Journal of Interdisciplinary Dentistry

CASE REPORT
Year
: 2022  |  Volume : 12  |  Issue : 2  |  Page : 70--73

Esthetic rehabilitation of maxillary anterior teeth with porcelain laminate veneers


Bharath Makonahalli Jaganath, Sahadev Chickmagravalli Krishnegowda, Sandeep Rudranaik, Siri Parvathi Beedubail 
 Department of Conservative Dentistry and Endodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India

Correspondence Address:
Dr. Siri Parvathi Beedubail
Department of Conservative Dentistry and Endodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka
India

Abstract

This case report emphasizes on esthetic rehabilitation of maxillary anterior teeth with porcelain laminate veneers. A male patient aged 24 years reported with a chief complaint of spacing between teeth in the upper front teeth region. The patient was unwilling for orthodontic correction since time was the major constraint. A complete intraoral and extraoral examination was performed, preoperative photographs were taken, and study models were prepared. Tooth component, i. e., dental midline, incisal lengths, tooth dimensions, zenith points, axial inclinations, interdental contact area and point, incisal embrasure, symmetry, and balance, was observed. The soft-tissue examination included gingival health, interdental embrasure, and smile line. Clinical examination revealed diastema between 11, 12, 21, and 22. Discoloration was noted in 21 teeth, and the patient reported a history of root canal treatment for the same. Considering the esthetic need of the patient and the duration of treatment, porcelain veneers were planned for the correction of diastema. Tooth preparation for veneers was made with incisal overlap design with respect to 12, 11, and 22, and e-max crown was planned for 21. The advantages of this treatment include quick results, minimal tooth structure removal, long-term solution, better esthetics, and firm fit.



How to cite this article:
Jaganath BM, Krishnegowda SC, Rudranaik S, Beedubail SP. Esthetic rehabilitation of maxillary anterior teeth with porcelain laminate veneers.J Interdiscip Dentistry 2022;12:70-73


How to cite this URL:
Jaganath BM, Krishnegowda SC, Rudranaik S, Beedubail SP. Esthetic rehabilitation of maxillary anterior teeth with porcelain laminate veneers. J Interdiscip Dentistry [serial online] 2022 [cited 2022 Dec 8 ];12:70-73
Available from: https://www.jidonline.com/text.asp?2022/12/2/70/354448


Full Text

 Clinical Relevance to Interdisciplinary Dentistry



Proper diagnosis of mid line diastema and appropriate treatment planning, considering hard and soft tissue esthetics aids in obtaining better results in shorter duration of time.

 Introduction



Over the years, society has grown more beauty conscious which has led to increased demand for esthetic dental treatment.[1] Good dental appearance is an integral part of facial esthetics. The esthetic rehabilitation of maxillary anterior teeth poses a significant challenge to clinicians. Spacing greater than 0.5 mm between the proximal surfaces of adjacent teeth in the midline is defined as midline diastema by Keene.[2] Midline diastema, being a multifactorial aesthetic problem, needs multidisciplinary approach for diagnosis and devising an appropriate treatment plan.

Decision on choosing the treatment relies on careful differential diagnosis. This allows the clinician to choose between orthodontic or restorative options. Diastema caused due to tooth-size discrepancy is amenable to restorative options.[3] To attain success in the treatment of diastema, it is not only crucial that the patient understands various treatment options but while clinician also should be able to assess the clinical condition and patient's expectations. Although orthodontic treatment was considered to be the conservative approach for the correction of diastema, the potential chance of relapse has precluded its utilization as the first choice for treatment.[4] Furthermore, the longer time duration is another major factor that makes the patient express unwillingness for orthodontic treatment. Restorative options such as composite veneers or porcelain veneers are alternative treatment strategies that can offer the solution in considerably less period. Although composite veneers are comparatively less invasive, cost-effective, and single-stage procedures, ceramic veneers offer long-term solutions with better esthetics and firm fit.[5]

The present case report is an attempt to highlight the benefits of ceramic veneers in the management of diastema when the duration of the treatment procedure is a prime factor.

 Case Report



A male patient aged 24 years reported with a chief complaint of spacing between teeth in the upper front teeth region. A complete intraoral and extraoral examination was performed, preoperative photographs were taken, and study models were prepared. Tooth component, i.e., dental midline, incisal lengths, tooth dimensions, zenith points, axial inclinations, interdental contact area and point, incisal embrasure, symmetry, and balance, was observed. The soft-tissue examination included gingival health, interdental embrasure, and smile line. Clinical examination revealed diastema between 11, 12, 21, and 22. The discoloration was noted in 21 teeth, and the patient reported a history of root canal treatment for the same. The patient denied orthodontic correction due to the prolonged time needed for the treatment. Considering the esthetic need of the patient and the duration of treatment, porcelain veneers were planned for the correction of diastema. A written informed consent was obtained from the patient prior to treatment.

Treatment procedure

Diagnostic models of both maxillary and mandibular arches were obtained using elastic impression material and type IV die stone. The treatment began with a diagnostic wax-up. Desired results were verified with the mock-up. Informed consent was obtained from the patient. Scaling and root planning were accomplished. Shade selection was performed using Vita classical shade guide, followed by minimal tooth structure removal for porcelain laminate veneers for 11, 12, and 22, and e-max crown for 21. Tooth preparation was done with respect to 21 to receive an e-max crown. Further, tooth preparation was done starting with 12, followed by 11 and 22 for porcelain laminate veneers with incisal overlap design. Initially, depth cutting bur was used to remove a layer of enamel approximately measuring 0.3 mm at the incisal third, 0.5 mm at the middle third, and 0.7 mm at the cervical third of the teeth. The labial contour of the teeth was taken care by achieving two-plane reductions. Preparation was extended incisally overlapping the incisal third palatally. Proximally, margins were extended to the area just beyond contact points. A 0.5-mm deep chamfer finish margins were placed in the entire preparation using round end tapered bur. The teeth were finally prepared, and all internal line angles were rounded to reduce stresses leading to fracture of porcelain laminate veneers. Full-arch impression was taken using polyvinyl siloxane material – addition silicone. Impression of the opposing arch was taken using elastic impression material and was sent to the laboratory for IPS e.max porcelain veneers with respect to 11, 12, and 22, and e-max crown with respect to 2.

Veneer try-in and cementation procedure

Oral prophylaxis was carried out, followed by assessing the size, fit, shade, occlusion, and symmetry of the processed veneers. The patient's consent was obtained on the day of try-in and later sent to the laboratory for final finishing. On the day of cementation, teeth were isolated. The intaglio surface of the veneers and the e-max crown was treated with 4% hydrofluoric acid. Resin cement (3M ESPE Relyx U200 self-adhesive resin cement) was used for luting the veneers and e-max crown to the tooth. A 20 s curing for each tooth was further carried out [Figure 1].{Figure 1}

Postoperative care to be provided for porcelain laminate veneers was informed to the patient. A thorough follow-up was carried out for assessing if any marginal discrepancy, fracture lines, surface discolorations, etc., existed.

 Discussion



Orofacial esthetics has a significant role in people's lives, especially related to social interactions. Physical appearance and attractiveness are important for men and women alike. Components of orofacial esthetics include the shape of the tooth, position, size, color, and also gingival display.[6] Diastema is one of the most encountered clinical scenarios which needs great clinical expertise to handle. This clinical scenario greatly affects the self-confidence of the patient at public. The different treatment options for diastema closure are the orthodontic approach, restorations using direct composite resin, indirect composite resins, and ceramic veneers.[7] Although orthodontic treatment is a viable option, the patient preference has been found to be lesser due to the increased duration of treatment. Among the various restorative options, composite resin veneers are economical and easy to perform for the clinician. However, it has less resistance to wearing and also can be affected by surface stains. They need to be repaired or changed over the years due to staining. These disadvantages of composite resin make it inferior to porcelain veneers. Porcelain veneers exhibit excellent tissue response and the finished surfaces mimics a natural tooth. With its property of absorption, reflection, and transmission of the light exactly as natural tooth, it helps in transforming smile dramatically.[8] Considering the benefits of porcelain veneers in the management of diastema and the patient preference, porcelain veneers were the treatment of choice in the current case report.

A proper case selection is important while planning such a treatment approach. Indications of whether veneers should be used include diastema closure, restoration of localized enamel defects, discolored teeth resistant to vital bleaching procedures, the need for morphologic modifications, minor tooth alignment, mild-to-moderate fluorosis, and fractured teeth.[9] The contraindications are edge-to-edge bite, deep bite, bruxism, and other parafunctional habits.[10] In the present case, the patient had diastema with normal overjet and overbite, sufficient thickness of the enamel, and did not have any parafunctional habits.

Even though, porcelain laminate veneers preserve more tooth structure, there are certain limitations and various factors that can influence the survival rate. They include preparation design, vitality status of tooth, type of porcelain material, and adhesive system. In addition, parafunctional habits such as bruxism also can influence the survival rate. Among various manifestations of the failure of porcelain laminate veneers, fracture and debonding were commonly reported in clinical trials. Tooth fracture, dental caries, and periodontal disease have also been noted. The preparation, in this case, was entirely on the enamel without exposing the dentin, thus ensuring minimally invasive preparation of teeth. The use of porcelain laminate veneers offers an excellent combination of hardness, resistance, and resilience.[11] Literature reveals that lithium disilicate-based veneers have improved flexural strength and also provide high esthetic results.[12] A recent systematic review reported that the 10-year cumulative success rate of porcelain laminate veneers was 95%, when factors such as debonding, fracture, secondary caries, and need for endodontic treatment were considered reasons for the failure of the restoration. Furthermore, it was found that porcelain laminate veneers with incisal coverage presented lower failure rates.[13] In the current case, IPS e.max Press, which is based on lithium disilicate was employed with incisal coverage.

The follow-up of this case has shown to be a promising, reliable, and successful treatment approach. Thus, diastema closure was achieved with the use of IPS e.max Press ceramic veneers in a minimally invasive manner.

 Conclusion



One of the most common indications of porcelain laminate veneers is a case of diastema closure. It is the details that make porcelain laminate veneers more precious than other veneers. Since it is a reliable treatment option with better long-term clinical results, making it one of the most commonly employed clinical approaches for esthetic correction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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