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Esthetic Rehabilitation of Maxillary Anterior Teeth with Porcelain Laminate

Veneers

Article in Journal of Interdisciplinary Dentistry · August 2022

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Case Report

Esthetic Rehabilitation of Maxillary Anterior Teeth with Porcelain

Laminate Veneers
Bharath Makonahalli Jaganath, Sahadev Chickmagravalli Krishnegowda, Sandeep Rudranaik, Siri Parvathi Beedubail

Department of Conservative This case report emphasizes on esthetic rehabilitation of maxillary anterior teeth

Abstract
Dentistry and Endodontics,
Sri Hasanamba Dental
with porcelain laminate veneers. A male patient aged 24 years reported with a chief
College and Hospital, complaint of spacing between teeth in the upper front teeth region. The patient was
Hassan, Karnataka, India unwilling for orthodontic correction since time was the major constraint. A complete
intraoral and extraoral examination was performed, preoperative photographs were
taken, and study models were prepared. Tooth component, i. e., dental midline, incisal
lengths, tooth dimensions, zenith points, axial inclinations, interdental contact area
and point, incisal embrasure, symmetry, and balance, was observed. The soft‑tissue
examination included gingival health, interdental embrasure, and smile line. Clinical
examination revealed diastema between 11, 12, 21, and 22. Discoloration was noted
in 21 teeth, and the patient reported a history of root canal treatment for the same.
Considering the esthetic need of the patient and the duration of treatment, porcelain
veneers were planned for the correction of diastema. Tooth preparation for veneers
was made with incisal overlap design with respect to 12, 11, and 22, and e‑max
crown was planned for 21. The advantages of this treatment include quick results,
minimal tooth structure removal, long‑term solution, better esthetics, and firm fit.

Keywords: Esthetic dentistry, diastema, veneers

Clinical Relevance to Interdisciplinary Dentistry

Received: 15 May 2022 Proper diagnosis of mid line diastema and appropriate treatment planning,
Accepted in Revised Form: considering hard and soft tissue esthetics aids in obtaining better results in shorter
30 July 2022
Published: 23 August 2022 duration of time.

Introduction caused due to tooth‑size discrepancy is amenable to

O ver the years, society has grown more beauty
conscious which has led to increased demand for
esthetic dental treatment.[1] Good dental appearance is an
integral part of facial esthetics. The esthetic rehabilitation
of maxillary anterior teeth poses a significant challenge
to clinicians. Spacing greater than 0.5 mm between
the proximal surfaces of adjacent teeth in the midline
is defined as midline diastema by Keene.[2] Midline
diastema, being a multifactorial aesthetic problem, needs
multidisciplinary approach for diagnosis and devising an
appropriate treatment plan.
Decision on choosing the treatment relies on careful
differential diagnosis. This allows the clinician to choose
between orthodontic or restorative options. Diastema
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restorative options.[3] To attain success in the treatment
of diastema, it is not only crucial that the patient
understands various treatment options but while clinician
also should be able to assess the clinical condition and
patient’s expectations. Although orthodontic treatment
was considered to be the conservative approach for
the correction of diastema, the potential chance of
relapse has precluded its utilization as the first choice
Address for correspondence: Dr. Siri Parvathi Beedubail,
Department of Conservative Dentistry and Endodontics,
Sri Hasanamba Dental College and Hospital, Hassan,
Karnataka, India.
E‑mail: drsiribhat@gmail.com
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as
appropriate credit is given and the new creations are licensed under the identical
terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

DOI: How to cite this article: Jaganath BM, Krishnegowda SC, Rudranaik S,
10.4103/jid.jid_13_22 Beedubail SP. Esthetic rehabilitation of maxillary anterior teeth with
porcelain laminate veneers. J Interdiscip Dentistry 2022;12:70-3.

70 © 2022 Journal of Interdisciplinary Dentistry | Published by Wolters Kluwer - Medknow

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Jaganath, et al.: Porcelain laminate veneers for diastema correction
for treatment.[4] Furthermore, the longer time duration
is another major factor that makes the patient express
unwillingness for orthodontic treatment. Restorative
options such as composite veneers or porcelain veneers
are alternative treatment strategies that can offer the
solution in considerably less period. Although composite
veneers are comparatively less invasive, cost‑effective,
and single‑stage procedures, ceramic veneers offer
long‑term solutions with better esthetics and firm fit.[5]
The present case report is an attempt to highlight the
benefits of ceramic veneers in the management of
diastema when the duration of the treatment procedure
is a prime factor.
Case Report
A male patient aged 24 years reported with a chief
complaint of spacing between teeth in the upper
front teeth region. A complete intraoral and extraoral
examination was performed, preoperative photographs
were taken, and study models were prepared. Tooth
component, i.e., dental midline, incisal lengths, tooth
dimensions, zenith points, axial inclinations, interdental
contact area and point, incisal embrasure, symmetry,
and balance, was observed. The soft‑tissue examination
included gingival health, interdental embrasure, and smile
line. Clinical examination revealed diastema between 11,
12, 21, and 22. The discoloration was noted in 21 teeth,
and the patient reported a history of root canal treatment
for the same. The patient denied orthodontic correction
due to the prolonged time needed for the treatment.
Considering the esthetic need of the patient and the
duration of treatment, porcelain veneers were planned for
the correction of diastema. A written informed consent
was obtained from the patient prior to treatment.
Treatment procedure
Diagnostic models of both maxillary and mandibular
arches were obtained using elastic impression material
and type IV die stone. The treatment began with a
diagnostic wax‑up. Desired results were verified with
the mock‑up. Informed consent was obtained from the
patient. Scaling and root planning were accomplished.
Shade selection was performed using Vita classical shade
guide, followed by minimal tooth structure removal for
porcelain laminate veneers for 11, 12, and 22, and e‑max
crown for 21. Tooth preparation was done with respect to
21 to receive an e‑max crown. Further, tooth preparation
was done starting with 12, followed by 11 and 22 for
porcelain laminate veneers with incisal overlap design.
Initially, depth cutting bur was used to remove a layer of
enamel approximately measuring 0.3 mm at the incisal
third, 0.5 mm at the middle third, and 0.7 mm at the
cervical third of the teeth. The labial contour of the
Journal of Interdisciplinary Dentistry ¦ Volume 12 ¦ Issue 2 ¦ May-August 2022
teeth was taken care by achieving two‑plane reductions.
Preparation was extended incisally overlapping the
incisal third palatally. Proximally, margins were
extended to the area just beyond contact points.
A 0.5‑mm deep chamfer finish margins were placed in
the entire preparation using round end tapered bur. The
teeth were finally prepared, and all internal line angles
were rounded to reduce stresses leading to fracture of
porcelain laminate veneers. Full‑arch impression was
taken using polyvinyl siloxane material – addition
silicone. Impression of the opposing arch was taken
using elastic impression material and was sent to the
laboratory for IPS e.max porcelain veneers with respect
to 11, 12, and 22, and e‑max crown with respect to 2.
Veneer try‑in and cementation procedure
Oral prophylaxis was carried out, followed by assessing
the size, fit, shade, occlusion, and symmetry of the
processed veneers. The patient’s consent was obtained
on the day of try‑in and later sent to the laboratory for
final finishing. On the day of cementation, teeth were
isolated. The intaglio surface of the veneers and the
e‑max crown was treated with 4% hydrofluoric acid.
Resin cement (3M ESPE Relyx U200 self‑adhesive
resin cement) was used for luting the veneers and e‑max
crown to the tooth. A 20 s curing for each tooth was
further carried out [Figure 1].
Postoperative care to be provided for porcelain laminate
veneers was informed to the patient. A thorough
follow‑up was carried out for assessing if any marginal
discrepancy, fracture lines, surface discolorations, etc.,
existed.
Discussion
Orofacial esthetics has a significant role in people’s
lives, especially related to social interactions. Physical
appearance and attractiveness are important for men
and women alike. Components of orofacial esthetics
Figure 1: Pre- and postoperative clinical photographs
71
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Jaganath, et al.: Porcelain laminate veneers for diastema correction
include the shape of the tooth, position, size, color,
and also gingival display.[6] Diastema is one of the
most encountered clinical scenarios which needs great
clinical expertise to handle. This clinical scenario
greatly affects the self‑confidence of the patient at
public. The different treatment options for diastema
closure are the orthodontic approach, restorations using
direct composite resin, indirect composite resins, and
ceramic veneers.[7] Although orthodontic treatment is
a viable option, the patient preference has been found
to be lesser due to the increased duration of treatment.
Among the various restorative options, composite resin
veneers are economical and easy to perform for the
clinician. However, it has less resistance to wearing
and also can be affected by surface stains. They need to
be repaired or changed over the years due to staining.
These disadvantages of composite resin make it inferior
to porcelain veneers. Porcelain veneers exhibit excellent
tissue response and the finished surfaces mimics a
natural tooth. With its property of absorption, reflection,
and transmission of the light exactly as natural tooth, it
helps in transforming smile dramatically.[8] Considering
the benefits of porcelain veneers in the management of
diastema and the patient preference, porcelain veneers
were the treatment of choice in the current case report.
A proper case selection is important while planning such
a treatment approach. Indications of whether veneers
should be used include diastema closure, restoration of
localized enamel defects, discolored teeth resistant to
vital bleaching procedures, the need for morphologic
modifications, minor tooth alignment, mild‑to‑moderate
fluorosis, and fractured teeth.[9] The contraindications
are edge‑to‑edge bite, deep bite, bruxism, and other
parafunctional habits.[10] In the present case, the
patient had diastema with normal overjet and overbite,
sufficient thickness of the enamel, and did not have any
parafunctional habits.
Even though, porcelain laminate veneers preserve more
tooth structure, there are certain limitations and various
factors that can influence the survival rate. They include
preparation design, vitality status of tooth, type of
porcelain material, and adhesive system. In addition,
parafunctional habits such as bruxism also can influence
the survival rate. Among various manifestations of
the failure of porcelain laminate veneers, fracture and
debonding were commonly reported in clinical trials.
Tooth fracture, dental caries, and periodontal disease
have also been noted. The preparation, in this case, was
entirely on the enamel without exposing the dentin, thus
ensuring minimally invasive preparation of teeth. The
use of porcelain laminate veneers offers an excellent
combination of hardness, resistance, and resilience.[11]
72 Journal of Interdisciplinary Dentistry ¦ Volume 12 ¦ Issue 2 ¦ May-August 2022
Literature reveals that lithium disilicate‑based veneers
have improved flexural strength and also provide high
esthetic results.[12] A recent systematic review reported
that the 10‑year cumulative success rate of porcelain
laminate veneers was 95%, when factors such as
debonding, fracture, secondary caries, and need for
endodontic treatment were considered reasons for the
failure of the restoration. Furthermore, it was found
that porcelain laminate veneers with incisal coverage
presented lower failure rates.[13] In the current case, IPS
e.max Press, which is based on lithium disilicate was
employed with incisal coverage.
The follow‑up of this case has shown to be a promising,
reliable, and successful treatment approach. Thus,
diastema closure was achieved with the use of IPS e.max
Press ceramic veneers in a minimally invasive manner.
Conclusion
One of the most common indications of porcelain
laminate veneers is a case of diastema closure. It is
the details that make porcelain laminate veneers more
precious than other veneers. Since it is a reliable
treatment option with better long‑term clinical results,
making it one of the most commonly employed clinical
approaches for esthetic correction.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Journal of Interdisciplinary Dentistry ¦ Volume 12 ¦ Issue 2 ¦ May-August 2022 73

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