CASE PRESENTATION
Treating Anterior Defects Predictably, Esthetically, and Efficiently
Historically, one of the most time-consuming and challenging therapies to treat esthetically, efficiently, and predictably is with the use of direct composite for an anterior defect, such as diastema, incisal wear, or Class IV fracture. The reason for this is that the operator had to do the sculpting and shaping freehand. Results using the freehand method can vary from unacceptable to extraordinary based on the skill set of the dentist and how much time the dentist is prepared to spend. Manufacturers have developed many devices over the years, such as stints and guides, to assist the dentist with this dilemma. This article focuses on the Uveneer system (Ultradent), which is designed to overcome these somewhat difficult obstacles in placing anterior direct composites.
Discussion
This case presentation demonstrates the application of direct composite on an upper central (No. 8) and a lower central (No. 24) to correct their incisal defects in an efficient and esthetic manner using the Uveneer system (Figure 1). The incisal edges of teeth Nos. 8 and 24 were abraded to remove any smear layer and uncut enamel, and a long chamfer finishing line was created about 2 mm apical to the incisal edges using a coarse long chamfer diamond bur. This was done to ultimately hide the finished margins, as should be done with all direct composites. The appropriate Uveneer stint size for each tooth was selected and confirmed (Figure 2). The total-etch technique was utilized, so a 37% phosphoric acid was applied for 20 seconds and rinsed. This was followed by applying a universal adhesive (Peak Universal Bond, Ultradent), which was thoroughly applied to each tooth based on the manufacturer’s recommendation, thinned with warm dry air, followed by light-curing for 20 seconds.
As most of the deficiency for these teeth occurred on the incisal edges, a universal composite (Mosaic, Ultradent) was chosen (shade A1 enamel) that blended with the adjacent tooth structure. The composite was loaded into the Uveneer stints and pressed firmly against each tooth surface (Figures 3 and 4). Excess composite that oozed out of the stint was removed and, while holding the stint in place, the teeth were light-cured (Figures 5 and 6).
The stints were removed (Figure 7), and the small amount of excess composite was trimmed with carbide finishing burs. Since the stints are rigid and built with typical surface anatomy, the finished composite closely duplicates a normal-appearing anterior tooth. The bite was checked in all excursions and any necessary adjustments made. Since the internal surface of the Uveneer stint is so rigid and smooth, polishing the final restoration may not be necessary unless the operator chooses to make some modifications to the resin after the stints are removed. In this case, the shape and form were modified to blend the finish line into the adjacent tooth structure, so a composite finishing system (Jiffy, Ultradent) was used to create a highly polished finish that blended seamlessly with the adjacent tooth structure (Figure 8).
Conclusion
For direct composites, the Uveneer system allows the dentist to create beautiful and predictable anterior direct composites easily, quickly, and efficiently. Besides treating incisal deficiencies, as described in this article, the Uveneer system also can be used for other clinical situations, such as to create direct full-resin veneers or to restore a Class IV fracture, either temporarily in an emergency scenario or as the defi nitive restoration.
Discussion
This case presentation demonstrates the application of direct composite on an upper central (No. 8) and a lower central (No. 24) to correct their incisal defects in an efficient and esthetic manner using the Uveneer system (Figure 1). The incisal edges of teeth Nos. 8 and 24 were abraded to remove any smear layer and uncut enamel, and a long chamfer finishing line was created about 2 mm apical to the incisal edges using a coarse long chamfer diamond bur. This was done to ultimately hide the finished margins, as should be done with all direct composites. The appropriate Uveneer stint size for each tooth was selected and confirmed (Figure 2). The total-etch technique was utilized, so a 37% phosphoric acid was applied for 20 seconds and rinsed. This was followed by applying a universal adhesive (Peak Universal Bond, Ultradent), which was thoroughly applied to each tooth based on the manufacturer’s recommendation, thinned with warm dry air, followed by light-curing for 20 seconds.
Figure 1—Preop teeth Nos. 8 and 24
Figure 2—Try-in of the Uveneer stint
Figure 3—Uncured resin in the upper stint
Figure 4—Uncured resin in the lower stint
Figure 5—Curing resin through upper stint
Figure 6—Curing resin through lower stint
Figure 7—Unfinished cured upper resin
Figure 8—Upper and lower finished resins
For direct composites, the Uveneer system allows the dentist to create beautiful and predictable anterior direct composites easily, quickly, and efficiently. Besides treating incisal deficiencies, as described in this article, the Uveneer system also can be used for other clinical situations, such as to create direct full-resin veneers or to restore a Class IV fracture, either temporarily in an emergency scenario or as the defi nitive restoration.
GO-TO PRODUCTS USED IN THIS CASE
UVENEER
This minimally invasive system creates beautiful direct composite veneers with predictable shape and symmetry—all in one visit. Each template mimics natural dentition and is designed to create high-quality, natural-looking anterior restorations.
This minimally invasive system creates beautiful direct composite veneers with predictable shape and symmetry—all in one visit. Each template mimics natural dentition and is designed to create high-quality, natural-looking anterior restorations.MOSAIC
Mosaic is a universal composite that balances esthetics and performance for lasting, lifelike restorations. It can be used for all restorative purposes and its well-balanced nanohybrid formula produces restorations of the highest quality.
Mosaic is a universal composite that balances esthetics and performance for lasting, lifelike restorations. It can be used for all restorative purposes and its well-balanced nanohybrid formula produces restorations of the highest quality.JACK RINGER, DDS, FAACD, FIADFE
Dr. Ringer, an Accredited Fellow of the American Academy of Cosmetic Dentistry and a Fellow of the International Academy of Dental Facial Esthetics, has been in private practice for more than 30 years in Anaheim Hills, CA. He has been teaching at various dental teaching institutions for almost 25 years and has published several articles in the field of contemporary esthetic dentistry. He served on the Board of Directors of the American Academy of Cosmetic Dentistry before serving as its president, and is currently a member of its Professional Education Committee. He is co-founder and past president of the Orange County Academy of Cosmetic Dentistry, a faculty mentor at Spear Education, and a member of the Seattle Study Club Speaker Bureau.
Dr. Ringer, an Accredited Fellow of the American Academy of Cosmetic Dentistry and a Fellow of the International Academy of Dental Facial Esthetics, has been in private practice for more than 30 years in Anaheim Hills, CA. He has been teaching at various dental teaching institutions for almost 25 years and has published several articles in the field of contemporary esthetic dentistry. He served on the Board of Directors of the American Academy of Cosmetic Dentistry before serving as its president, and is currently a member of its Professional Education Committee. He is co-founder and past president of the Orange County Academy of Cosmetic Dentistry, a faculty mentor at Spear Education, and a member of the Seattle Study Club Speaker Bureau.
