A technique is described that provides rapid restoration of fractured, malformed, or badly discolored teeth. The use of preformed and color-shaded laminate veneers enables the dental practitioner to obtain direct-bonded restorations with superior appearance and minimum chair time.
Laminate veneer restoration of permanent incisors F ra n k R. F a u n c e , DDS, H o u s to n D a v id R. M y e rs , DDS, M S, A u g u s ta , Ga
Esthetically pleasing restoration of young, frac tured or malformed permanent incisors has long been a perplexing problem for the dentist. Be cause of the large size of the pulp, esthetic restor ations have not been possible without endan gering the vitality of those teeth. Recent acidetch bonding techniques have been introduced that have partially solved that problem.1'3 Restoration of malformed and badly stained teeth with direct acid-etch bonding has shown some promise.4,5 However, the acrylic materials used leave much to be desired because of their poor resistance to abrasion and their discolora tion with age. Another difficulty has been the proper color matching of these materials with an adjacent tooth or the masking of dark discol orations that the tooth may have. Recent re search has demonstrated that marginal leakage and discolorations of composite restorations can be kept to a minimum by the use of seal ants.6,7 Although full veneer, direct bonding of com posite resins has been used to improve the ap pearance of discolored, mottled, or fractured teeth, it requires time and artistry by the dentist to achieve the desired results. To obtain a pleas ing result in color, bulk of the material is usually necessary. This article describes a direct-bonding tech nique with the use of preformed, tooth-shaded laminate veneers. 790 ■ JADA, Vol. 93, October 1976
■ Possible indications: Direct bonding of pre formed acrylic laminate veneers to permanent incisors is indicated for the esthetic restoration of fractured, malformed, or badly discolored permanent incisors if placement of a jacket or porcelain-veneered crown is not practical or if irreversible damage to the tooth may result. Preliminary evaluation has been conducted with extracted teeth to determine the feasibil ity of this technique for the esthetic restoration of incisors and to determine whether adequate retention is possible.
L a m in a te ve n e e r te c h n iq u e
The teeth are carefully examined (Fig 1) and proper laminate size and shade are determined. An alginate impression of the teeth to be restored is made, poured in white stone, and sent to the laboratory. The denture teeth,* corresponding to the size and shape determinations, are select ed (Fig 2) and hollow ground to a uniform 0.5 mm in thickness. They are then shaped to the labial contour of the teeth to be restored. ■ Preparation: The teeth to be restored are iso lated with a rubber dam (Fig 3) of medium weight since maximum gingival retraction is desired. It may be necessary to use dental floss ligatures to
Fig 1 ■ Labial and proximal views of teeth to be restored. Teeth should be carefully examined and proper laminate size and shade determined.
Fig 2 ■ Laminate veneers, corre sponding to size and shade of teeth to be restored, are selected. Denture teeth are then shaped to labial con tour of teeth to be restored.
Fig 3 ■ Teeth to be restored are isolated with rubber dam, and labial surfaces of enamel are etched with acid-conditioning solution. Teeth are then washed and dried. Sealant is applied to etched enamel, shown here, and also to inside of laminate veneer, and partially polymerized.
secure the rubber dam to prevent leakage. Any sharp comers near the fracture site are rounded and any caries present is removed. The entire labial surface of the enamel of the tooth that is to receive the laminate veneer is carefully etched with an acid-conditioning solu tion. This solution is gently applied with a cotton pledget and allowed to remain for one minute. The teeth are thoroughly washed and dried. At this time, the enamel should have a dull, frosted appearance. ■ Placement o f restoration: The sealant (Nuva-Sealt) is mixed according to the manu facturer’s instructions and carefully applied to the etched enamel (Fig 3) and the inside of the laminate veneer. The laminate veneer is placed aside and the sealant on it is partially polymer ized with ultraviolet light. Care must be taken not to place the sealant at the contact point of the teeth or they may be bonded together. If the sealant does contact these areas, a piece of un waxed dental floss may be used to remove it. The sealant on the enamel is then partially
Fig 4 ■ Filler is placed inside veneer, and ven eer pressed into place. Excess filler is removed. Sealant on tooth enamel and inside of veneer is then, polymerized for two to three minutes. Thus, filler is bonded to inside of veneer and to tooth enamel. Here, veneer on maxillary right central incisor is in place.
polymerized. The filler (Nuva-Filt) is sparingly placed inside the veneer, and the veneer is pressed into place. Excess filler is forced out around the margins of the veneer and care must be taken not to trap air bubbles. The excess filler is removed with a plastic instrument or explorer and a smooth marginal junction achieved with a wiping motion of the plastic instrument. Contact points are cleared with dental floss and the ven eer, filler, and sealant are polymerized together with ultraviolet light for two to three minutes. Thus the filler is bonded to the inside of the ven eer and to the tooth enamel (Fig 4). The veneer is then ready for finishing and sealing. ■ Finishing o f restoration: The margins of the restoration are lightly finished with sandpaper disks. After this is done, sealant is carefully placed over the marginal areas with a small cam el’s hair brush and polymerized with ultaviolet light. The rubber dam is then removed and the occlusion carefully checked (Fig 5). Any prema ture contact areas on the crown should be re moved with a stone and polished. Faunce—Myers: LAMINATE VENEER RESTORATION OF INCISORS ■ 791
Fig 5 ■ Labial and proximal views of teeth after restoration with laminate veneers.
Fig 6 ■ Labial and proximal views of restored teeth after two years.
S u m m a ry
Direct bonding of composite resins to fractured or discolored teeth has been shown to be a prac tical and effective method for restoring teeth. Previously, lack of uniform shade matching and excessive bulkiness of material have been asso ciated with full veneer bonding. The ultraviolet light (Nuva-Litet) in our stud ies penetrates veneers as thick as 2 mm and effec tively cures the filler material. We also have used cold-curing bonding materials (Concisei and Adaptic§) and they seem to be equally effective,, although working time is shortened. We have had no clinical problems with this technique and after two years the veneers are intact (Fig 6). A technique has been presented that requires no tooth reduction, except where necessary for caries removal, or time-consuming contouring and color shading. Laminate veneers enable the dental practitioner to obtain consistent esthetics with minimal chair time. Further evaluation of this technique to restore malformed, fractured, or discolored permanent incisors is being con ducted. 792 ■ JADA, Vol. 93, October 1976
Dr. Faunce is assistant professor of pedodontics at the Uni versity of Texas Dental Branch, 6516 John Freeman Ave, Hous ton, 77025. Dr. Myers is associate professor and chairman of the department of pedodontics, Medical College of Georgia School of Dentistry. Address requests for reprints to Dr. Faunce. *Trubyte Corp., York, Pa, 17404. +L. D. Caulk Co., Milford, Del 19963. t3M Corp., St. Paul, 55101. ¡¡Johnson & Johnson, New Brunswick, NJ 08903. 1. Buonocore, M.G. Principles of adhesive retention and adhe sive restoration materials. JADA 67:382 Sept 1963. 2. Laswell, H.; Welk, D.A.; and Regenos, J. Attachment of resin restorations to acid pretreated enamel. JADA 82:558 March 1971. 3. Oppenheim, M., and Ward, G. The restoration of fractured incisors using Nuva Seal and Adaptic. J Dent Res 52 (special issue): 185 abstract no. 507 Feb 1973. 4. Sheykholeslam, Z. The use of adhesive sealant for restora tion of enamel opacities. J Dent Child 41:204 May-June 1974. 5. Klaff, M., and Ward, G. Composite technic for restoration of malformed teeth. Dent Surv 49:34 March 1973. 6. Buonocore, M.G.; Sheykholeslam, Z.; and Glena, R. Evalu ation of an adhesive to prevent marginal leakage. An in vitro study. J Dent Child 40:119 March-Aprll 1973. 7. Buonocore, M.G., and Davila, J. Restoration of fractured anterior teeth with ultraviolet-light-polymerized bonding mater ials: a new technique. JADA 86:1349 June 1973.
Laminate veneer restoration of permanent incisors F ra n k R. F a u n c e , DDS, H o u s to n D a v id R. M y e rs , DDS, M S, A u g u s ta , Ga
Esthetically pleasing restoration of young, frac tured or malformed permanent incisors has long been a perplexing problem for the dentist. Be cause of the large size of the pulp, esthetic restor ations have not been possible without endan gering the vitality of those teeth. Recent acidetch bonding techniques have been introduced that have partially solved that problem.1'3 Restoration of malformed and badly stained teeth with direct acid-etch bonding has shown some promise.4,5 However, the acrylic materials used leave much to be desired because of their poor resistance to abrasion and their discolora tion with age. Another difficulty has been the proper color matching of these materials with an adjacent tooth or the masking of dark discol orations that the tooth may have. Recent re search has demonstrated that marginal leakage and discolorations of composite restorations can be kept to a minimum by the use of seal ants.6,7 Although full veneer, direct bonding of com posite resins has been used to improve the ap pearance of discolored, mottled, or fractured teeth, it requires time and artistry by the dentist to achieve the desired results. To obtain a pleas ing result in color, bulk of the material is usually necessary. This article describes a direct-bonding tech nique with the use of preformed, tooth-shaded laminate veneers. 790 ■ JADA, Vol. 93, October 1976
■ Possible indications: Direct bonding of pre formed acrylic laminate veneers to permanent incisors is indicated for the esthetic restoration of fractured, malformed, or badly discolored permanent incisors if placement of a jacket or porcelain-veneered crown is not practical or if irreversible damage to the tooth may result. Preliminary evaluation has been conducted with extracted teeth to determine the feasibil ity of this technique for the esthetic restoration of incisors and to determine whether adequate retention is possible.
L a m in a te ve n e e r te c h n iq u e
The teeth are carefully examined (Fig 1) and proper laminate size and shade are determined. An alginate impression of the teeth to be restored is made, poured in white stone, and sent to the laboratory. The denture teeth,* corresponding to the size and shape determinations, are select ed (Fig 2) and hollow ground to a uniform 0.5 mm in thickness. They are then shaped to the labial contour of the teeth to be restored. ■ Preparation: The teeth to be restored are iso lated with a rubber dam (Fig 3) of medium weight since maximum gingival retraction is desired. It may be necessary to use dental floss ligatures to
Fig 1 ■ Labial and proximal views of teeth to be restored. Teeth should be carefully examined and proper laminate size and shade determined.
Fig 2 ■ Laminate veneers, corre sponding to size and shade of teeth to be restored, are selected. Denture teeth are then shaped to labial con tour of teeth to be restored.
Fig 3 ■ Teeth to be restored are isolated with rubber dam, and labial surfaces of enamel are etched with acid-conditioning solution. Teeth are then washed and dried. Sealant is applied to etched enamel, shown here, and also to inside of laminate veneer, and partially polymerized.
secure the rubber dam to prevent leakage. Any sharp comers near the fracture site are rounded and any caries present is removed. The entire labial surface of the enamel of the tooth that is to receive the laminate veneer is carefully etched with an acid-conditioning solu tion. This solution is gently applied with a cotton pledget and allowed to remain for one minute. The teeth are thoroughly washed and dried. At this time, the enamel should have a dull, frosted appearance. ■ Placement o f restoration: The sealant (Nuva-Sealt) is mixed according to the manu facturer’s instructions and carefully applied to the etched enamel (Fig 3) and the inside of the laminate veneer. The laminate veneer is placed aside and the sealant on it is partially polymer ized with ultraviolet light. Care must be taken not to place the sealant at the contact point of the teeth or they may be bonded together. If the sealant does contact these areas, a piece of un waxed dental floss may be used to remove it. The sealant on the enamel is then partially
Fig 4 ■ Filler is placed inside veneer, and ven eer pressed into place. Excess filler is removed. Sealant on tooth enamel and inside of veneer is then, polymerized for two to three minutes. Thus, filler is bonded to inside of veneer and to tooth enamel. Here, veneer on maxillary right central incisor is in place.
polymerized. The filler (Nuva-Filt) is sparingly placed inside the veneer, and the veneer is pressed into place. Excess filler is forced out around the margins of the veneer and care must be taken not to trap air bubbles. The excess filler is removed with a plastic instrument or explorer and a smooth marginal junction achieved with a wiping motion of the plastic instrument. Contact points are cleared with dental floss and the ven eer, filler, and sealant are polymerized together with ultraviolet light for two to three minutes. Thus the filler is bonded to the inside of the ven eer and to the tooth enamel (Fig 4). The veneer is then ready for finishing and sealing. ■ Finishing o f restoration: The margins of the restoration are lightly finished with sandpaper disks. After this is done, sealant is carefully placed over the marginal areas with a small cam el’s hair brush and polymerized with ultaviolet light. The rubber dam is then removed and the occlusion carefully checked (Fig 5). Any prema ture contact areas on the crown should be re moved with a stone and polished. Faunce—Myers: LAMINATE VENEER RESTORATION OF INCISORS ■ 791
Fig 5 ■ Labial and proximal views of teeth after restoration with laminate veneers.
Fig 6 ■ Labial and proximal views of restored teeth after two years.
S u m m a ry
Direct bonding of composite resins to fractured or discolored teeth has been shown to be a prac tical and effective method for restoring teeth. Previously, lack of uniform shade matching and excessive bulkiness of material have been asso ciated with full veneer bonding. The ultraviolet light (Nuva-Litet) in our stud ies penetrates veneers as thick as 2 mm and effec tively cures the filler material. We also have used cold-curing bonding materials (Concisei and Adaptic§) and they seem to be equally effective,, although working time is shortened. We have had no clinical problems with this technique and after two years the veneers are intact (Fig 6). A technique has been presented that requires no tooth reduction, except where necessary for caries removal, or time-consuming contouring and color shading. Laminate veneers enable the dental practitioner to obtain consistent esthetics with minimal chair time. Further evaluation of this technique to restore malformed, fractured, or discolored permanent incisors is being con ducted. 792 ■ JADA, Vol. 93, October 1976
Dr. Faunce is assistant professor of pedodontics at the Uni versity of Texas Dental Branch, 6516 John Freeman Ave, Hous ton, 77025. Dr. Myers is associate professor and chairman of the department of pedodontics, Medical College of Georgia School of Dentistry. Address requests for reprints to Dr. Faunce. *Trubyte Corp., York, Pa, 17404. +L. D. Caulk Co., Milford, Del 19963. t3M Corp., St. Paul, 55101. ¡¡Johnson & Johnson, New Brunswick, NJ 08903. 1. Buonocore, M.G. Principles of adhesive retention and adhe sive restoration materials. JADA 67:382 Sept 1963. 2. Laswell, H.; Welk, D.A.; and Regenos, J. Attachment of resin restorations to acid pretreated enamel. JADA 82:558 March 1971. 3. Oppenheim, M., and Ward, G. The restoration of fractured incisors using Nuva Seal and Adaptic. J Dent Res 52 (special issue): 185 abstract no. 507 Feb 1973. 4. Sheykholeslam, Z. The use of adhesive sealant for restora tion of enamel opacities. J Dent Child 41:204 May-June 1974. 5. Klaff, M., and Ward, G. Composite technic for restoration of malformed teeth. Dent Surv 49:34 March 1973. 6. Buonocore, M.G.; Sheykholeslam, Z.; and Glena, R. Evalu ation of an adhesive to prevent marginal leakage. An in vitro study. J Dent Child 40:119 March-Aprll 1973. 7. Buonocore, M.G., and Davila, J. Restoration of fractured anterior teeth with ultraviolet-light-polymerized bonding mater ials: a new technique. JADA 86:1349 June 1973.
