Aesthetic Management of Fluoresced Teeth with Ceramic Veneers and Direct Composite Bonding – An Overview and A Case Presentation

Abstract

A 17-year-old girl was referred to the private clinic at Jaipur, Rajasthan for aesthetic management of discoloured teeth. The patient primarily complained of an unpleasant smile due to stained teeth. Detailed clinical history was elicited. The patient was born at full term in Gangapur, Rajasthan, India after an uneventful pregnancy and had stayed in the same region ever since. The medical history of the patient was non contributory. She had an elder brother who also suffered from a similar condition.Intraoral examination revealed generalized discolouration of her dentition. All teeth were affected with pitting and chalky white areas . The pits on the enamel were generalized and yellowish brown in colour. A diastema was present between the maxillary central incisors. Both the maxillary lateral incisors had Ellis class I fractures of their incisal edges and both maxillary canines had Ellis class I fractures of their cusp tips.The preparatory stage of the treatment started with smile analysis, preliminary shade selection, photographs and study models. The occlusion of the patient was determined as class I. The various treatment modalities for dental fluorosis including polishing, micro/ macroabrasion, dental bleaching, composite veneering, porcelain laminate veneers and full veneer crowns were explained to the patient's parents. After discussing the treatment options and considering the age of the patient and the severity of fluorosis, it was decided to place ceramic veneers on the maxillary incisors and canines. Direct composite veneers were planned for the maxillary premolars and mandibular incisors, canines and first premolars. The palatal margins of the veneer preparations were planned to be kept as a butt joint [1]. On assessment of the patient's smile, teeth as far as the second maxillary bicuspids could be seen, which did not necessitate involvement of the first molars.Before commencing the tooth preparation, direct composite mockup [Table/ Fig-1b] was done to build up the fractured teeth and to close the midline diastema. The size and shape of the teeth were approved by the patient and her parents. A polyvinyl siloxane impression was made and was used as a preparation template in the further procedures [Table/ Fig-2a&b]. Tooth preparation was first started with a 0.5 mm depth cutting diamond point and the depth grooves were marked with non-water-soluble ink. The labial and incisal tooth reduction was completed [Table/ Fig-3a] using the preparation template as a guide to gauge the depth of preparation.Proximal preparation was not carried out and the contacts were not involved. Only the mesial surfaces of the maxillary central incisors were included in the preparation.After adequate gingival retraction with a retraction cord (Ultrapak, Ultradent, South Jordan, Utah, United States), a two step dual impression was made and sent to the laboratory for fabrication of IPS e.max veneers (Ivoclar Vivadent AG, Schaan/Liechtenstain, Germany). Tooth discolouration is a common problem and affects people of all ages. Apar...

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