Prefabricated composite veneers: Historical perspectives, indications and clinical application

Abstract
Veneering anterior teeth is a well-established technique, which was brought to Dentistry by Dr Pincus as early as 1937. From the mid-1970s, boosted by the development of composites and adhesive techniques, various concepts emerged including direct composite restorations, prefabricated composite veneers and of course, individualized porcelain indirect veneers. The prefabricated composite veneer option was however soon abandoned due to former technological limitations. Recently, the creation of a new shade guide comprising enamel shells revitalized this "old idea," and in combination with a high pressure and temperature molding process followed by a laser surface vitrification, a novel, improved composite prefabricated system (Venear, Edelweiss Dentistry) was born. This paper provides an overview of the potential indications and clinical protocol of this original veneering technique.
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Prefabricated Composite Veneers:
Historical Perspectives, Indications
and Clinical Application
Didier Dietschi, DMD, PhD, Privat-docent
Senior lecturer, Department of Cariology & Endodontics,
School of Dentistry, University of Geneva, Switzerland
Adjunct Professor, Department of Comprehensive Dentistry,
Case Western University, Cleveland, Ohio
The Geneva Smile Center clinic and education center, Geneva, Switzerland
Alessandro Devigus, DMD
Private practice and education center, Bülach, Switzerland
Correspondence to: Didier Dietschi
Department of Cariology & Endodontics, School of Dentistry, 19 Rue Barthélémy Menn, 1205 Geneva, Switzerland
tel: +41 22 38 29 165/150; fax: +41 22 39 29 990; e-mail: ddietschi@medecine.unige.ch
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Abstract
Veneering anterior teeth is a well-estab-
lished technique, which was brought to
Dentistry by Dr Pincus as early as 1937.
From the mid-1970s, boosted by the de-
velopment of composites and adhesive
techniques, various concepts emerged
including direct composite restorations,
prefabricated composite veneers and of
course, individualized porcelain indirect
veneers. The prefabricated composite
veneer option was however soon aban-
doned due to former technological limi-
tations. Recently, the creation of a new
shade guide comprising enamel shells
revitalized this “old idea,” and in com-
bination with a high pressure and tem-
perature molding process followed by
a laser surface vitrification, a novel, im-
proved composite prefabricated system
(Venear, Edelweiss Dentistry) was born.
This paper provides an overview of the
potential indications and clinical proto-
col of this original veneering technique.
(Eur J Esthet Dent 2011;6:178–187)
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Historical perspectives
and development
While the “invention” of veneering ante-
rior teeth by Dr Pincus1 was presented
in 1937, it became more popular in the
mid-1970s, using three different ap-
proaches: direct bonding using resin
composites, prefabricated composite
veneers, and indirect, custom-made
porcelain veneers.2-4 The pre-fabricated
composite veneer (Mastique®, Caulk)
was then explored about 35 years ago,
using a methyl-methacrylate matrix and
large glass fillers, such as that used
in resin composites3-4, but with limited
success due to technological limita-
tions and poor surface qualities.5 The
breakthrough in porcelain veneering
techniques happened with the develop-
ment of ceramic etching and true adhe-
sive cementation as developed by Ro-
chette (1975)6 and thereafter improved
by Calamia and Simonsen (1983).7 From
there, this technique underwent consid-
erable success and development over
the following years until today. The rapid
loss of surface gloss and surface deg-
radation of prefabricated resin veneers
linked to some interfacial defects led the
system to be soon abandoned and de-
finitively replaced by porcelain veneers,
which also had the advantage of an in-
dividual fabrication process.
More recently, an innovative shade
guide was developed to allow the com-
bination of all dentin and enamel shades
in the context of the “natural layering
concept;”8 this concept is based on a
two layer incremental technique, mim-
icking the anatomy of natural teeth.9 The
shade guide consists of enamel shells
into which the dentin samples are in-
serted, and then allow the practitioner to
foresee the result produced by the com-
bination of any selected dentin-enamel
shades. When a proper match between
the shade guide and contralateral or ref-
erence tooth is obtained, a predictable
esthetic result and restoration optical
Figs 1 and 2 Section (left) and surface (right) of the Edelweiss veneer showing the inorganic vitrified
restoration surface, providing optimal surface gloss.
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integration is ensured. Based on a tech-
nology comparable to the one used to
produce the enamel shells of this shade
guide, the concept of prefabricated
composite veneers was recently revital-
ized, taking advantage of new technolo-
gies.10
The so-called Direct Venear®
system (Edelweiss Dentistry, Hoerbranz,
Austria) was recently launched and is
based on high pressure molding and
heat curing processes, followed by laser
surface vitrification (Figs 1 and 2). This
enables the veneers to exhibit a hard
and glossy surface, with a texture to fit
the majority of dentitions. The system is
actually designed to facilitate the esthet-
ic restoration of decayed or discolored
single and multiple anterior teeth.
Indications
The aforementioned direct composite
veneer system does not aim to system-
atically replace the well established indi-
vidualized porcelain veneer technique,
but rather offers an alternative to directly
(or freehand) built up composite veneers,
which is a delicate and time-consuming
technique (Figs 3–5). Composite prefab-
ricated veneers present an obvious po-
tential in the following indications:
1) Single facial restorations:
large restorations/decays with loss of
natural tooth buccal anatomy/color
non-vital, discolored teeth
traumatized, discolored teeth (with-
out endodontic treatment)
severe/extended tooth fracture
extended tooth dysplasia or hypo-
plasia.
Fig 4 Set of prefabricated composite veneers fea-
turing a vitrified inorganic surface with high gloss.
Fig 3 Preoperative view of a patient showing
moderate to severe front tooth wear; despite the
significant tissue destruction, a micro-invasive treat-
ment approach was selected using prefabricated
composite veneers.
Fig 5 Postoperative view showing the good es-
thetic and functional integration of cemented res-
torations.
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2) Full smile facial rehabilitations:
moderate to severe discolorations
(ie, tetracycline staining and fluoro-
sis)
generalized enamel hypoplasia/
dysplasia (ie, amelogenis imperfecta
IIIA)
large serial restorations/decays with
loss of natural tooth buccal anatomy/
color
attrition of incisal edges (after proper
occlusal and functional manage-
ment)
financial limitations
young patients with immature gingi-
val profile.
In fact, the aforementioned indications
cover the accepted application field of
“classic” veneers, while other mere cos-
metic indications are to be considered
controversial with this technique. The
whole spectrum of esthetic procedures
embraces four different types of treat-
ments (Table 1).
Then, non-invasive or minimally-inva-
sive techniques such as orthodontics,
bleaching, and direct bonding show
their best potential when an esthetic en-
hancement of virgin and healthy teeth is
considered; here, veneering techniques
have to be considered sub-optimal, es-
pecially when treating young patients.11
The other major advantage of this “dif-
ferent” veneering approach is the rela-
tively cost-effective and straight-forward
solution featuring a “one-appointment”
treatment; however, this should not be
considered an argument that would
overrule proper biomechanical judg-
ment or make it preferable to indirect,
custom-made ceramic veneers. In fact,
this new, alternative treatment option
falls fully in the aforementioned “bio-
esthetic concept.”11
Comprehensive clinical protocol
and treatment sequence
The case preparation for prefabricated
composite veneers does not differ from
other functional and esthetic treatments.
Actually, as soon as initial therapy was
completed and proper prophylaxis
measures engaged, the treatment ap-
proach and sequence will develop as
depicted in Table 2.
Table 1 The whole spectrum of esthetic proce-
dures embraces four different types of treatments.
Treatment approach Usual procedures
Non-invasive
Bleaching, micro-
abrasion, orthodon-
tics
Minimally-invasive Direct composites,
enamel recontouring
Micro-invasive Veneers, inlays and
onlays
Macro-invasive Crowns and bridges
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Preliminary evaluation of fatigue
resistance of prefabricated
composite veneers
A scanning electron microscopy (SEM)
evaluation of marginal and internal ad-
aptation of Edelweiss composite ve-
neers was conducted to evaluate the
resistance to mechanical loading of the
vitrified surface and adhesive interfaces
(restoration to luting composite and lut-
ing composite to enamel or dentin). For
this purpose, minimally invasive ven eer
preparations were performed (n = 5),
which approximately corresponded to
the dimensions of medium maxillary
central incisor prefabricated veneers
(Venear Upper Size Medium); the prep-
aration was about half in enamel and
half in dentin. After cementation, the
samples were stored in saline for 24 h
before the stress test was carried out. All
specimens were submitted to 1,000,000
cycles with 100 N occusal loading force,
applied on the occlusal restoration mar-
gin. The axial force was exerted at a
1.5 Hz frequency following a one-half
sine wave curve. These conditions are
taken to simulate approximately 4 years
of clinical service.12,13
Results have shown overall an excel-
lent performance of the restorations, un-
der simulated functional loading. Almost
no defect was observed either before or
after loading at both enamel and dentin
margins. The most relevant demonstra-
tion of the satisfactory behavior of test-
ed prefabricated veneers was obtained
with the evaluation of restoration internal
adaptation. Actually, there was no de-
fect found at the interface with enamel
or in between luting cement and the ven-
eer, which confirms the excellent bond
Table 2 Treatment approach and sequence.
functional
biological evaluation
esthetic
waxup/new
smile configuration
Y/N
bleaching (lateral areas, lower teeth) Y/N
class III-V restorations (rubber dam) Y/N
VENEER TREATMENT
dentin shade selection
veneer size selection
tooth preparation
veneer adjustment
adhesive procedures on tooth
adhesive procedures on veneer
color characterization
(Y/N)
Cementation (retraction cord)
13 <- 11 / 21 -> 23
cervical & proximal finishing/polishing
functional & occlusal adjustments
simple casecomplex case
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strength at either composite–enamel
or composite–composite interfaces. At
the dentin level, minor defects were ob-
served but which all together account for
an insignificant proportion of the overall
dentin–luting composite interface.
Case report
A young female patient born in 1976 pre-
sented with a complaint about two dark
front teeth. The discoloration of teeth 11
and 21 was the result of an endodontic
treatment she received after an accident
that happened several years ago. Dif-
ferent treatment options were discussed
with the patient, but an internal bleaching
of the discolored teeth followed by cer-
amic laminate veneers was considered
a “state-of-the-art treatment” for such a
case. On the one hand, the patient could
not consider this option because of eco-
nomic limitations, but on the other hand
wished to change the color and form of
her incisors as quickly as possible for an
already planned video recording. Then,
it was decided to go for an immediate
long-term temporary solution using pre-
fabricated composite veneers to cover
the dark tooth structure and to enhance
the anatomy of the existing teeth. The
aforementioned clinical protocol was fol-
lowed to restore these two incisors.
Fig 6 View of the transition area, from enamel to
dentin. The composite–composite interface is also
visible and shows that this interface is stable and
resisted perfectly to occlusal loading.
Figs 7 and 8 The interface with enamel proved
to be free of any defect after the loading test, as
shown on the top image. Only a few bubbles were
observed but which did not affect the adaptation
(bottom image).
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Figs 9 and 10 The adaptation to dentin was also highly satisfactory after the loading test (left). Only
negligible proportions of interfacial defects (gaps) were observed (right).
Conclusions
The concept for prefabricated compos-
ite veneers was introduced in dentistry
about 35 years ago with rather limited
success due to former technological
limitations. As a result, this interesting
treatment option was replaced by an
increase in the porcelain veneering
technique. This “old” idea has been
recently revisited by taking advantage
of modern technology via the introduc-
tion of a surface laser vitrification for
the first time, enabling the production
of a resistant, inorganic glossy sur-
face. However, this rejuvenated tech-
nique does not replace conventional
“custom-made” ceramic veneers, but
rather offers the clinician a one-visit,
cost-effective alternative to directly (or
freehand) built up composite veneers.
This system may also allow clinicians to
fill in gaps within their treatment arma-
mentarium with obvious and interesting
application potential, such as the treat-
ment of young patients with localized or
generalized hypoplasia/dysplasia, dis-
coloration, and in general when a long-
term temporary and highly-esthetic so-
lution is needed.
With an exception for the need to in-
dividualize the cervical profile and pos-
sibly the proximal and incisal edges,
the overall preparation and cementation
procedures are for the most part very
similar to those applied for indirect por-
celain veneers, which keeps the learning
curve for this technique to a minimum.
Another advantage for both the patient
and the dental team is of course the fact
that no temporaries are needed. With
regard to the internal surface treatment,
these restorations are handled identical-
ly to composite inlays and onlays, which
eliminates the need to acquire additional
material or products.
In conclusion, the prefabricated com-
posite veneer is likely to establish itself
as the modern and improved version for
direct composite veneers.
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Figs 11 and 12 Initial situation showing discolored incisors due to endodontic treatment and old com-
posite buildup performed after an accident that happened several years before.
Fig 13 Bonded composite veneers. The discolor-
ation is almost invisible and the integration in the
surrounding tissue is clinically acceptable.
Figs 14 and 15 Postoperative smile views with enhanced esthetics using simple, one-session pre-
fabricated veneers to restore the two non-vital discolored central maxillary incisors.
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References
1. Pincus CL. Building mouth
personality. A paper present-
ed 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-periodon-
tal care. J N J Dent Assoc
1982;53:25–27.
5. Jensen OE, Soltys JL. Six
months clinical evaluation of
prefabricated veneer resto-
rations 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 por-
celain facial veneers: a
new treatment modality
based on scientific and
clinical evidence. N Y J Dent
1983;53:255–259.
8. Patent No US2002/0064749
A1, May 30, 2002.
9. Dietschi D, Ardu S, Krejci
I. A new shading concept
based on natural tooth colour
applied to direct composites
restorations. Quintessence
Int 2006;37:91–102.
10. Patent No A1124/2010 July
2, 2010.
11. Dietschi D. Optimizing smile
composition and esthetics
with resin composites and
other conservative proce-
dures. Eur J Esthet Dent
2008;3:14–29.
12. Krejci I, Reich T, Lutz F,
Albertoni M. In-vitro Testver-
fahren zur Evaluation den-
taler Restaurationssysteme.
Schweiz Monatsschr Zahn-
med 1990;100:953–959.
13. Krejci I, Heinzmann JL, Lutz
F. Verschleiss von Schmelz,
Amalgam und ihrer Schmelz-
Antagonisten im computer
gesteuerten Kausimulator.
Schweiz Monatsschr Zahn-
med 1990;100:1285–1291.
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    Esthetics restorative dentistry has reached a new spectrum with the advancement in modern technology. Therefore, one of the reasons why patients are concerned to seek dental treatment is to improve their dental appearance. The objective of this review is to highlight the importance of visual assessment tools, patient’s psychology, selection of restorations and oral self-care instructions, while considering esthetic restorative treatment planning for dental professionals in their practice. According to the reviewed articles, the success of restorative esthetic treatment depends on dentist’s ability to plan the treatment indicated for each case and to inform the patients regarding possible treatment outcome. Effective patient communication and essential records are required in the treatment planning stage to reduce problems. Nevertheless, Oral self-care instructions and regular dental appointments should be advised to these patients which help in the long-term clinical predictability of esthetics restorations.
  • In-vitro Testverfahren zur Evaluation dentaler Restaurationssysteme
    • I Krejci
    • T Reich
    • F Lutz
    • M Albertoni
    Krejci I, Reich T, Lutz F, Albertoni M. In-vitro Testverfahren zur Evaluation dentaler Restaurationssysteme. Schweiz Monatsschr Zahnmed 1990;100:953–959.
  • Verschleiss von Schmelz, Amalgam und ihrer Schmelz- Antagonisten im computer gesteuerten Kausimulator
    • I Krejci
    • Jl Heinzmann
    • F Lutz
    Krejci I, Heinzmann JL, Lutz F. Verschleiss von Schmelz, Amalgam und ihrer Schmelz- Antagonisten im computer gesteuerten Kausimulator. Schweiz Monatsschr Zahnmed 1990;100:1285–1291.
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    Numerous esthetic deficiencies may be present in natural, restored, or orthodontically enhanced smiles. The most frequent defects are transposed anterior teeth following aplasia, existing or remaining diastemas, form abnormalities and discolorations, abrasion, erosion, and dysplasia. Conservative treatment modalities such as enamel recontouring, bleaching, microabrasion, and resin composites have the potential to correct or improve esthetic problems. These treatments deserve more attention because they have tremendously improved in practicability, efficiency, and predictability. The search for a perfect smile should not always lead to invasive solutions such as veneers and crowns, since invasive treatments may have a negative impact on the long-term tooth biomechanical behavior and global treatment cost. This article discusses the treatment rationale for the use of nonrestorative and additive procedures and their respective indications in a comprehensive approach to dental esthetics.
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    Direct bonding of composite resins to fractured or discolored teeth has been shown to be a practical and effective method for restoring teeth. Previously, lack of uniform shade matching and excessive bulkiness of material have been associated with full veneer bonding. The ultraviolet light (Nuva-Lite) in our studies penetrates veneers as thick as 2 mm and effectively cures the filler material. We also have used cold-curing bonding materials (Concise and Adaptic) and they seem to be equally effective, although working time is shortened. We have had no clinical problems with this technique and after two years the veneers are intact (Fig 6). A technique has been presented that requires no tooth reduction, except where necessary for caries removal, or time-consuming contouring and color shading. Laminate veneers enable the dental practitioner to obtain consistent esthetics with minimal chair time. Further evaluation of this technique to restore malformed, fractured, or discolored permanent incisors is being conducted.
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    This report describes a technique for making ceramic restorations for fractured incisors without operative interference. The ceramic block is baked in the laboratory on a 24 karat gold matrix cast. A resin is bonded to a silane-treated porcelain block and etched enamel.
  • Article
    Thirty-three preformed plastic laminate veneers were placed in maxillary anterior teeth of twenty-one subjects. The indications for veneer placement were intrinsic staining of large conventional composite restorations or discolouration caused by previous endodontic therapy. The veneer restorations were evaluated clinically over a 6-month period for retention, colour match, surface texture, marginal integrity and gingival response. Twenty-nine restorations were available for evaluation at 6 months. Three restorations exhibited bonding failure during the study period, giving an overall retention rate of about 91%. Deep brown discolouration in two teeth could not be adequately matched with the opaquer and shader pastes supplied with the kit. Only one patient exhibited any change in veneer surface texture during the study period. Slight, but clinically inconsequential deterioration of marginal integrity was also noted in several restorations. The gingival response to the veneer restorations was uniformly excellent. It was concluded that restoration with preformed veneers, using the enamel reduction and heat adaptation techniques, provided an aesthetic, conservative and functional alternative to fixed prosthodontic therapy in selected cases.
  • Article
    The literature has described the clinical aspects of the laminate veneer restoration; however, the laboratory preparation of these veneers has not been detailed This paper outlines a step-by-step laboratory technique for the construction of a commercially available laminate veneer, Mastique.® J_Jaminate veneers have been successfully used on patients with hypoplasia, tetracycline staining, fluorosis, mottling, endodontic staining, fractured teeth, and cosmetic problems.113 Although the prac- titioner has the option of doing these directly at chair- side, most prefer the indirect method. This approach is chosen not only because it permits closer adapta- tion of the veneer, but also because it does not re- quire as much chair time and it is, therefore, more economically practical.l' To date there have been two alternatives available for indirect veneer fabrication: (1) the custom-made acrylic resin veneer, and (2) the pre-formed plastic veneer (Mastique®" and Den-Mat®"). The purpose of this paper is to detail the laboratory procedures for the Mastique® laminate veneer.
  • Article
    Patient demands have prompted manufacturers to improve intrinsic optical properties of resin composites and clinicians to refine application procedures. The aim of this study is to present a shading concept based on colorimetric L*a*b* and contrast ratio data of human dentin and enamel. Extracted teeth of the A and B Vita shade groups (n = 8 per group) were sectioned according to 2 different planes to measure specific color (using the CIE L*a*b* system) and opacity (contrast ratio). Standardized samples of enamel and dentin shades of a new composite system (Miris, Coltène Whaledent) were submitted to the same colorimetric evaluation for comparison with natural tissues. Comparison of teeth from the Vita groups A and B having the same chroma showed limited variations regarding a* (green to red) and b* (blue to yellow) values; the only significant variation was the increasing b* values (yellow) with increasing chroma (A1 to A4 and B1 to B3). As for dentin contrast ratio, limited differences were reported, while enamel proved to increase in translucency with age (reduced contrast ratio). These data served as the foundation of the so-called natural layering concept, which makes use of 2 basic composite masses (dentin and enamel) that optically mimic natural tissues. This concept allows for simplified clinical application and layering of composite, as it uses only 1 universal dentin hue with several chroma levels and 3 enamel types for young, adult, and old patients, each exhibiting specific tints and translucency levels.