A technique for direct placement of transitional anterior resin veneers
JOHN P. LAZARUS, D.D.S.
When developing a treatment plan for anterior veneers, I find it useful to consider using direct resin buildups.1 This not only lets the patient evaluate the direction of the rehabilitation and provide feedback, but it also allows me to refine the definitive restorations, thus achieving functionally and esthetically superior results. A problem often encountered is how to restore the multiple surfaces on several teeth (in this case, teeth nos. 23 through 26) and establish a reasonable initial contour and interproximal contacts. Rendering these with a free hand can prove difficult and time-consuming. Below, I describe a simple technique to facilitate the placement of such interim/transitional resin veneers.
THE PROCEDURE
First, obtain diagnostic casts and interocclusal records, and mount the casts to an articulator. Instead of using a traditional diagnostic wax-up approach, which would require a duplicate cast, apply light-cured flowable resin directly to the original model. Cure and shape as desired.
Sculpt the new diagnostic model along the gingival crest (marked in red in Figure 1
) to better define the sulcus, thus allowing a more tightly adapted matrix. Next, vacuum form a sheet of clear thermoplastic resin to make the custom coping, paying particular attention to the gingival crest area.
Trim the custom coping and, using a scalpel blade, carefully slice vertically through the proposed interproximal contacts to the height of the papilla. This is to allow insertion of customized matrix strips. I usually use clear matrix strips, but also have had success with metal strips (Figure 1
). The custom coping/matrix is then fitted in the patient’s mouth to ensure that it can be seated properly. Next, pumice, etch and coat the teeth with bonding agent in the usual manner.
The dentist then fills the custom coping/matrix with a flowable microhybrid resin2 and seats it over the teeth. While the dentist maintains the matrix’s position, the dental assistant can cure the resin. When the resin is completely cured, remove the interproximal strips and then the custom coping/matrix. The resin veneers can now be easily sculpted with the rotary instrumentation of choice. Contour and shape the resin veneers with a variety of rotary diamonds and carbide burs. Complete the process using finishing strips, cups, disks and points (Figure 2).
CONCLUSION
This technique saves considerable chairside time and yields adequate interproximal adaptation and morphology for multiple, transitional, anterior resin veneers.
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FOOTNOTES
Dr. Lazarus is a staff dentist, Department of Veterans Affairs, the VA of Western New York Healthcare System, Dental Service-160, 3495 Bailey Ave., Buffalo, N.Y. 14215, e-mail "john.lazarus{at}med.va.gov". Address reprint requests to Dr. Lazarus.
The author expresses his appreciation to Mary Alice Conaway for her assistance in preparing the manuscript.
REFERENCES
- McIntyre F. Restoring esthetics and anterior guidance in worn anterior teeth: a conservative multidisciplinary approach. JADA 2000;131:1279–83.
- Fahl N Jr. Achieving ultimate anterior esthetics with a new microhybrid composite. Compend Contin Educ Dent 2000;21(26 supplement):4–13; quiz 26.
