International Journal of Oral Care and Research

CASE REPORT
Year
: 2020  |  Volume : 8  |  Issue : 1  |  Page : 14--16

Aesthetic correction of discolored fluorosed anteriors with porcelain laminate veneers: Case report


Sanju Dahiya, Monika Ahlawat, Amit Gandhi, Ambica Khetarpal, Meenakshi Gill, Neha Singhal 
 Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Jhajjar, Haryana, India

Correspondence Address:
Monika Ahlawat
H.NO. 1049, Sector-2, Rohtak 124001, Haryana.
India

Abstract

Restoration of smile is one of the most gratifying services, which can be rendered to a patient by a dentist. Veneer is a thin layer of tooth-colored material, which is applied to tooth surface to correct the enamel defects, intrinsic discoloration, and malaligned or malformed teeth. Porcelain laminate veneer is a conservative, minimally invasive alternative to full-coverage restoration that has evolved over the last several decades. This article presents conservative aesthetic procedure in the management of teeth affected with fluorosis using porcelain laminate veneers.



How to cite this article:
Dahiya S, Ahlawat M, Gandhi A, Khetarpal A, Gill M, Singhal N. Aesthetic correction of discolored fluorosed anteriors with porcelain laminate veneers: Case report.Int J Oral Care Res 2020;8:14-16


How to cite this URL:
Dahiya S, Ahlawat M, Gandhi A, Khetarpal A, Gill M, Singhal N. Aesthetic correction of discolored fluorosed anteriors with porcelain laminate veneers: Case report. Int J Oral Care Res [serial online] 2020 [cited 2021 Oct 24 ];8:14-16
Available from: https://www.ijocr.org/text.asp?2020/8/1/14/281343


Full Text



 Introduction



The most artistic piece of work, which can be delivered to a patient by a cosmetic dentist, is the restoration of smile to make it more beautiful.[1] Porcelain laminate veneer is a tooth-colored material and is a conservative treatment alternative to full-coverage restoration that has evolved since 1983 to harmonize the aesthetics.[2] It is a minimally invasive treatment option for the restoration of beautiful smile.[3],[4] Veneers are biologically compatible with periodontium and can be delivered with minimum preparation.[5],[6] Porcelain laminate veneers have excellent aesthetics, mechanical, and optical properties along with the preservation of tooth structure. Therefore they can be specified in cases such as small enamel defects such as cracks, for rectifying midline diastemas, spacing, malformed, malpositioned teeth, teeth pretentious with fluorosis and tetracycline stains.[7],[8]

 Case Report



A 21-year-old female patient reported to the department of conservative dentistry and endodontics with the chief complaint of yellowish discoloration of her upper front teeth. A detailed history was taken with no relevant medical history. Past dental history revealed that none of her family members had similar defects. No abnormal findings were noted in extraoral examination. Intraoral examination revealed dental fluorosis affecting maxillary anterior teeth. All the teeth were vital with no relevant history of hypersensitivity. Various treatment options such as bleaching, composite veneering, and porcelain laminate veneers were explained and discussed with the patient. Owing to the requirement of minimum preparation and in the interest of the patient, it was decided to use porcelain laminate veneers.

 Procedure



Preoperative photos [Figure 1] and impression of both arches were obtained for diagnostic cast. Shade selection was carried out in natural daylight using a color scale (VITA Toothguide 3D-MASTER, Zahnfabrik H. Rauter GmbH. & Co.KG Spitalgasse, Germany).{Figure 1}

Depth orientation grooves were placed on facial surface providing a depth of 0.3mm on gingival region and 0.5mm on incisal half using depth cutter diamond bur. The remaining tooth structure was removed using round end tapered diamond bur. Chamfer finish line was given at the level of gingival crest [Figure 2].{Figure 2}

Tooth preparation proximally was extended to contact areas without breaking contact to conserve interproximal enamel. An overlapped incisal edge preparation was chosen, which provides a vertical stop to aid in correcting the positioning of the veneer. The finish line on lingual surface was prepared using round end tapered diamond bur, which connected the two proximal finish lines. The preparation was refined by rounding the sharp angles. After finishing the preparation, occlusal contacts were checked during jaw movements. A putty wash impression was made using polyvinyl siloxane after gingival retraction [Figure 3]. Temporization was carried out with tooth-colored acrylic resin, and composite resin was used to temporize them.{Figure 3}

 Cementation



Temporized veneers were removed, followed by cleaning and drying of teeth. The porcelain veneers (IPS e.max, Total Prosthetic Solutions Dental Lab, Delhi, India) were then tried on to the teeth and checked for fit and aesthetics. After the checks were complete, the veneers were etched with 5% hydrofluoric acid for 20s. Veneers were washed and dried. The inner surface of veneers was coated with silane-coupling agent (Monobond N; Ivoclar Vivadent, AG Schaan Liechtenstein USA) and allowed to dry for 1min. Then, the etching of the teeth was carried out with 37% phosphoric acid for 15–20s, rinsed thoroughly with water, and dried. A layer of bonding agent (Adper; 3M ESPE, St. Paul, MN, USA) was applied on tooth surface and cured for 20s. Veneers were bonded to teeth with dual cure resin cement (RelyX; 3M ESPE), and cement was applied on the inner side of veneers. They were then positioned on to the teeth with gentle pressure, and excess cement was removed using a probe. Light curing of the composite was performed for 10s. Polymerization was started from the lingual side, followed by curing on the facial side for 60s, which was followed by light curing the other areas of veneers for 40s [Figure 4]. Occlusion and contact points were checked to avoid interferences during protrusive movements.{Figure 4}

 Discussion



Aesthetic rehabilitation with ceramic laminates is a preferred restorative option due to its minimal tooth tissue removal and adhesive mechanism of bonding to tooth structure.[7] It is considered as one of the most conservative treatments, which is able to modify the shape, size, and color of teeth with the thickness ranging from 0.2 to 0.5mm. Porcelain veneers are capable of providing an extremely faithful reproduction of natural teeth with great color stability.[5] Three types of incisal preparation have been described—window, incisal bevel, incisal overlapped, and feather preparation.[9] The long-term success of ceramic veneers depends on proper case selection and treatment planning procedures such as shade selection, tooth preparation, cementation technique, and patient maintenance. Therefore, the case must be selected carefully and properly planned treatment should be done.[10]

 Conclusion



The objective of cosmetic dentistry is to provide maximum improvement in aesthetics with minimal invasion and trauma to the dentition. The minimally invasive porcelain laminate veneer technique is an extremely versatile clinical procedure that offers advantages of aesthetic quality, conservative preparation, fracture resistance, tissue acceptance, patient satisfaction, and negligible incidence of caries. Hence, the treatment has positive psychological effects of improving patients’ smile with enhanced self-esteem.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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