137

5.7
Direct Resin Veneers
Subir Banerji and Shamir B. Mehta 
Video: Direct Resin Veneers
Presented by Subir Banerji and Shamir B. Mehta

Principles
Direct resin veneer restorations offer the potential to apply changes to the colour and
shape of a tooth in a minimally invasive manner when compared to the use of indirect
restorations. There is evidence to suggest favourable, long-term success with ceramic
laminate veneers. The use of resin composite offers an alternative to dental ceramic.
Resin composite may be used either indirectly or in a direct (chairside) manner.
Direct resin veneers have a plethora of indications in restorative dentistry. These include:
●● Management of fractured, discoloured and rotated teeth
●● Treatment of tooth malformations (such as peg-shaped lateral incisors)
●● Closure or narrowing of diastemata
●● Management of congenital or acquired defects
●● Management of palatally positioned teeth
●● Treatment of worn anterior dentition
●● Camouflaging of teeth, such as modification of a canine to mimic a lateral incisor
●● Where an increase in tooth length or width may be indicated (as in Part 9).
Direct resin veneers offer a number of potential advantages over indirect veneers. Their
primary merit is the lack of the need for any tooth preparation (or minimal prepara-
tion), thereby eliminating the need for the removal of healthy tooth tissue, as well as the
ability to readily undertake intra-oral adjustments, repairs and polishing. Direct resin
veneers may also be placed in a single visit, with the absence of associated laboratory
costs, impressions or provisional restorations. The lack of the need for a cement inter-
face is also beneficial. Direct resin veneers can allow for direct masking and chromatic
customisation of the restoration without reliance on the dental technician, who without
the benefit of the patient’s presence will otherwise have to depend on photographic
records and written instructions from the dental operator.
There are, however, some clear drawbacks to the prescription of direct resin veneers,
such as a relatively lower resistance to wear, reduced lustre when compared to glazed por-
celain, the tendency for discoloration, staining, chipping and fracture. However, there

Practical Procedures in Aesthetic Dentistry, First Edition. Edited by Subir Banerji, Shamir B. Mehta and
Christopher C.K. Ho.  © 2017 John Wiley & Sons, Ltd. Published 2017 by John Wiley & Sons, Ltd.
Companion website: www.wiley.com/go/banerji/aestheticdentistry
138    Practical Procedures in Aesthetic Dentistry

is evidence to suggest that patients will often be willing to accept these disadvantages in
exchange for a less invasive approach, thus emphasising the importance of informed consent.

Procedures
The need for tooth preparation may vary according to the desired outcome. Where
there is a need to preserve the emergence profile or in the presence of a discoloured/
darkened tooth, you may consider a labial reduction of up to 0.8 mm, following the
principles of tooth preparation for ceramic veneers, as described in Chapter 7.2. It is
imperative, however, that preparations are finished on enamel and are kept supragingi-
val. The presence of dental caries, unaesthetic or failing dental restorations will need to
be addressed beforehand.
For discoloured teeth, you may choose to see whether simply placing resin over an
opacious material without any tooth preparation will suffice in a diagnostic manner.
Figures 5.7.1 and 5.7.2 provide an example of such as case where no tooth preparation
has been carried out.
Where there is a need to prescribe an increase in tooth length or width, you may
choose to have a diagnostic wax-up at your disposal from which a silicone key can be
fabricated. For cases involving a minor increase in length, you may elect to not use a
key; however, it is important not to introduce an undesirable change to the occlusal
scheme that may culminate in premature failure.
Prior to isolation, carry out a detailed exercise in colour mapping. Using an adjacent
or contralateral tooth, determine the colour variations that you wish to introduce into
your restoration. You can also add to the tooth itself prior to any etching or bonding

Figure 5.7.1  A discoloured upper maxillary central incisor

 5.7  Direct Resin Veneers    139

Figure 5.7.2  Completed direct resin veneer (3 years post-operative). Veneer was placed without any
removal of tooth tissue

process. In the case of a stained tooth, this may require the placement of an opacious
layer or indeed a white tint to mask out intrinsic stain prior to the opacious layer. Take
note of any areas that may require further characterisation, such as craze lines, hypopla-
sia, translucency or the exposure of cervical dentine. It is worth noting these down in a
diagrammatic format together with determining the shades you wish you use and their
respective areas of placement.
Apply your chosen method of isolation. Rubber dam that has been inverted and
retained in situ with ligatures is a gold standard, as in Chapter 5.2. The use of retraction
cord will also help with the control of unwanted gingival crevicular fluid.
Using air abrasion, pumice or burs, roughen the surfaces where the resin is to be
applied. Isolate adjacent teeth with an appropriate matrix such as PTFE (polytetrafluo-
roethylene) tape or a cellulose acetate strip. Condition the surfaces for resin bonding, as
described in Chapter 5.1.
In the case of a deeply discoloured tooth, apply a thin layer of evenly distributed
white resin tint over the labial face of the affected tooth, making sure that it is streak
free. A thin layer of opacious dentine finished interdentally to an infinity margin should
follow this. In the cervical area, you may choose to place some yellow tint to add body
colour. In the incisal area, as the space to place restorative material may be too limited
to allow the inclusion of mamelons, place some blue resin tint to mimic translucency
and overlay with your chosen enamel shade. Finish and polish, as in Chapter 5.6.
For cases involving diastema closure, place a dead-soft sectional matrix band (as
described in Chapter 5.3) into the interproximal area. The band should be gently slipped
into the gingival crevice to avoid any overhanging margins developing. Contour your
140    Practical Procedures in Aesthetic Dentistry

band using a burnisher, such that material may be applied to the desired horizontal
dimension. The band may be additionally supported with the aid of a silicone key posi-
tioned palatally. Using a cotton wool pledget, form a custom wedge. Apply your chosen
shade of material (which may be in enamel or dentine) as per your colour map. Form an
interproximal pillar, as described in Chapter 5.4. Light cure according to the manufac-
turer’s instructions. You may now remove the matrix. Apply further resin composite to
complete the labial face. Repeat the procedure on the adjacent surface. Finish and polish
accordingly, paying close attention to the embrasure space(s).
For cases involving an increase in tooth length, where the colour is acceptable (with
or without the aid of a silicone key), place a thin layer of enamel shade across the entire
labial face, finishing interproximally with an infinity margin. For resin veneers not
involving an increase in tooth length, sculpt some mamelons and place some resin blue
tint. Overlay with some enamel shade, finish and polish. Where an increase in length
has been planned, you may choose to cut back palatally without breaching the labial
face, and place some dentine shade into the areas of cut-back to characterise the incisal
edge.
In the event of a malformed tooth such as a peg-shaped lateral incisor, resin augmen-
tation would be carried out in a similar manner to a Class IV restoration, as described
in Chapter 5.4.
For a malpositioned tooth such as a palatally placed tooth, the restorative approach
will depend on the level of discrepancy. Where it is large, commence with a dentine
shade of resin. The latter may be sculpted to account for the characterisation of the
incisal edge, such as the presence of mamelons. Overlay with an enamel shade.

Tips 
●● Resin composite veneers can provide a minimally invasive and desirable solution for
the treatment of many problems in aesthetic restorative dentistry.
●● The importance of informed consent should not be overlooked.
●● Patients must be made aware of the maintenance requirements of resin veneers,
including the need for regular polishing and possible repair.
●● Allocate an appropriate amount of time when planning and making resin veneers;
artistic efforts should not be rushed!

Further Reading
Korkut B, Yanikoglu F, Gunday M. Direct composite laminate veneers. Three case reports.
J Dent Res Dent Clin Dent Prospects. 2013;7(2):105–11.
Nalbandian S, Millar BJ. The effect of veneers on cosmetic improvement. Br Dent Jour.
2009;207(2):72–3.