Dentaltown March 2020 - 72

Solving the
stress points
W hen it comes to the
stresses of doing direct composite veneers, shade match,
longevity, staining, chipping
and contouring top the list. Most
dentists instead choose porcelain
veneers and transfer the artistic
responsibilities to lab techs,
while the dentists just make
sure they grind down enough
tooth structure and prepare two,
four or six teeth so they match.
The thought is (as my friend once
In-office direct composite veneers can now be created more
put it before going into clinic
easily, faster and more profitably with new methods, matrix
to teach a hands-on porcelain
inventions and a new template.
veneer course), "Let's go 'smoke'
some enamel!" Porcelain veneers are invasive
and expensive-they cost patients not only
thousands of dollars but also priceless tooth
structure that's destroyed for a lifetime.
Now, though, composites that have a
"chameleon effect" can match teeth without
too much translucency or opacity, and without
layering. Staining and chipping hazards have
been addressed with the usage of matrices and
warm-injection molding of composite. Plus,
a facial template gives artistically challenged
dentists like me a "cheat sheet" template for
forming facial contours and anatomy of
anterior teeth and bicuspids. This template
leaves a smooth, oxygen-inhibited facial surface
for easy polishing and provides a convenient
method to test shades in the mouth before
starting direct veneers.

Saving tooth structure, stain
resistance and strength
(I credit dental inventor Dr. David
Clark, Dr. Jihyon Kim and the Bioclear
Learning Center for teaching me the
foundations of the technique I'm about
to discuss.)

To do this process, both the flowable and
paste composite (Filtek Supreme from 3M)
are warmed and "injected" into Bioclear's
curved mylar anterior matrices (Fig. 1),
which wrap interproximally and even
lingually, so when the composite is cured,
it "hugs" the tooth nearly 360 degrees.
This Bioclear method of warm-injection
molding also leaves composite cured in
one piece (monolithic), making it stronger
and more stain-resistant than conventional
placement of composite, which is like placing
layers of concrete over previously placed layers
of concrete-a "patty-cake" placement that
could incorporate voids, air or weakness into
each layer bonded. Warm-injection molding
is the equivalent to the pressing of porcelain
like E.max-strong and monolithic-while
layered composite is the equivalent to feldspathic porcelain, which is baked in layers and
is weaker. Monolithic heated and injected
composite has better marginal adaptation
and is stronger and more stain-resistant
than layered composite.1

Preserving more
tooth structure
Cosmetic dentistry is not known for
saving tooth structure and, in fact, tooth
structure is often prepared or destroyed for
the pure sake of an enhanced smile (Figs. 2a
and 2b). By using Uveneer templates, Bioclear
matrices and warm-injection molding,
cosmetic dentistry now has direct composite
veneers that are nearly completely additive,
so there often is no need for tooth structure
to be prepped, removed or destroyed. This
is a huge advantage: Imagine adding back
the tooth structure your patients have lost
from years of grinding, while not removing
any of their existing tooth structure.
Porcelain restorations almost always
require at least 0.3mm of tooth structure
removed facially, and interproximal tooth

MARCH 2020 // dentaltown.com

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Dentaltown March 2020

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