tooth can now be defined.

(Fig. 5). If corrective positioning is to be performed, then considerable reductions in substance may well prove necessary.

 01 Initial situation with anterior dysfunction and multiple, differently coloured composite fillings

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 02 Try-in of the selected veneer set prior to preparation: protrusions are visible; if necessary, the veneer shells need to be ground to provide a correct fit. Colour (choice: translucent material) and shape blend in perfectly.

 03 The entire tooth surface is blasted with AL O 2

3

powder for cleaning, especially interdentally. The transitions of existing, sufficient composite restorations are cleaned in the process. OpalDam is applied beforehand to protect the gingiva.

 04 The blasted and clean surface and Strength II retraction cords already placed; a wide opening of the subgingival area is advantageous for luting and excess management. Clean interdental surfaces were also created.

 05 The preparation was designed in a shell shape so that the composite veneers can adopt an optimal, reproducible position.

In this process, care should be taken to create as flat an adhesive base as possible, as this will make subsequent luting considerably easier. It is advisable to constantly check the fit and position of the veneers to be bonded. Minor subtraction of the veneer may also be required.

To check the fit (fitting), the veneer to be bonded is applied repeatedly until an optimal reproducible and passive position is achieved. Depending on the indication, this can be a time-consuming procedure.

To ensure that the veneers adhere to the teeth during checking,

using a glycerine gel is recommended.

If the natural tooth exhibits pronounced discolouration, consider abrasion and overlaying the tooth with an opaque colour liner (Flow). This creates a monochromatic base colour, which facilitates later colour integration.

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tw Curriculum Vitae Ulf Krueger-Janson has been a dentist in private practice in Frankfurt since 1991.

He has been Vice President of the German Society for

 06/07 Left: before conditioning the tooth surface, the adjacent teeth are

masked with a Teflon tape. It is advisable to attach the veneers individually. This avoids an uncontrolled excess of the luting material, for example, possibly becoming wedged in the interdental area. Right: active application of the etching gel, especially interdentally.

Restorative and Regenerative Dentistry (DGR²Z) since 2012.

He has made a name for himself as an expert in composite restorations, particularly for aesthetic anterior restorations. Many of his procedures, such as the use of Teflon tape, the mixing of Flow colours for the colour design of the surface and the application of the dynamic tape technique for designing morphologically adequate contours, have meanwhile become state-of-the-art.

His range of experience with allceramic systems also spans a period of more than 28 years. He is the author of a book (Composite 3D), has numerous national and international publications to his name and is an experienced speaker.

 08/09 The result 3.5 hours later after finishing and polishing

Luting For luting, the veneer should be able to assume a definitive and reproducible position. Luting is performed with the aid of "passive fitting". In this process, the luting composite is displaced under the veneer by applying gently increasing pressure.

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Due to its thixotropic properties, the

In the documented case, each veneer as

material begins to "flow" as pressure

well as the tooth surface were conditioned

increases. This can lead to inadvertent shifting. To avoid this, a passive,

according instructions,

reproducible position of the veneer is

isolated with Teflon tape and then fixated

desirable. During preparation, care should be taken to grind the tooth in such a

individually (Figs. 6 and 7). When removing the still soft excess, care should

manner that the marginal areas of the veneer and the tooth surface are largely

be taken not to displace the veneer, while at the same time levelling any uneven

congruent with each other; this makes positioning considerably easier.

marginal areas - possibly by applying Flow or solid composite.

to the

the manufacturer's adjacent teeth were

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 10–12 Follow-up after two weeks: minor reworking and further polishing of the surface was performed. Minor discolourations are present in the transition area between the veneer and the tooth structure and need to be monitored. If necessary, correction in the context of a repair can be performed here. The adaptation to the physiological structures is very good.

The gingiva is irritation-free and perfectly adapted to the surface of the veneer. The balanced proportions, even after the functionally necessary incisal corrections, provide for aesthetically harmonious integration.

However, the final marginal structure can

polishers/Venus

also be adapted and thus reworked after curing using the tape technique. As long as

creates clean transitions between the Componeer and the tooth substance.

morphologically adequate tooth shapes (proportions). In this sense, even less

an intact inhibition layer is still present, further corrective application is not a

(Figs. 10 to 12).

experienced clinicians will also be able to provide immediate aesthetic restorations.

problem.

Once all excess has been removed, the

Conclusion

marginal structure can be checked for a void-free and tight fit. However, further corrective measures - especially in the transition area necessary.

-

may

well

prove

Highly

Kulzer)

aesthetic

additionally

shapes

facilitate

the

integration

Contact address results

can

be

Ulf Krueger-Janson

achieved using prefabricated composite veneers. Functional parameters were also taken into account in the case presented.

Canine guidance was reconstructed from palatal using composite abutments and protrusion and lateroprotrusion were

tw Service Recommended reading

If excess luting material or protrusions

ground in for anterior guidance. A favourable prerequisite for the handling

Composite 3D - Natural colour and form design Ulf Krueger-Janson

from the prefabricated shell still need to be removed, we recommend using a flat,

and processing of prefabricated veneers is a clinician who has already gained

ISBN 978-3-932599-28-6

oscillating file

experience with the luting of partial crowns or veneers. The result shows that

Finishing

(EVA from KaVo) or

alternatively Proxoshape (Intensive).

Applying the vertical stroke, all

both functionally and aesthetically good

protrusions in the marginal area are evenly and smoothly finished and aligned.

restorations can be achieved with this procedure.

Direct restoration with

Owing to the subgingival position of the retraction cord, careful atraumatic

Componeers is a constructive alternative to indirect restoration with ceramic

finishing should be assured under visual

veneers or partial crowns in the anterior region. The savings in materials and time

control. (Figs. 8 and 9). Subsequent polishing with pre-polishers and highgloss

polishers

(pink

and

grey

264 pages, approx. 1300 illustrations

are considerable, which benefits the patient's

budget.

The

prefabricated 1/22 – teamwork – 25th Volume

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tw Praxis & Konzept Stettenstraße 48, 60322 Frankfurt a.M. ulf.krueger-janson@email.de https://praxis-krueger-janson.de/

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