Conservative Approach in Anterior Aesthetic Rehabilitation: An Updated Review and Case Report

uma revisão atualizada e relato de caso

Abstract

Introduction: Patients often visit dental offices to boost their self-esteem, seeking to change the color and shape of their teeth. Brazil, internationally recognized as one of the countries where the population undergoes a high number of aesthetic procedures, reflects a culture where beauty and appearance care hold significant importance in daily life. In recent years, dental veneers have gained prominence and popularity on social media, influencing the decisions of many individuals who wish to achieve more harmonious smiles. In this context, ceramic laminates are known for being fabricated in a laboratory and then cemented onto the teeth. Similarly, composite resins are directly applied to the surface, usually in a single session. However, the rehabilitation process goes beyond aesthetics. Restoring function is one of the essential pillars in dentistry that cannot be overlooked, ensuring that patients not only have a harmonious smile but also maintain proper occlusion and the health of periodontal tissues. Objectives: This article aims to compare the use of indirect ceramic laminates and direct composite veneers, emphasizing their minimally invasive approach. Techniques, longevity, optical and physical properties of these materials, and the customization of treatment according to the individual needs of patients will be discussed. Additionally, the article will include a case report focused on the clinical protocol of ceramic laminates with conservative preparations. Methodology: The review was conducted using databases and bibliographic research of scientific articles indexed in the Virtual Health Library (BVS), PubMed, and Google Scholar, selected for their relevance to the topic, in July 2024. In the BVS, the following keywords were used: "laminados de cerâmica" and "facetas e periodonto," applying filters for dental veneers, dental aesthetics, and ceramics, limiting the search to articles in Portuguese published in the last five years. The search resulted in 19 articles, of which 2 were chosen. In Google Scholar, the descriptor "laminados de cerâmica minimamente invasivo" was used, and the filter was applied for research from 2024. This search returned 20 results, of which 2 were preferred: 1. "Comparação entre laminados cerâmicos e facetas diretas em resina composta: revisão de literatura." 2. "Heraceram: cerâmica ultraconservadora para substituição de restaurações anteriores de resinas compostas na reabilitação do sorriso." The clinical case described by Fernandes (2018) in his monograph "Reabilitação estética anterior com laminados cerâmicos ultraconservadores" was included to exemplify the practical application of the reviewed concepts. Results: In the literature review, the articles by Cunha (2023) and Oliveira (2023) value indirect ceramic veneers for their biocompatibility, strength, and durability, making them ideal for the aesthetic correction of tooth shape, symmetry, and color. However, they are costly. They are contraindicated in cases of significant dental structural reduction, harmful habits, or severe periodontal pathology. In contrast, direct composite veneers are more economical and practical, dispensing with impressions and temporaries, and are suitable for closing diastemas and aesthetic alterations. However, they present color instability, high porosity, susceptibility to marginal leakage and staining, and are more fragile in high-stress areas. Cunha (2023) emphasizes that ceramics stand out for their color stability and better abrasion resistance compared to composite resin. Case Report: The patient F.A.S., a 28-year-old female, sought the Dental Clinic dissatisfied with the aesthetics of her smile. The patient's main complaint was the "tamanho dos dentes e quanto eles aparecem no sorriso," desiring longer teeth. The patient had a history of teeth whitening and was dissatisfied with the current color of her teeth. Extraoral and intraoral photographs were taken to document the initial smile, and a model of the upper and lower arches in type III stone was made and sent to the laboratory. Incisal and palatal reference walls or guides, vestibular wear guide, and mock-up were developed to test the result. The color of the laminates was selected based on a photographic record of the samples, with the final color chosen being BL1 (Bleach I). The dental preparations were minimally invasive with sandpaper discs and a multi-blade bur, following the guides for occlusal and vestibular wear, and the interproximal areas were prepared with a metal strip. For the impression, the double cord retraction technique and double impression with addition silicone were used. The ceramic veneers were made with the Emax Press System - Ivoclar Vivadent and, after the dry try-in, were cemented with transparent light-cured cement (Variolink II, Ivoclar Vivadent AG). The conditioning of the ceramics included hydrofluoric acid, phosphoric acid, and silane to improve adhesion. The treatment resulted in an aesthetically satisfying smile, with the desired color and shape by the patient. Conclusion: The case report exemplifies the practical application of the discussed approach, highlighting the effectiveness of ceramic laminates compared to direct veneers. The indirect rehabilitative technique is recommended for its ability to preserve healthy tooth structure, minimize wear, provide high-quality aesthetic and functional results, and offer the patient predictability of the procedure. In the described clinical case, the veneers were made with the Emax Press ceramic system from Ivoclar Vivadent. This system is particularly advantageous for patients seeking a definitive and long-term solution, combining excellent marginal adaptation, mechanical strength, and natural aesthetics. Recognizing the need for proper and individualized planning, it is concluded that it is essential to emphasize that the operative technique must be executed correctly according to the protocol. It is important to note that, when necessary, to achieve better results, it is crucial to integrate a multidisciplinary approach involving different areas of dentistry. In this way, it is possible to understand the association between the literature review and the case description, as well as to provide additional data for future research.