Smile Restoration: Direct Veneers Facilitated by 3D Printing

A 55-year-old woman presented with caries, enamel fractures, discoloration, and slight misalignment of anterior teeth wanting to improve her smile. She had heavily restored dentition with stable posterior occlusion and bilateral group function. Due to high caries risk and a limited budget, direct resin veneers rather than indirect restorations were performed to restore dental health, function, and esthetics. A smile design was created for the patient's maxillary anterior incisors using exocad software. A wax-up model was printed with Rodin^® Model resin (Pac-Dent, pac-dent.com), and a clear retainer was created from the printed model. Incisions were made in the retainer to insert iMatrix^™ Clear mylar bands (Pac-Dent). The patient was anesthetized. Caries was removed, contacts broken, and enamel lightly prepared. After etching with PacEtch^™ Pro 38% phosphoric acid (Pac-Dent), all teeth were bonded using Rodin^® Bond dental adhesive (Pac-Dent). To maximize adhesive strength and minimize hypersensitivity, SensiGuard^™ HEMA-based desensitizer (Pac-Dent) was used as a primer. The Clear retainer was placed and the teeth were separated using the clear mylar bands. Rodin^® OptiFlow^™ II flowable composite (Pac-Dent) was injected into the retainer. Initial adjustments were accomplished with a carbide finishing bur and #15 blade. The iMatrix Clear composite polishing kit was used for the final polishing.

KEY TAKEAWAYS

Digital design technologies greatly improve the clinician's ability to rapidly prototype digital restorations.

Custom-made injection molds can be greatly enhanced with the innovative use of supplies like clear mylar bands.

To effectively create a direct veneer restoration, the flowable composite, bonding adhesive, and primer need to seamlessly integrate for definitive and esthetically pleasing results. This case used modern techniques in cosmetic and restorative dentistry and state-of-the-art materials to restore a patient's dental health, function, and esthetics while limiting costs.

Joshua Grenier, DMD
Private Practice, Coventry, Rhode Island

Figures and Images

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Figure 1

Fig 1. Preoperative view. The patient’s smile was misaligned and damaged. A smile study was conducted to ensure optimal esthetic results.

Figure 2

Fig 2. A wax smile guide was created and digitally scanned to create a 3D design file.

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Fig 3. The smile design fit was compared digitally to the patient’s smile for proper fit.

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Fig 4. A model was printed with Rodin Model material.

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Fig 5. Mylar matrices of 4.5 mm and 5.5 mm were taken from the iMatrix Clear kit to be used with the clear retainer.

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Fig 6. The printed model was used to create a clear retainer. Slices were added through contact areas to allow for the placement of the sectional clear matrix.

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Fig 7. Severe wear of the enamel required restorative treatment. Teeth Nos. 7 through 10 were prepared by removing broken, decayed, and decalcified enamel. Healthy enamel was left in place.

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Fig 8. Rodin Bond adhesive and SensiGuard desensitizer were prepared in dappen dishes to be applied to the teeth.

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Fig 9. After etching and application of Rodin Bond adhesive, Rodin OptiFlow II flowable composite was injected into the clear retainer. The clear mylar bands were added to break contacts.

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Fig 10. The patient’s dental health and function were fully restored while appealing esthetics and a more youthful smile were created.