No prep indirect composite in anteriors
Although ceramic stays the gold standard in anterior esthetic treatment, the progress of composites and adhesive procedures allows 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 preparation free approach, 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 had just finished a 2 years orthodontic treatment witch failed to extrude her left upper canine. She presents also some decays and defective composites. The orthodontist asked 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 decay 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 it 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 adhesive cement (Rely X unique, 3Mespe). The other restorations will be luted 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.
Composite is a good alternative to ceramic treatment for young patients and those at high risk of occlusal disorders, or for economical reasons, and in all cases a 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. It offers an additional treatment solution combining maximum tissue preservation, simplicity, personalization and great aesthetic result with moderate economic cost.