September 2012, Volume 8, Issue 9
Published by AEGIS Communications
An established technique is revisited with new technologies.
While the “invention” of veneering anterior teeth by Pincus was presented in 1937,1 it became really popular in the mid-1970s, using three different approaches: direct bonding by means of resin composites; prefabricated composite veneers; and indirect, custom-made porcelain veneers, although this option did initially not benefit from proper adhesive cementation procedure.2-4 The prefabricated composite veneer (Mastique®, DENTSPLY Caulk, www.caulk.com) was then explored about 35 years ago, using a methyl-methacrylate matrix and large glass fillers, such as that used in resin composites,3,4 but with limited success due to technological limitations and poor surface qualities.5 The breakthrough in porcelain veneering techniques happened shortly later with the development of true adhesive cementation toward enamel by Rochette (1975)6 and toward ceramic, through etching, by Calamia and Simonsen (1983).7 From that moment, this technique underwent considerable success and development. Conversely, the rapid loss of surface gloss and surface degradation of prefabricated resin veneers linked to some interfacial defects led the system to be soon abandoned.
Recently, the concept of prefabricated veneers was revitalized, leading to the launch of two composite systems and one ceramic system. The first composite system, the Edelweiss™ Composite Veneer system (Ultradent Inc., www.ultradent.com) is based on high pressure molding and heat-curing processes, followed by laser surface vitrification,8 while the Componeer™ veneers (Coltene, www.coltene.com) are molded and light-cured without any specific tempering or surface process. The ceramic system Cerinate One-hour™ (DenMat, www.denmat.com) is made of pressed, leucite-reinforced material with a glazed surface.
Among the two composite options, the Edelweiss system exhibits superior properties and is taking advantage of new technologies, which enables the veneers to exhibit a hard and glossy surface.8 Although little is known about the long-term performance of these prefabricated veneer restorations, they all make use of recognized dental materials and undoubtedly fill a gap in the therapeutic armamentarium.
The aforementioned prefabricated veneer systems do not aim to systematically replace the well-established individualized porcelain veneer technique, but rather offer an alternative to direct, freehand composite veneers, which is a delicate and time-consuming technique. The prefabricated veneers then present an obvious potential in the following indications:
1. Single Facial Restorations
• large restorations/decays with loss of natural tooth buccal anatomy/color
• nonvital, discolored teeth
• traumatized, discolored teeth (without endodontic treatment)
• severe/extended tooth fracture
• extended tooth dysplasia or hypoplasia
2. Full-Smile Rehabilitation
• moderate to severe discolorations (ie, tetracycline staining and fluorosis)
• generalized enamel hypoplasia/dysplasia (ie, amelogenesis imperfect IIIA)
• large serial restorations/decays with loss of natural tooth buccal anatomy/color
• attrition of incisal edges (after proper occlusal and functional management)
• financial limitations
• young patients with immature gingival profiles
In fact, the aforementioned indications cover the accepted application field of “classic” veneers, while other mere cosmetic indications are to be considered controversial with this technique. Actually, when an esthetic enhancement of virgin and healthy teeth is considered, a veneering technique has to be considered suboptimal, especially when treating young patients.9 The other major advantage of this “different” veneering approach is the relatively cost-effective and straightforward solution featuring a “one-appointment” treatment; however, this should not be considered an argument that would overrule proper biomechanical judgment or make it preferable to indirect, custom-made ceramic veneers. In fact, this new, alternative treatment option falls fully in the “bioesthetic concept,”9 which focuses on biology and biomechanics as much as it does on esthetics.
The clinical application features normal procedures of a veneering technique, starting with a microinvasive preparation and normal adhesive procedures both on the tooth and restoration side. In fact, the main distinction relates to the adaptation of the veneer peripheral, proximal, and cervical outlines as well as normally the inside profile, to minimize the need for additional tissue removal. Figure 1 through Figure 8 present two different applications of prefabricated veneers; the first case illustrates a full-smile rehabilitation of tooth wear while the second one also shows the potential for a “partial” treatment such as the replacement of two very large, unesthetic anterior restorations.
The concept for prefabricated composite veneers was introduced in dentistry about 35 years ago but with rather limited success due to former technological limitations. As a result, this attractive treatment option was abandoned and replaced by indirect, individualized porcelain veneers. The “former” idea was then recently revisited, taking advantage of modern technologies via, for instance, the introduction of a surface laser vitrification for the composite option or a glazing of the pressed ceramic veneers, enabling the production of a more resistant and glossy surface. However, these “rejuvenated” techniques will not replace indirect conventional and “custom-made” ceramic veneers, but rather offers clinicians a one-visit, cost-effective alternative to directly (or freehand) built-up composite veneers; it will then fill in gaps in the modern treatment armamentarium with application potential for young or less privileged patients showing localized or generalized hypoplasia/dysplasia, discoloration, or severely decayed anterior dentition.
The author is a consultant for Edelweiss Dentistry GmbH (Austria), and received material support for this article from Edelweiss Dentistry.
1. Pincus CL. Building mouth personality. Paper presented at: California State Dental Association, 1937: San Jose, California.
2. Faunce FR, Myers DR. Laminate veneer restoration of permanent incisors. J Am Dent Assoc. 1976;93:790-792.
3. Helpin LM, Fleming JE. Laboratory technique for the laminate veneer restoration. Pediatr Dent. 1982;4:48-50.
4. Haas BR. Mastique veneers: a cosmetic and financial alternative in post-periodontal care. J N J Dent Assoc. 1982;53:25–27.
5. Jensen OE, Soltys JL. Six-month clinical evaluation of prefabricated veneer restorations after partial enamel removal. J Oral Rehabil. 1986;13:49-55.
6. Rochette AL. A ceramic restoration bonded by etched enamel and resin for fractured incisors. J Prosthet Dent. 1975;33:287-293.
7. Calamia JR. Etched porcelain facial veneers: a new treatment modality based on scientific and clinical evidence. NY J Dent. 1983;53:255-259.
8. Dietschi D, Devigus A. Prefabricated composite veneers: historical perspectives, indications and clinical application. Eur J Esthet Dent. 2011;6:178-187.
9. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent. 2008;3:14-29.
About the Author
Didier Dietschi, DMD, PhD, Privat-Docent
Department of Cariology & Endodontics
School of Dentistry
University of Geneva
Department of Comprehensive Dentistry
Case Western University
Private Practice & Education Center
The Geneva Smile Center