Younger patients are seeking cosmetic dentistry now more than ever. With the popularity of social media platforms such as TikTok, Instagram, and YouTube, many younger adults want a beautiful and dynamic smile to elevate their facial beauty, drive more attention to their posts, and increase their number of followers and subscribers. During this time of instant gratification, younger patients want cosmetic dental procedures to be done quickly.
Thus, minimally invasive composite resin veneers have become popular during this post-COVID-19 surge.
CASE REPORT
The patient was an 18-year-old female who presented with congenitally misshapen teeth (Figures 1 and 2). This patient did not like her aggressive canine, undersized lateral incisors, and unfeminine smile. The patient wanted a more uniform size and shape of her teeth to create a beautiful facial impact.
To show the patient the possibilities of her new smile, a diagnostic wax-up was hand-sculpted by the clinician and shown to her. A diagnostic wax-up is a great 3D tool to help patients assess the vision of the dentist. Aesthetics are a subjective aspect of dentistry; therefore, it is important that the dentist and the patient have the same vision for the aesthetic results prior to starting the cosmetic dental procedure.
After a discussion with the patient, it was determined that full-contoured composite resin veneers would produce minimal trauma to the tooth, maximum protection due to total sealing with adhesive bonding, and a minimally invasive solution to the existing problem.
In addition, this would be a one-appointment procedure, meeting the patient’s need for speedy resolution. Having a fast, painless, dynamic solution that can be completed in the least number of appointments possible is the best option for the demanding, young cosmetic dental patient.
After accepting the treatment plan, pretreatment preparations were done to prepare for the direct composite resin veneers procedure. The amount of tooth preparation was predetermined on the diagnostic model to attain minimal invasiveness.
To re-create the lingual and incisal contours of the central incisors, a PVS impression was taken only along the lingual and incisal aspects of the diagnostic wax-up. This PVS matrix is also used as a preparation guide, so only a minimal amount of tooth structure was removed to accomplish the goals of the new smile design (Figure 3).
Isolation of the area was achieved with an OptraGate (Ivoclar Vivadent). A thin retraction cord (4-0 suture cord [Patterson Dental]) was placed along the facial aspect in the gingiva to create a contamination-free environment prior to performing the procedure.
When performing a smile design, it is important to first restore both central incisors, which sets the stage in the new smile design. After the central incisors are completed, the clinician sequentially restores the lateral incisors and canines together. Then, if needed, the premolars are the last teeth to be veneered.
Full-Contoured Composite Resin Veneer Procedure
First, the enamel surface was cleaned with a microetcher (MicroEtcher II [Zest Dental Solutions]) to remove all dental pellicle from the tooth surface. Then, using a selective-etch technique, the enamel was etched with 32% phosphoric acid with benzalkonium chloride (Select HV Etch with BAC [BISCO Dental Products]).
It is important to ensure the adjacent teeth are not etched, so a clear matrix was placed interproximally for protection prior to etching. An all-in-one adhesive resin (G-Premio BOND [GC America]) was used as the adhesive bonding resin. One to 2 layers of G-Premio BOND were placed for 10 seconds, then blown thin using forced air for 5 to 10 seconds. The adhesive was light-cured for 10 to 15 seconds on both the facial and lingual sides (Figure 4).
Next, a very thin film layer of nanohybrid composite resin (G-ænial A’CHORD A1 [GC America]) was placed along the lingual and incisal aspects of the PVS matrix of both central incisors (Figure 5). The PVS matrix was then placed on the teeth, so the composite resin material intimately adhered to the lingual aspect of both central incisors.
After light curing the composite resin, the matrix was removed, which revealed a hardened lingual and incisal halo shell. This shell mimics the position, color, and contour of the lingual enamel coloration and the incisal halo shade.
Next, a body shade (G-ænial Sculpt OBW [GC America]) was used to brighten the appearance of the tooth. Then a translucency for youthful teeth (G-ænial Sculpt JE [GC America]) was placed as the final layer and shaped prior to final curing. It is important to note that each layer of composite resin should be cured prior to applying the next layer. Final shaping, contouring, and polishing were completed on both central incisors.
Next, the lateral incisor and canine were done together on the left side to completion, followed by the right side (Figure 7). Once again, using the PVS matrix, the lingual and incisal contours were established for the right lateral incisor and canine using G-ænial A’CHORD A1 (Figure 8). Then, as a dentin replacement, an opacious dentin shade (G-ænial Sculpt AO-2 [GC America]) was placed as the second layer. This opacious dentin shade mimics dentin and assists in naturally blocking out any translucency.
The next layer of body shade (G-ænial Sculpt OBW) was placed and sculpted onto the opacious dentin to ensure bubble-free composite resin blending. Using an interproximal carver, mamelons were artistically sculpted to mimic the internal characteristics of a natural tooth.
Each layer was light-cured prior to placing the next layer. Color modifiers, like violet and opal color tints (Kolor + Plus [Kerr Corporation]), were artistically placed along the proximal and incisal areas to create subtle incisal characterization. Once again, this was light cured (Figure 9).
Finally, using a free-hand artistic sculpting technique, a youthful translucent shade (G-ænial Sculpt JE) was sculpted over the facial surfaces. This final layer was handsculpted with a flat artist’s brush (No. 4 flat brush) to create natural facial contours and mimic feminine topography.6 Final light curing was done on both the facial and lingual surfaces. To seal the surface of the composite, resin glycerin (Glycerin USP) was placed and light cured. Doing this removed the oxygen-inhibited surface layer.
