Predictable Porcelain Repair With Composite Resin
Mitch Conditt, DDS
As a result of
reviewing this case study, the reader should:
- Understand the role of composites in porcelain veneer
repair and aesthetics
- Be able to visualize the process of repairing
porcelain veneers using different types of composite resins
now provide their patients with the options of porcelain veneers or porcelain
crowns to improve the appearance of their smiles. Many journals have published
the importance, both professionally and personally, of an attractive smile. Yet
barely half of these patients are satisfied with the appearance of their own
smile . With
the more aesthetically conscience baby boomer population coming into their
prime, dentists are experiencing their demand to look and feel younger.
Fortunately, we now have tools and techniques available to respond and, in many
cases, change the lives of these individuals. Porcelain veneers have been
successfully placed for over two decades. With the continuous improvement of
bonding agents and composite resin cements, the success of these restorations
continues to rise. Along with these material innovations and what seems to be a
growing awareness of occlusion, the occurrence of chips and fractures in these
porcelain restorations has been minimized .
Nevertheless, there will always be the occasional need to repair a porcelain
restoration, if only from trauma.
case shows a severe traumatic fracture to a 10-year-old porcelain veneer on a
45-year-old female. Radiographs revealed no pulpal injury from the trauma.
While several veneers had fractures within the porcelain, tooth #9 was an
immediate concern (Figure 1). This veneer and others will require replacement,
but the patient opted for long term repair only at this time. Fortunately, with
current porcelain repair techniques, dentin bonding agents, and contemporary
composite formulations, this task can be predictable, long-term, and aesthetic.
Any large direct
anterior composite restoration has to begin with proper shade assessment and
color mapping. In this case, the adjacent veneer was used as a guide (Figure 2). An alginate impression of the fracture was taken, a stone model was
fabricated, and replacement of the fracture with a composite mock-up was
performed. A silicone matrix would later be fabricated from this mock-up and
used to accurately reproduce the palatal anatomy and incisal edge for the first
initial layer of composite. A matrix of this type was not mandatory and this
palatal increment could have been placed freehand, but it was much easier for
the author to build the anatomy on a composite mock up in the laboratory than
directly in the patient’s mouth. This silicone matrix also substituted for
matrices placed interproximally to help form the lingual embrasures (Figures 3-4-5).
in the techniques begins with how one roughens the porcelain. Some clinicians
suggest sandblasting the porcelain with aluminum oxide; others recommend
roughening with a diamond. Still others suggest that roughening of the
porcelain is altogether unnecessary. Treating the porcelain with hydrofluoric
acid of different percentages often constitutes the next step. Although still
widely used, some kits have concluded that this step also is unnecessary.
Silane (though its name varies from kit to kit), however, seems to remain essential
in all the techniques.
patient, the porcelain was roughened with a course diamond. A scalloped bevel
extending approximately 4 mm in length was placed with this same diamond. The
larger bevel provided a greater surface area for the composite, which helped
increase fracture resistance. The scalloping also concealed the junction of the
composite and porcelain materials (Figure 6). The lingual was also beveled, but
to a lesser degree than required on the facial aspect. In this case, there was remaining
enamel and dentin exposed after the fracture. To prevent hydrofluoric acid or
silane from contacting the tooth structure, a thin layer of composite was
placed for additional protection. Clear matrices placed interproximally
prohibited the contact of etchant or bonding agent with the adjacent teeth.
These were removed once the boding agent was cured (Figure 7).
the porcelain with a course diamond, the tooth surface was cleansed with 2%
chlorohexidine gluconate for 20 seconds. Phosphoric acid 35% was placed on the
enamel for 15 seconds and dentin for 12 seconds, rinsed thoroughly, and blotted
dry. An etchant with an antibacterial included could have also been used for
the cleansing and etching steps simultaneously. Next, the tooth was remoistened
with a rewetting agent) for 20 seconds and blotted. A bonding agent was placed
on the tooth in multiple coats for 20 seconds and dried with light air for 5 to
10 seconds to evaporate the acetone and leaving a shiny appearance on the
dentin. This was then cured with a halogen light for 10 seconds.
composite resin was chosen for the repair, use of this material would eliminate
the need to use both a microfill and a hybrid resin. In this particular case, a
micro-matrix composite resin was chosen for the repair. Due to its strength and
polishability, the need for the sandwich technique of surrounding the stronger
hybrid with the more aesthetic microfil was eliminated . The
custom shade guide for this material greatly aided with the operator’s
selection and application of the opaque, body and incisal shades. Each
individual shade tab listed the opaque, body, and incisal shades that were
required to achieve a proper shade match with the patient’s veneers. In this
case, the desired shade (A1) required the use of an A2 opaque shade, A1, and
the clear enamel shade. The opaque shade was selected to conceal and protect
the tooth structure from the hydrofluoric acid and silane. This also helped to
mask any possible show-through of the darker tooth structure.
strips were used to protect the adjacent teeth from etchant and bonding agents.
They were not necessary after this process, because the silicone putty matrix
would be used to form the lingual embrasures. Once the dentin was protected,
the porcelain was prepared. Hydrofluoric acid (9.5%) was placed on the
roughened and beveled porcelain for 60 seconds, rinsed thoroughly, and dried.
Silane was then applied to the porcelain for 5 seconds and air dried. The
bonding agent was applied over the porcelain and composite, thinned with air,
and cured for 10 seconds. If there were any exposed tooth structures present,
they too would have been included in the bonding procedure.
The next resin
applied was a very thin layer (0.5 mm) of the translucent shade. If this layer
is placed too thick it can give a grayish appearance or a decrease in value.
The silicone matrix was used to adapt the composite for proper lingual anatomy
and the initial contour of the lingual embrasures (Figure 8). Most of the body
of the tooth, including the mammelons, was created with the A2 shade. This body
shade was brought to full thickness on the facial aspect--except for between
the mammelons and along the interproximals areas (Figure 9). These areas will
be brought to full contour with an incisal shade for translucency. Placing an
incisal shade over the middle and gingival third of the restoration would be
characteristics were created to mimic the optical effects present on the
adjacent tooth. Tooth #8, a porcelain veneer, was designed with three very
distinct mammelons. After polymerizing the composite, the operator noticed the
middle mammelon was too long incisally, so it was recontoured with a finishing
bur to its correct dimensions (Figure 10). The bonding agent was once again
painted over the surface of the composite after the oxygen inhibited layer had
been removed with the finishing bur. This step allowed the following layer of
composite to bond properly (Figure 11). Another layer of A1 was placed to
complete the middle third to full facial contour (Figure 12). The white halo at
the incisal edge of the patient’s teeth was reproduced with a very thin line of
white tint, which was painted on the edge of the CE lingual layer (Figure 13).
Lastly, the interproximal regions and the areas between the mammelons were
filled with a final layer of microhybrid resin to again mimic the facial incisal translucency
of porcelain (Figure 14).
Finishing and Polishing
contouring was accomplished with finishing discs. Discs and points were
used to polish the lingual anatomy, which was minimal due to the successful
application of the silicone matrix. The discs and points ere also used to
contour and finish the facial and incisal surfaces. Final polishing with a
polishing disc rendered an aesthetic luster for the small-particle resin
The aesthetic capabilities
(eg, color matching, polishability) of this composite will allow the patient to
show her smile with confidence. From the clinician’s perspective, the bond
strength of the adhesive agent allowed the delivery of a predictable,
conservative repair for the damaged porcelain restoration. As the physical and
optical qualities of contemporary composite resins continue to increase, their
utility for direct restorations will undoubtedly follow.
practice, Fort Worth, TX.
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