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Cédrik Bernard

Private practice in Paris, FRANCE.
Member of academy of adhesive dentistry France (ADDA)

No prep indirect composite in anteriors

9521 Views - Mar 2016

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If ceramic stays the gold standard in anterior esthetic treatment, the progress of composites and adhesive procedures allow us to use this material as a credible alternative for our patients. In simple cases, the direct technique with stratification has already proven its qualities. With complex ones, we are used to go with ceramic veneers. But with young patients, or when we want a prep free technique, composite can be the best option. The indirect way allow us an easier management of the global forms of the restorations, less bubbles incorporation with the press technique and time to finish the surface texture, the most important parameter to achieve aesthetic.

A young female patient (20 years old) come at the clinic asking for a smile enhancement. She has just finished a 2 years orthodontic treatment witch failed to extrude the left canine (23). She presents also some decays and defective composites. The orthodontist ask also for a retainer because of the mobility of the anterior teeth.
a closer view of the left canine, emerging.
The 2 central incisors may not have a long life, but we must try to preserve them as long as possible, because of the young age of the patient (20) and the current recommendations for implants in the anterior area.
After removing decays and old composites.
I use a tender flask to press the composite on the carrot die. It allows to precisely reproduce the wax up, and il gives less bubble incorporation on the restorations.
A transparent silicone (Elite glass, Zhermack) is used to record the wax up
The composite restorations finished on the model. I use UD3, UE1 (press on the tender flask), IWS (Enamel HRI, Micerium) and OM (Essential, GC) to build the veneers. Some gum composites (Amaris Gingiva, Voco) are also used for the left canine. All the restorations are post-polymerized.
the composite restoration for the left canine looks like a crown. It will be assembled with a adhesive cement (Rely X unique, 3Mespe). The other restorations will be fixed with an adhesive system and pre-heated composite.
A fiber composite retainer is also prepared on the model, using Everstick.
Final restorations two weeks after the assembly session.

Conclusions

Conclusion:

Composite is a good alternative to ceramic treatment for young or occlusal risked patients, or for economical reasons, and in any cases when no prep approach is a priority. The indirect technique allow us to associate the advantages of this material (simplicity, modifying and repairing abilities) with the latitude and the decline of working on a model. Il offers an additional treatment solution combining maximum tissue preservation, simplicity, personalization and great aesthetic result with moderate economic cost.
 

Bibliography

References:

1.- DIETSCHI D. Layering concepts in anterior composite restorations. J Adhesive
Dent 2001;3:71-80.

2.- DIETSCHI D, DEVIGUS A. Prefabricated composite veneers : historical perspectives, indications and clinical application. Eur J Esthet Dent 2011 ; 6 : 178-187

3.- Fahl Junior N. The direct/indirect composite resin veneers : a case report. Pract Periodontics Aesthet Dent 1996 ; 8 : 627-638

4.- VANINI L, DE SIMONE F, TAMMARO S. Indirect composite restorations in the anterior region : a predictable technique for complex cases. Pract Periodont Aesthet Dent 1997 ; 9 (7) : 795-802

5.- MANGANI F et al. Approche clinique dans le secteur antérieur avec des facettes composite. Eur J Esthet Dent 2010 été; vol 2 n°2 : 120-139

6.- C. BERNARD. Restauration du sourire par composite en technique indirecte. Information Dentaire n°36/37, 21 Octobre 2015

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