Smile makeover with composite veneers using injection moulding - Dr. Stephen D'souza

Case report:

This 27-year-old male visited us with concerns about his smile. He disliked the gaps between his anterior teeth and sought treatment to “lessen the size of the central incisors,” as they appeared “large” compared to his other teeth while smiling. (Fig. 1)

We examined his teeth and took high-quality photographs with a DSLR camera. We noted his upper central incisors were quite large compared to the lateral incisors and the teeth also had some amount of tooth wear. There were spaces between the teeth, and overall, his smile appeared disproportionate.

Problem list: (Fig. 2)

• Spacing
• Disproportionate anterior teeth
• Malalignment
• Worn edges of the teeth

We presented treatment options to the patient, and he declined orthodontic treatment. He inquired if any options did not involve cutting teeth. We informed him about direct composite veneers and decided to proceed with a wax-up. (Fig. 3) Shade matching was done.

We planned to treat his anterior teeth and the first premolars on both sides, given his wide smile. Impressions were made, and a wax-up addressing our problem list was fabricated. We decided to test-drive the mock-up by transferring it with ProTemp by 3M (bis-acrylate composite).

We noted the changes to be made during the mock-up transfer, especially with the left canine, as it looked bulky and longer. We also decided to add more volume to the premolars. (Fig. 4)

After we were satisfied with our mock-up and finalized it, we planned on fabricating the final veneers with an injection moulding technique. The changes were minimal, which would work well with injection moulding of composite. The material of choice was Filtek Supreme Restorative Flowable by 3M, as it contains 65% filler content. For injection moulding, a clear silicone matrix was made using Exaclear by GC.

On the day of fabrication of the veneers, we commenced treatment with etching and bonding. Flowable composite is injected into the silicone mould through a vent that is created using a bur on an airotor. The position of the vent is preferred to be slightly labial on the incisal edge.

While injection moulding flowable composite, it is vital to cover the adjacent teeth to prevent excess composite from flowing onto them. We used PTFE tape (polytetrafluoroethylene) on the adjacent teeth while the veneer was being moulded (Fig. 5). Alternatively, “place-holders” (veneers fabricated on dental casts) can be used, which are prepared on a cast and placed on adjacent teeth while injecting.

Excess was removed before proceeding with moulding of the other teeth. Finishing and polishing were done with Sof Lex discs and spirals by 3M.

The final outcome eliminated the spaces between teeth. It also resulted in the teeth being proportionate and fairly aligned (Fig. 8 - 11). The patient was extremely happy with the results.

Discussion:

Direct composite veneers are additive, and thus there is no requirement for tooth preparation. Being minimally invasive, the aesthetic outcomes are excellent. As the literature suggests, composite veneers can be considered long-lasting, even though they may require more frequent maintenance visits. Injection moulding allows the clinician to have superior anatomic details without sculpting this directly in the mouth. As the veneers are moulded, the finishing required is minimal, and the procedure is completed relatively quickly.

In this case, the changes required were minor and thus were a good selection for injection moulding. Shade selection was appropriate and increasing the size of the teeth allowed for a proportionate appearing smile. The left lateral incisor was comparatively more labially placed than the right, and it appears bulkier than the other teeth. It would require some trimming to correct it, and we decided against it as it did not significantly affect the final smile. Including the first premolar teeth in this smile design was important as the patient had a wide smile. We can hope to see these veneers last long with regular maintenance appointments and proper hygiene. Any repairs in the future, if needed, will be relatively simple as composite can be added fairly easily. None of the teeth were cut, and thus the procedure was minimally invasive.

Author: Dr. Stephen D'souza

Dr. Stephen Dsouza BDS | MSc (Aesthetic Dentistry) is a private practitioner in Mumbai and the founder of The Happy Tooth Dental Clinic. He focuses on Aesthetic and Restorative Dentistry. He practices minimally invasive dentistry.

Tags: