Dental Asia January/February 2019

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User Report associated with the veneer (transparent) was selected. The colour matching of the Componeer relies on the concept of natural layering, in which two layers of the incremental technique is able to mimic the natural aspect of the teeth. Fig. 1b: Direct restoration with Brilliant NG composite (A2/B2 dentin) Fig. 1c: Size selection with the Contour Guide Moisture was controlled with a rubber dam and a new restoration was placed on tooth # 22 to reestablish the original anatomy (Fig. 1b). The treatment proceeded with the selection of the PCRV size (medium), using the contour guide specific to the Componeer (Fig. 1c). This contour guide presented different sizes of PCRV for the antero-superior and inferior tooth, which enables the dentist to select the correct size for each patient, respecting the fundamentals of the aesthetic smile. was etched with 37% phosphoric acid (Magic Acid, COLTENE) for 30 seconds, followed by abundant water rinse and air drying. The adhesive system One Coat Bond (COLTENE) was applied with a Technobrush (COLTENE) on the Fig. 1d: Tooth reduction to receive the PCRV tooth and on the internal surface of PCRV. The Brilliant NG composite resin (A2/B2 dentin) was used as the luting agent. Clinical steps of tooth wear, adhesive procedure and cementation were executed without the use of a rubber dam. However, it is important to note that the control of moisture was ensured through the insertion of the retraction cord (Pro Retract 0000, FGM). Such technique allows a satisfactory control of the gingival fluid and facilitates the correct positioning of PCRV. Fig. 1e: Placer Instrument of the Componeer system The veneer was fixed on the tooth with the instrument “Placer” included in the Componeer system (Fig. 1e). Excess resin was removed after a slight compression of the PCRV. The light-curing was carried out with an LED (Radii cal, SDI) with an irradiance of 1.200 mW/cm 2 for 40 seconds. The excess resin was removed and no final polishing was required due to manufacturers’ pre-polishing of the PCRV (Fig. 1f). The patient was extremely pleased with the result. Case 2: Multiple restorations with PCRV In addition to single element (case 1), the PCRVs are also indicated for extensive rehabilitations. A 37-year-old female patient presented with an unhappy smile. Clinical examination revealed some deficient restorations (class III and IV) with multiple colour changes (Fig. 2a). As the patient requested urgency in the treatment, a one-visit technique using PCRVs was suggested. The restorations were removed with diamond burs (Fig. 2b), followed by the relief of the interproximal contact with abrasive stainless-steel strip (Fig. 2c). The teeth #13-23 were reduced to a minimum of 0.5 mm with a diamond bur in the buccal surface to facilitate the PCRV insertion. A haemostatic gel (Hemosthase, FGM) was applied in the gingival margin to contain possible bleeding (Fig. 2d), and a single retractor cord (ProRetract 0000, FGM) was inserted to control moisture (Fig. 2e). Subsequently, the contour guide was used A minimal preparation was performed on the buccal surface with a diamond bur #2068 (KG Sorensen) to facilitate the setting of the PCRV (Fig. 1d). The dental wear did not involve the dentin. It is important to highlight that there is no specific amount of dental wear for luting a PCRV, and the dentist should evaluate minimal wear to facilitate the luting procedure. The dental substrate Fig. 1f: Final aspect Fig. 2a: Initial situation 42 DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>
User Report Fig. 2b: Tooth preparation Fig. 2c: Interproximal reduction with abrasive stainless-steel strips Fig. 2d: Application with haemostatic gel Fig. 2e: Insertion of retraction cord Fig. 2f: Dry proof of PCRV Fig. 2g: Acid-etching to select the veneer size (medium) and a dry proof with the PCRV was performed to view the possible final result (Fig. 2f). The colour matching was performed as described in case 1, and the Brilliant NG composite resin (A1/B1 dentin) and PCRV (Bleach) were selected. A mylar strip (Epitex, GC) was inserted into the proximal regions and fixed with a wood wedge (TDV) to facilitate cervical adaptation during cementation. The teeth were etched for 30 seconds with 37% phosphoric acid (Magic Acid, COLTENE) (Fig. 2g), followed by abundant rinsing and drying. The adhesive One Coat Bond (COLTENE) was applied with a Technobrush (COLTENE) and gently airdried to remove the excess. The same adhesive system was also applied on the internal surface of the PCRV (Fig. 2h). The Brilliant NG composite resin (A1/B1 dentin) was manipulated in a sterile glass plate to facilitate the manipulation and adaptation into the PCRV. A Componeer system instrument was used to seat the PCRV and remove the excess resin. Photoactivation was performed as described in case 1 (Fig. 2i). Cervical and proximal polishing was performed with abrasive disks (Diamond Pro, FGM), felts and diamond paste. The patient was satisfied and very happy with the result. Finally, the proper alignment of the teeth, desirable tooth shade and harmonious smile of the patient was achieved (Fig. 3). Discussion There are different techniques available for anterior restorations. The design of the tooth preparation can be extensive (ex. total crown) or minimally invasive (ex. veneers). 5 Although different, both crown and veneer treatments require multiple clinical and laboratory steps. Therefore, the single session required in the treatment with PCRV attracted a lot of attention in the dental community. 17,19-21 Fig. 2h: Application of adhesive on the PCRV Fig. 2i: Light-curing with LED Ceramic veneers have been considered the gold standard due to their wellknown properties. 8-9 A previous study reported high survival rate of ceramic veneers, especially when the luting procedure is limited to enamel tissue. 9 Additionally, the literature reported that the ceramic type and the extension of dental wear corroborate to the satisfactory results obtained. 2,3,9 A wellknown veneer alternative is based on the use of direct composite resin. This technique provides a high reproduction of details due to the greater number of composite with different shades. However, some drawbacks such as colour instability associated with the difficulty to execute the restoration, render this technique a JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 43
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Dental Asia January/February 2019

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