CATEGORY AUSTRALASIAN DENTIST 93 LINICAL 1. Free hand 2. Stent a. Laboratory-made palatal putty stent. b. Uveneer, with or without the Paladex system. c. Injectable technique. Advantages of composite veneers include the ability to be completed at any age post-eruption, unlike porcelain veneers which require the individual to reach full periodontal maturity. Further, the direct approach allows easy chairside maintenance and repairs. Stents provide the operator with more predictability and clinical efficiency with the additional advantage to preventing formation of the oxygen inhibition layer. This is evident in both the Uveneer system and injectable technique, as the final composite layer is cured through an oxygen barrier that still facilitates light transmission. Enamel’ssemi-translucencyisnoteasily simulated. A preoperative mock-up aids not only to select the correct hue, chroma and value but also match its opalescent likeness. Often clinicians disregard the thickness of the final restoration in the mock-up phase resulting in an intensified final chroma or opaqueness. To improve likeness of the mock-up to the final shade ensure a sufficient composite thickness is tested to assess its suitability. In order to maximise adhesion a 29-micron aluminium oxide air abrasion (Velopex AquaCare Twin, Willesden, London, England), pre-treatment was utilised under split rubber dam technique to protect the patient’s airway. Aluminium oxide air abrasion prior to an etch-andrinse system increases the longevity of the composite restorations by significantly improving bond strength (from 33.78MPa to 55.08MPa) (Fig 12).12 This is explained by an increase in surface area, surface free energy and wettability of dentine and enamel to the adhesive.11 Given the desire to mask the underlying hypoplastic discoloration the injectable technique was rejected as it does not readily allow separate layering of composite resin to achieve the desired masking properties. Additionally, the injectable technique burdens patients with an increase in laboratory cost for construction of injectable stent. Rather, the Uveneer and Paladex systems were selected as they increase predictability compared to free-hand composite build-up, allow incremental composite layering to increase hypoplastic masking property and are more cost-effective relative to a wax-up and laboratory-made palatal putty stent (Table 2). The Paladex (Dental Art Innovations, City of Glen Eira, Victoria, Australia) (Figs 6a-6c & 13) is a silicone palatal index that adapts to the palatal surface replacing traditional silicone palatal keys. For the bulk of the veneer, two increments of the same shade of composite are layered; curing each layer separately. The aim of this method is to create the opaqueness to mask the underlying hypoplastic tooth shade (Figs 8b & 8c). Once the palatal aspect has been established using the Paladex, the facial is built using a first layer of packable composite that is light cured followed by a second packable composite layer pressed with the Uveneer and left uncured. The Uveneer is then lined with high filler flowable composite (Figs 7a-7c, 8a-8c & 14), pressed onto the uncured second layer of packable composite and cured together; reproducing the aesthetically natural facial anatomy based on Dr Jan Hajtó’s natural ‘Anteriores’.13 Collectively, these tools were utilised over the free-hand technique, to save time and improve predictability, and over the injectable technique to allow separate layer application to mask the hypoplastic discolouration. Conclusion TDI most frequently occur in children during the development of permanent dentition. The ramifications to the succedent teeth ranges fromdiscoloration’s and enamel hypoplasia to more severe dilaceration and root angulations. Restoring hypoplastic teeth not only provides a smoother less plaque retentive surface to promote oral hygiene but also reestablishes aesthetics and in doing so the confidence to smile. Acknowledgment Dr Sigal Jacobson declares she is the inventor of the Uveneer and Paladex systems. For a complete list of references email gapmagazines@gmail.com About the authors Sigal Jacobson DMD, Jacobson Dental Group, Melbourne. Dr Sigal Jacobson, entrepreneur and lecturer in regards to aesthetics dentistry, has been named one of the Top 25 Women in Dentistry (Dental Products Report Magazine 2017, USA). She is the inventor of the Uveneer and Paladex systems used to create beautiful and predictable direct composite veneers. Dr Jacobson currently practices in her private clinic in Melbourne. Ido Landau BHSc(Dent), MDent (La Trobe). Dr Ido Landau has a passion for comprehensive patient centric dental care and advancing dental technologies. Dr Landau is rthe ecipient of the Australian Dental Association Victorian Branch (ADAVB) LTU academic prize and member of the La Trobe Excellence Academy Figure 14. Uveneer Extra Figure 13. Paladex Figure 12. AquaCare Twin Air Abrasion
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