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http://www.journal-imab-bg.org RECONSTRUCTION OF FRACTURED PERMA-LAMINATE VENE Ani BelchevaDepartment of Pediatric Dentistry, Faculty of Dental Medicine,Medical University, Plovdiv, Bulgaria - Annual Proceeding (Scientific Papers) SUMMARY: clinicians must deal with sometimes small patient’s age, needcases because of compromised results as time passed by. In this review are collected data for the usage oflaminate veneers for restoring fractured incisors in A critical analysis of proposed from different authorsimprovements and objections has been made. Theseapproach. Key words: veneers, crown fractures, permanentteeth Aim of this study is to discuss the available dentalliterature concerning reconstruction of fractured permanentincisors using laminate veneers. In the last 20 years dentists manufacture veneers tothe teeth using different techniques for corrections ofaccording to the materials and techniques applied: 1. direct composite veneers 2. direct-indirect composite veneers and preformedacryl laminates 3. indirect (laboratory made) acryl, composite,porcelain and glass-ceramic veneers · Advantages and disadvantages The clinicians prefer and recommend definite kind ofveneer according to the clinical case. Most often cited inthe literature advantages and disadvantages of the veneersare shown on table 1. Introduction of enamel etching technique andelaboration of hybrid and microfilled composite resinmaterials gives opportunity for more conservativerestoration of fractured teeth connected with application ofhave been placed after testament of the connection withtooth structures (16). Development of the adhesive systems · Indications discolorations (4). Veneers are indicated in restoration of Table 1. Advantages and disadvantages of different kinds veneers, utilized for restoration of permanent teeth DOI: 10.5272/jimab.14-2-2008.101 ISSN: 1312-773X (Online) http://www.journal-imab-bg.org · Tooth preparation Vestibular surface well as the correlation between upper and lower jaw. extends in the enamel borderlines (3, 8, 10, 17). Some authors do not recommend tooth preparation (17, 19). According to Gingival margin Preparation design for direct and indirect veneersmost often finishes with chamfer edge gingival andinterproximal (17,19). Thus enough space is ensured torepresent all color features of natural teeth. subgingivaly. The contemporary tendencies report favorable for veneers should remain in the enamel (6). With theinfluence veneer’s retention (8). Incisal edge According to Walls et al. there are four basicpreparation designs for incisal edge (fig. 1) (20). Thebeen examined through the years. According to the lingual with enamel bevel (10). Bevel’s width depends on fracture the veneer. Indirect porcelain veneer Direct-indirect composite veneer - conservative approach - excellent esthetics - very good gingival reply - conservative approach - excellent esthetics - excellent gingival reply - complete polymerization - easy reparation - acceptable price - requires two appointments - requires more preparation - technical difficulties - difficult reparation - high price - requires technical skills - requires prolonged time - requires extra appliances to Walls et al. a) “Window” preparation, the veneer is situated close b) “Feather” preparation, the veneer is taken up to theheight of the incisal edge but the edge is not reduced; c) “Beveled” preparation, a buco-palatal bevel is http://www.journal-imab-bg.org prepared across the full width of the preparation and there issome reduction of the incisal edge; d) Preparation of “incisal overlap”, in which the incisaledge is reduced and the preparation extended palatal Very important conclusions are made in the study of Lingual overlap of the preparation margins starts anargument between clinicians. In one of his investigationsMagne (13) develops experimental scientific setting andoptimizes preparation design with the principles ofdecision for neutralizing of the inherent in techniques andmaterials loading. The conclusions of this investigationrisk for incisal fracture as well as the loading that stand bothtooth and material (5). Proximal finishing lines It suggested by some authors that proximal finishinglines should not extend beyond contact point in the incisalthird of the tooth. It means to preserve the contact pointwith the adjacent teeth (8,20). According to the published in the literature datawhen the preparation has sharp edges this leads toconcentration of different forces on that place and cracksand fractures of the veneer may occur (3,8,15). Smooth andreduce stresses at the preparation edges and prevents fromfractures (10,20). principles that help fracture resistance Adhesive bondingfracture probability. It is necessary to achieve adequate Composite veneers can be made directly on the toothor direct-indirectly with the help of plaster models and extrapolymerization light box. Lack of laboratory proceduresfacilitates the method and makes it preferable at smalltechnician in laboratory conditions (20). · Placement and luting Before placement tooth surfaces are thoroughlycleaned with pumice. Placement and luting of direct manufacturer’s instructions as a clinical protocol. color. It is possible to do this procedure with the luting resinveneer. After that prior to placement of the veneer to its Direct-indirect veneers are placed and luted in thesame way as porcelain ones without applying of silane -coupling agent (10) · Finishing and polishing The last stage is finishing and polishing the margins.Finishing and polishing contribute for smooth andimportant to eliminate any occlusal interference (20). For thisdisks (Soflex discs) and polishing pastes are used.(9) · Prognoses Composite veneers can stand unchanged from 2 upto 13 years in good hygiene and minimal harmful habits (9).gloss (2). Some resin materials have included small bubblesstains. That leads to early repair of the veneer (18). Direct-indirect veneers have long live longevity thanthe direct veneers. Their strength and abrasion stability is Composite veneers can be easily repaired whenoccurring some of the problems mentioned. That makes them Reconstruction of fractured children’s teeth withwith porcelain veneers (20). According to a clinical studyof Welbury, made on 289 composite veneers of child and Porcelain veneers are with best esthetic andmechanical properties and show low fracture degree. Unlike http://www.journal-imab-bg.org Address for correspondence: Dr. Ani Beltcheva, PhD Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria Å-mail abeltcheva@yahoo.com 1. Alonge OK, Nerendran S,Williamson DD. Prevalence of fracturedCounty, Texas. Dent Traumatol 2001; 17: 2. AlSarheed M, Bedi R, Hunt NP.year-old Saudi Arabian children with a 3. Bruton PA, Aminian A, WilsonNH. Tooth preparation techniques for etched porcelain veneers. Am J Dent 5. Castelnuovo J, Tjan AH, Phillips 6. Christensen GJ. Veneering of 7. Dhur VB, Lloyd CH. The fracturetoughness of repaired composite. J veneers. A retrospective evaluation Meijering AC. Meta-analysis of anterior veneer. JADA 1987; 115: 449-53. 11. Magne P, Douglas WH. 12. Magne P, Douglas WH. 13. Magne P, Douglas WH. Optimi- 14. Padbury Jr A, Eber R, Wang H- 15. Peumans M, Van Meerbeek B,Lambrechts P, Vanherle G. Porcelain REFERENCE 16. Rochette AL. A ceramic 17. Shaini FJ, Shortall AC, Maruislaminate veneers. A retrospective 18. Shortall AC, Uctasli S, MaruisPM. Fracture resistance of anterior, 19. Troedson M, Derand T. Effect of 20. Walls AWG, Steele JG, Wassell. 21. Welbury RR. A clinical study ofveneers. Pract Periodontics Aesthet Patient’s hygiene is also of great importance. A serious CONCLUSIONS Elaboration of veneers on teeth with compromisedesthetics and function is a conservative method that improves appearance, modifies contour without reducingthe method is minimal invasive and indicated for children.Even in the period of growth and development, whenbe successfully restored with minimal tooth preparationutilizing composite veneers. Knowledge of the methods foris useful advantage of dental doctor for mastering theesthetic and functional problems of the young patients.