Professional Documents
Culture Documents
Introduction
One of the most frequent reasons for seeking dental treatment or care is
discolored anterior teeth. Even persons having teeth with normal color often
request to have them more whiter. Treatment options include removal of
surface stains, bleaching, microabrasion or macroabrasion, veneering and
placement of porcelain crowns. Many dentists recommend porcelain crowns as
the best solutions for badly discolored teeth. If crowns are properly done with
the highly esthetic ceramic materials presently available, they have great
potential for being esthetic and long lasting. On the other hand, there are
increasing number of patients who do not want their teeth cut down! for
crowns and are electing an alternative, conservative approach such as veneers,
that preserves as much of the natural tooth as possible. Their treatment is
performed with the understanding that the conservative measures may be less
permanent!.
Discolorations maybe classified as
"# E$trinsic stains% E$trinsic stains are located on the outer surfaces of the
teeth.
&# Intrinsic stains% Intrinsic stains are those which are internal or present
with in the tooth structures.
Discoloration Cause
' (hite )luorosis
' *ight yellow )luorosis, aging, Tetracycline +Type
I#
' ,ark yellow +moderate stain# -ging, Tetracycline +Type II#
' .rown +dark stain# )luorosis, Tetracycline +Type I / II#
or endodontic therapy
' .luish gray +severe stain# Tetracycline stain or endodontic
therapy
' .lack 0aries, fluorosis, or amalgam stain
"
Extrinsic Discolorations:
Metallic Non-metallic
' Occupational e$posure to
metallic salts and with a
number of medicines
containing metal salts.
0haracteristics black staining
of teeth in people using iron
supplements.
0u causes a green stain in
mouth rinses containing 0u
salts.
-g1O
2
salt used causes a grey
colour.
3tannous fluoride causes a
golden brown discoloration.
' -re adsorped onto tooth
surface deposits such as
plaque 4 acquired pellicle.
' -etiological agents include
,iet.
.everages.
Tobacco.
Mouth rinses.
Other medicaments.
' 3taining effect due to
prolonged rinses with
chlore$hidine.
Originally the mechanism was thought to be breakdown of
chlorhe$idine, the oral cavity to a# form parachloraniline and b# it decreases
the bacterial activity such that partly metalised sugars were broken down and
degraded over time to produce brown'coloured compounds. 5ecently 2
mechanisms%
a# 1on'en6ymatic browning reaction decreased +Maillaro reaction#.
0hlorhe$idine accelerates the formation of the acquired pellicle +the
proteins and carbohydrates in the acquired pellicle could undergo a
series of condensation and polymeri6ation reaction leading to
discoloration of the acquired pellicle#.
b# The formation of pigmented sulphides of iron
&
tin
which then react with the metal ions to form metal sulphide.
increased level of iron are found in chlorehe$idine.
c# 7recipitation of dietary chromogens by chlorhe$idine
' Oellow 4 yellow brown stains are easier to remove than grey.
' Incisal halves of teeth respond to bleach more quickly than cervical
halves, due to thinner dentin.
T"e ad0anta&es of the dentist 'rescri(ed 4 "ome a''lied tec"ni1ue +night
guard vital bleaching# are%
"# The use of a lower concentration of pero$ide +generally "HG'"?G
carbomide pero$ide#.
&# The ease of application.
2# Minimal side effects.
=# *ower cost due to the reduced chair time required for treatment.
T"e disad0anta&es are%
"# The reliance on patient compliances.
&# The longer treatment time.
2# The +unknown# potential for soft tissue changes with e$cessively
e$tended use.
This uses an athletic style vacuum formed soft mouthguard and
currently available "HG carbamide pero$ide : containing materials to bleach
the teeth.
">
There are & basic regimens for the application of the whitening
solution.
a# 3leeping with the nightguard filled with the bleaching
material each night.
b# (earing the loaded nightguard during the day while
changing the solution every "P ' & hrs.
Treatment time is ='A weeks for nighttime bleaching and "'2 wks for
the daytime regimen of multiple applications.
Dentist 'rescri(ed-"ome a''lied tec"ni1ue: Ni&"t &uard 5 Matrix
(leac"in&6
"# -n alginate impression of the arch to be treated is made free of bubbles
and poured in cast stone.
Note% -fter appropriate infection control procedures, rinse the impression
vigorously, and then pour with cast stone. In complete rinsing of the
impression may cause a softened surface on the stone, which may result in a
guard which is slightly too small and irritates tissue.
&# Trim the resultant cast around the periphery to eliminate the vestibule
and thin the base of the cast.
2# -llow the cast to dry, and block out any significant undercuts.
=# The night guard is formed on the cast using a heat 4 vacuum forming
machine. -fter the machine has warmed up for "H mintues, a sheet of
H.&Q : H.2?Q might guard material is inserted and allowed to soften by
heat until it sags by "Q. Then close the top position of the machine
slowly and gently, and allow the vacuum to form the heat softened
material around the cast.
?# Kse a no. "" surgical blade in a bard'parker handle to trim in a smooth
straight cut about 2'? mm from the most apical portion of the gingival
crest of the teeth facially and lingually. This e$cess material is
removed first. Then remove the horseshoe shaped night guard from the
cast.
"F
A# Trim the edges of the night guard to a smooth te$ture using a sharp,
curved scissor until only about & mm of tissue +apically of gingival
crest# is covered, being sure the night guard does not engage tissue
undercuts. The night guard is completed and ready for delivery to the
patient.
D# Insert the night guard into the patients mouth and evaluate it for
adaptation, rough edges or blanching of tissue.
># )urther shortening +trimming# may be indicated in problem areas.
F# Evaluate the occlusion on the night guard with the patient in ma$imum
intercuspation. If the patient is unable to obtain a comfortable
occlusion due to premature posterior tooth contact, trim the night guard
to e$clude coverage of the terminal posterior teeth, as needed to allow
optimal tooth contact in ma$imum intercuspation.
"H# - "HG ' "?G carbamide pero$ide bleaching material is generally
recommended for this bleaching technique. "HG carbamide pero$ide
degrades into 2G <
&
O
&
and DG urea. .leaching materials containing
carbopol are recommended because it thickens the bleaching solution
and e$tends the o$idation process. To prolong the +carbopel
carbamide pero$ide#, hydro$y gel is now added.
""# Instruct the patient in the application of the bleaching solution into the
night guard. & or 2 drops of bleaching solution are placed onto the area
of each tooth to be bleached in the night guard.
If either of two primary side effects occur is sensitivity of the teeth or
irritated gingiva, the patient should reduce or discontinue treatment
immediately, and contact the dentist so the cause of the problem can be
determined.
It is recommended that only one arch should be bleached at a time,
beginning with the ma$illary arch. .leaching the ma$illary arch first allows
the untreated mandibular arch to serve as a constant standard for comparison.
Moreover, restricting the bleaching to one arch at a time reduces the potential
for occlusal problems which could potentially occur if the thickness of two
mouth guards were interposed simultaneously.
&H
,ue to the difficulty in bleaching tetracycline'stained teeth, some
clinicians advocated intentional 50T, with the use of a non'vital bleaching
technique in order to overcome this problem. (hile the esthetic result appears
much better than that obtained from e$ternal bleaching, this approach involves
all the inherent risks otherwise associated with 50T.
Microa(rasion and Macroa(rasion:
Microabrasion and macroabrasion represent conservative alternatives
for the reduction or elimination of superficial disolorations. -s the terms
imply, the stained areas or defects are abraded away. These techniques do
result in the physical removal of tooth structure and therefore are indicated
only for stains or enamel defects that do not e$tend beyond a few tenths of a
millimeter in depth. If the defect or discoloration still remains after treatment
with microabrasion or macroabrasion, a restorative alternative is indicated.
Microa(rasion:
In "F>=, Mc0loskey reported the use of ">G hydrochloric acid on
teeth for the removal of superficial fluorosis stains and white spots where
bleaching is not effective. 3ubsequently, in "F>A, 0roll modified the technique
to include the use of pumice with <0l to form a paste applied with a tongue
blade. This technique was called microabrasion! and involved the surface
dissolution of the enamel by the acid along with the abrasions of the pumice to
remove superficial stains or defects. 3ince that time, 0roll further modified the
technique, reducing the concentration of the acid to ""G along with increasing
the abrasiveness of the paste by using silicon carbide particles +in a water
soluble gel paste# instead of pumice. This product is marketed as 7rema!
compound +"FFH#.
' -ctually removes &&'&DNm of enamel 4 application.
It should be emphasi6ed that this technique involves the physical
removal of tooth structure and does not remove stains or defects through any
bleaching phenomenon.
"# Incipient caries is reversible if treated immediately. If however, the
carious lesion has progressed to have a slightly roughened surface,
microabrasion coupled with a reminerali6ation program is an initial
option, which if unsuccessful, can be followed by a restoration.
&"
&# The developmental discolored +opaque white 4 light brown# spot'
microabrasion is successful if the defect is superficial +or H.& : H.2
mm# if greater restoration is the treatment of choice.
3urface discoloration due to fluorosis also can be removed by
microabrasion if the discoloration is within the H.& : H.2 mm removal
depth limit.
3rocedure:
"# -pply rubber dam, protective glasses should be given to the patient to
shield the eyes from any splatter.
&# The 7rema paste in applied to the defective area of the tooth with a
special rubber cup which has fluted edges.
2# )or small locali6ed idiopathic white or light brown areas, a hand
application device is also available for use with the 7rema compound.
=# 7eriodically, the paste is rinsed away to assess defect removal.
?# The treatment areas are polished with a fluoride containing
prophypaste to restore surface lusture.
A# Immediately following treatment, a topical fluoride is applied to the
teeth to enhance reminerali6ation.
Macroa(rasion:
-n alternative technique for the removal of locali6ed superficial white
spots and other surface stains or defects is called macroabrasion!. It simply
utili6es a "& fluted composite finishing bur or micron finishing diamond in a
high'speed handpiece to remove the defect. 0are must be taken to use light
intermittent pressure and to carefully monitor removal of tooth structure in
order to avoid irreversible damage to the tooth.
)ollowing removal of the defect or upon termination of any further
removal of tooth structure, a 2H fluted composite finishing bur is used to
remove any factor or striations created by the previous instruments. )inal
polishing is accomplished with an abrasive rubber point.
&&
Microa(rasion Macroa(rasion
' Ensures better control of
the removal of tooth structure
' 5ecommended over
macroabrasion for the treatment
of superficial defects
' <igh speed
instrumentation.
' Is technique : sensitive
to operator ability.
' Is faster and does not
require the use of a rubber dam
' ,efect removal is easier
Cosmetic recontourin& !DCNA7 899$#
' 0an be used to reshape enamel, smooth incisal edges, round incisal
edges, open embrasures, reduce prominent surfaces or change line
angles.
' It is easily accomplished by lightly reducing enamel at moderate
speed with a small flame : shaped medium diamond followed by
an > or "& fluted carbide bur.
2eneers:
- veneer is a layer of tooth colored material that is applied to a tooth
for esthetically restoring locali6ed or generali6ed defects or intrinsic
discolorations.
Indications ,or 0eneers
' Tetracycline discoloration
' )lurosis discoloration
' Teeth darkened by age
' Irregular tooth positioning in the arch
' Malformed teeth
' Teeth discolored by endodontic procedures
&2
' Teeth with numerous visible cracks
' Teeth with numerous unsightly restorations
' Teeth denuded of superficial structure by acid deminerali6ation.
Contraindications ,or 0eneers
' <eavy occlusion
' Teeth in severe labial version +buck teeth!#
' Mouth breathers
' 7oor oral hygiene
' ,enuded dentin
' <igh fluoridated +fluorosed# teeth
Typically veneers are made of :
' 0hairside composite,
' 7rocessed composite
' 7orcelain
' 0ast ceramic materials.
-ccording to ,01-, "F>?, the current generation of materials and
concepts for veneers to teeth can be divided into three categories
"# )ree hand placed, composite or microfill
&# *aminate pre'formed
2# *aboratory formed, acrylic resin, microfill resin or porcelain
T'es:
' 7artial
' 0omplete
&=
artial veneers are indicated for the restoration of locali6ed defects
areas of intrinsic discolorations.
!ull veneers are indicated for the restorations of generali6ed defects or
areas of intensive staining involving the ma9ority of the facial surface of the
tooth.
<owever, several important factors including patient age, teeth
position and alignment, occlusion, tissue health, and oral hygiene must be
evaluated prior to pursuing full veneers. )urthermore, if full veneers are done,
care must be taken to provide proper physiological contours, particularly in the
gingival area, to favor good gingival health.
Full 0eneers
' ,irect technique
' Indirect technique
Direct tec"ni1ue% done when a small number of teeth are involved or
when the entire facial surface is not faulty +partial veneers#. ,irectly applied
composite veneers can be completed for the patient in one appointment with
chairside composite. 7lacing direct composite full veneers is very time
consuming and labor intensive. <owever, for cases involving young children,
a single discolored teeth or where economics or patient time are limited
precluding a laboratory fabricated veneer, the direct technique is a viable
option.
Indire"t veneers require two appointment but offer more advantages
over directly placed full veneers.
a# )irst, indirectly placed veneers are much less technique sensitive to
operator ability. 0onsiderable artistic e$pertise and attention to detail
are required to consistently achieve esthetic and physiologically sound
direct veneers. Indirect veneers are made by lab technician and are
typically more esthetic.
b# 3econd, if multiple teeth are to be veneered, indirect veneers usually
can be placed much more e$peditiously.
&?
c# Third, indirect veneers typically will last much longer than a direct
veneer, especially if made of porcelain or cast ceramic.
#ire"t: 3ome controversy e$ists regarding the e$tent of tooth preparation that
is necessary and the amount of coverage for veneers. 3ome operators prefer to
etch the e$isting enamel and apply the veneer over the entire e$isting facial
surface without any tooth preparation. The perceived advantage of this method
is that in case of failure or in the event the patient does not like the veneer, it
can be removed, thus being reversible. <owever, several significant problems
e$ist with this approach. In order to achieve an esthetic results the facial
surface of such a restoration must be overcontoured, thus appearing and
feeling unnatural. -n overcontoured veneer frequently results in gingival
irritation with accompanying hyperemia and bleeding due to bulbous and
impinging gingival contours. The veneers is more likely to be dislodged when
no tooth structure is removed before etching and bonding procedures. If the
veneer is lost it can be replaced, but the patient may live in constant fear that it
will happen again, possibly creating a embarrassing situation. The reversibility
of these veneers may seem desirable and appealing to patients from a
psychological standpoint, however, few patients who had to have veneers wish
to return to the original condition. -lso, removing full veneers with no damage
to the underlying unprepared teeth is e$ceedingly difficult if not impossible.
To consistently achieve esthetic and physiologically sound results, an intra
enamel preparation is almost always indicated. The only e$ception is in cases
where the facial aspect of the tooth is significantly under contoured due to
severe abrasion or erosion. In these cases more roughening of the involved
enamel and defining of the peripheral margins are indicated.
Intraenamel preparation +or the roughening of the surface in under
contoured areas# before placing a veneer is strongly recommended for the
following reasons%
"# To provide space for opaque, tinting, bonding and 4 or veneering
materials for ma$imal esthetics without overcontounting
&# To remove the outer fluoride'rich layer of enamel which may be more
resistant to acid etching.
2# To create a rough surface for improved bonding.
=# To establish a definite finish line.
&A
-nother controversy involves the location of the gingival margin of the
veneer. 3hould it terminate short of the free gingival crest, at the level of the
gingival crest, or apical to the gingival crestR
The answer depends on the individual situation. If the defect or
discoloration does not e$tend subgingivally, then the margin of the veneer
should not e$tend subgingivally.
The only logical reason for e$tending the margin subgingivally, is if
the area is carious or defective, warranting restoration, or if the area involves
significantly dark discoloration that presents a difficult esthetic problem.
5ecall that no restorative material is as good as normal tooth structure, and the
gingival tissue is never as healthy when it is in contact with an artificial
material.
Two basic preparation designs e$ists for full veneers
"# - Window! preparation and &# an incisal overlapping! preparation.
(indow preparation is recommended for most direct and
indirect composite veneer. This intraenamel preparation design
preserves the functional lingual and incisal surfaces of the
ma$illary anterior teeth, protecting the veneers from
significantly occlusal stress.
.y using a window! preparation, the functional surfaces are
better preserved in enamel. Their design reduces the potential
for accelerated wear of the opposing tooth.
Incisal lapping% preparation is indicated when the tooth being
veneered needs lengthening or when an incisal defect warrents
restoration. -dditionally, the incisal lapping design is
frequently used with porcelain veneers, because it not only
facilitates accurate seating of the veneer upon cementation, but
also allows for improved esthetics along the incisal edge.
Direct 0eneer tec"ni1ues:
7artial
)ull
&D
"# #ire"t partial veneers: 3mall locali6ed intrinsic defects or
discolorations are ideally treated with direct partial veneers.
Ste's%
"# 0leaning, shade selection and isolation with cotton rolls or rubber dam.
&# The outline is dictated solely by the e$tent of the defect and should
include all the discolored area.
2# Kse a coarse elliptical or round diamond instrument with air water
coolant to prepare the cavity generally to a depth of about H.? : H.D?
mm.
=# Ksually it is not necessary to remove all the discolored enamel in a
pulpal direction, however, the preparation must be e$tended
peripherally to sound, unaffected enamel.
?# Kse an opaquing agent for masking dark stain.
A# If the entire defect or stain is removal then a microfill composite is
recommended for restoring the cavity.
If a residual lightly stained area or white spot remains in enamel, an
intensively less translucent composite can be used rather than e$tending the
preparation into dentin to eliminate the defect.
Ste's%
The window! preparation is typically made to a depth roughly
equivalent to half the thickness of the facial enamel ranging from J H.? : H.D?
mm midfacially and tapering down to a depth of about H.& : H.? mm along the
gingival margin, depending on the thickness of enamel.
The preparation for a direct veneer normally is terminated 9ust facial to
the pro$imal contact e$cept in the area of a diastema. To correct the diastema,
the preparations are e$tended from the facial and the mesial surfaces,
terminating at the mesiolingual line angles. If the discoloration are not
involving the incisal edges, then it is not involved in the preparation. -lso,
preservation of the incisal edges better protects the veneers from heavy
functional forces as noted earlier for window! preparations.
&>
The teeth should be restored one at a time. -fter etching rinsing and
drying procedures apply and polymeri6e the resin bonding agent. 7lace the
composite on the tooth in increments, especially along the gingival margin to
reduce the effects of polymeri6ation shrinkage. -fter the first veneer is
finished, restore the second tooth in a similar manner. ,uring a second
appointment the remaining four anterior teeth are restored with direct
composite veneers.
In case of dark tetracycline stained teeth with the discoloration
e$tending subgingivally, the finish line is placed subgingivally.
Indirect 0eneer tec"ni1ue:
#rawba"$s o% dire"t veneering
"# 7reparation, insertion and finishing of several direct veneers at one
time is too difficult, fatiguing and time consuming. 3ome patients
become uncomfortable and restless during long appointments.
&# ;eneer shades and contour can be better controlled when made outside
+Indirect# of the mouth on a cast than direct technique.
Indire"t veneers in"lude those made o%:
"# 7rocessed composite
&# )eldspathic porcelain
2# 0ast ceramic
.ecause of superior strength, durability and esthetics, feldspathic
porcelain is by far the most popular material for indirect veneering techniques
used by dentist. 0ast ceramic veneers offer comparable qualities, but require
e$acting laboratory technique and allow only limited chairside finishing and
alteration of contourC however e$cellent laboratory support and the superb
marginal fit of these veneers can minimi6e or eliminate this disadvantage.
-lthough & appointments are required for indirect veneers, chair time is saved
because much of the work is done in the laboratory. E$cellent result can be
obtained when proper clinical evaluation and careful operating procedures are
followed. Indirect veneers are attached to the enamel by acid etching and
bonding with either a self cured, light cured or dual cured resin bonding
material.
&F
8# 3rocessed com'osite 0eneers:
0omposite veneers are processed in a lab to achieve superior
properties, using intense light, heat, vacuum, pressure or a combination of
these. 0ured composite can be produced which possess improved physical and
mechanical properties compared to traditional chairside composites.
-dditionally, indirectly fabricated composite veneers offer superior shading.
.ecause their composition is similar to chairside composite, indirect
composite veneer are capable of being bonded to the tooth with a resin
bonding medium.
-fter acid etching, a bonding agent is applied to the etched enamel as
with any composite restoration. - fluid resin bonding medium then is used to
bond the veneer in place.
- newly developed processed composite of the hybrid type, filled with
barium glass and colloidal silica, offers a significant increase in bond strength.
.ecause barium glass is a relatively soft radiopaque filler, it can be
sandblasted and etched in the lab with F : "HG of hydrofluoric acid to produce
numerous areas of microscopic undercuts, similar to the phenomenon that
occurs when enamel is etched.
Etched composite veneers.
7rocessed composite veneers are easily finished and polished. They
also can be replaced and repaired easily with chairside composite. ;eneers are
often recommended for placement in children and adolescents as interim
restorations until the teeth have fully erupted and achieved their complete
clinical crown length.
Indirect processed composite veneers are indicated for placement in
patient who e$hibit significant wear of their anterior teeth due to occlusal
stress. There offer esthetic affordable alternative to more costly porcelain or
castable ceramic types when economics is the primary consideration.
Etc"ed 'orcelain 0eneers:
The most frequently used indirect veneer type is the etched porcelain
+feldspathic# veneer. 7orcelain veneers etched with hydrofluoric acid are
2H
capable of achieving high bond strength to the etched enamel via a resin
bonding medium.
Ad0anta&es:
The etched porcelain veneers are
' <ighly esthetic
' 3tain resistant
' 7eriodontally compatible
' -ppear to significantly outlast composite veneers.
Indication:
@enerali6ed discoloration of the anterior teeth along with facial and
incisal hypoplastic defectsC a midline diastema will be closed as well when
porcelain veneer are replaced.
Incisal lapping preparation design is generally used for porcelain
veneers, especially if incisal defects warrant inclusion or the teeth need
lengthening.
The only difference in the procedure of bonding is the need to
condition the internal surface of each veneer with a silane primer 9ust prior to
applying the resin bonding agent. The silane acts as a coupling agent enabling
a chemical bond to occur between the porcelain and the resin. It also improves
wettability of the porcelain. The primary source of retention still remains the
etched porcelain surface. Only a modest increase in bond strength results from
silani6ation of the porcelain but is nonetheless recommended.
,arkly discolored teeth are more difficult to treat with porcelain
veneers.
<owever, several modifications in the veneering technique can be used
to enhance the final esthetic result.
a# Opaque porcelain is incorporated in the fabrication of the veneers
in order to induce more inherent masking +?'"?G opaque
porcelain#.
2"
b# - slightly deeper cavity preparation can be used to allow greater
veneer thickness. <owever, the preparation should always be
restricted to enamel to ensure optimal bonding of the veneer of
the tooth.
Casta(le ceramic 0eneers:
-nother esthetic alternative for veneering teeth is the use of castable
ceramics such as ,icor. Knlike etched porcelain veneers which are fabricated
by stacking and firing feldspathic porcelain, castable ceramic veneers are
literally cast using a lost wa$ technique. The castable ,icor veneer material
itself is grayish in shade and very translucent.
*ow fusing feldspathic shading porcelain fired onto the surface of the
veneer provide the final coloration. E$cellent esthetics and possible resin
castable ceramic materials for most cases involving mild to moderate
discoloration. <owever, due to the limited amount of intrinsic opaquing
possible with castable ceramic veneers, dark discoloration are best treated with
porcelain veneers.
The margins of castable ceramic veneers cannot be contoured and
finished with rotary instrumentation.
3ince shading of castable ceramic veneers is accomplished by surface
coloration, the use of rotary instrumentation on the veneer surface would result
in loss of their coloration revealing an unesthetic grayish appearance.
2eneers ,or existin& metal restorations:
Occasionally the facial portion of an e$isting metal restoration
+amalgam and gold# is 9udged to be distracting. - careful e$amination
including a radiograph is required to determine that the e$isting restoration is
sound before an esthetic correlation is made. The si6e of the offensive area
determines the e$tent of the preparation.
- no. & carbide bur rotating at high speed with air water coolant is
used to remove the metal and starting at a point midway between the gingival
and occlusal margins. The preparation is made perpendicular to the surface "
mm deep at a minimum leaving a butt 9oint at the cavosurface margins. The
"mm depth and a but 9oint should be maintained as the preparation is e$tended
occlusally. -ll the metal along the facial enamel is removed and the
2&
preparation is e$tended into the facial and occlusal embrasures 9ust enough for
the veneer to hide the metal. The contact areas on the pro$imal or occlusal
surface must not be included in the preparation. To complete the outline from,
the preparation is e$tended gingivally "mm past the mark indicating the
clinical level of the gingival tissue.
-fter it is etched, rinsed and dried, the cavity preparation is complete.
1ew adhesive resin liners containing a chemical called ='MET- capable
of bonding composite to metal, also may be used but are quite technique
sensitive. Manufacturer8s instructions should be followed e$plicitly to ensure
optimal results with these materials. The composite material is inserted and
finished in the usual manner.
Re'air o, 2eneers
)ailures of esthetic veneers occur because of breakage, discoloration or
wear. 0onsideration should be given to conservative repair of veneers if
e$amination reveals that the remaining tooth and restoration are sound. It is
not always necessary to remove all of the old restoration. The material most
commonly used for making repairs is light'cured composite.
2eneers on toot" structure
3mall chipped areas on veneers can often be corrected by recontouring
and polishing. (hen a si6able area is brokenC it can usually be repaired if the
remaining portion is sound.
)or direct composite veneers repair ideally should be made with the
same material that was used originally. The operator should roughen the
damaged surface of the veneer and 4 or tooth to a cavosurface margin. )or
more positive retention mechanical locks may be placed in the remaining
composite material with a small round bur. -n etching solution is applied to
clean the prepared area which is then rinsed and dried. - resin bonding agent
is applied to the preparation and polymeri6ed. 0hairside composite material is
then added, cured and finished in the usual manner.
Indirect processed composite veneers are repaired in a similar manner.
<owever, in order to repair porcelain veneers, a mild hydrofluoric acid
preparation, suitable for intraoral use, must be used to etch the fractured
porcelain, acid is applied washed and dried. - slightly frosted appearance,
similar to that of etched enamel should be seen if the porcelain has been
22
properly etched. - silane coupling agent may be applied to the etched
porcelain surface prior to the application of the resin bonding agent. 0hairside
composite material is then added, cured, and finished in the usual manner.
*arge fractures are best treated by replacing the entire porcelain veneers.
Conclusion:
Many a times, discoloration of the anterior teeth is the prime reason
that brings the patient to dental clinic for aesthetic correction. Ksing the above
mentioned techniques, we can do the needful for the patient. .ut these
techniques are not able to achieve the natural tooth esthetic qualities. 3o
patient should be informed about this prior to the treatment itself. Every effort
should be made to learn and deliver proper esthetic techniques for discolored
anterior teeth cases.
Re,erences
' 3turdevant.
' @rossman +S
th
and 4 SI
th
Edition#.
' 0ohen +A
th
Edition#.
' (eine.
2=
TREATMENT OF DISCOLORED TEETH
CONTENTS
Introduction
Types of 3tains
' Intrinsic
' E$trinsic
Treatment
' .leaching
o ;ital
o 1on vital
' Microabrasion
' Macroabrasion
' ;eneers
7artial
)ull
' 7reparation
' ,irect and Indirect techniques
' Etched porcelain veneers
' 0astable ceramic veneers
' ;eneers for metal restoration
' 5epair of veneers
0onclusion
5eference
2?