A Versatile Tool for Anterior Composite Applications
Uveneer™ templates effective for a variety of restorative uses
Robert A. Lowe, DDS
The Uveneer™ Direct Composite Template System (Ultradent Products, Inc, www.ultradent.com) is a reusable, anterior labial (facial) surface template kit that provides the dentist with preformed anatomic surfaces for simplified and expedient composite placement and finishing. The system was designed to create direct composite veneers with predictable shape and symmetry quickly and easily. There are, however, many clinical applications for Uveneer templates that extend beyond the typical placement of composite veneers that make this product highly useful to the restorative dentist.
Uveneer templates come in two sizes to better fit the facial profiles of most teeth. The sizes of the templates are made to match ideal 75% to 80% width-to-length ratios and to correspond to smile design esthetic proportions (“golden proportion”). With the nuances of facial proximal line angles, proper heights of contour, and facial outline form in the template, Uveneer templates provide a fast, predictable way to create anatomically beautiful direct composite veneers in a fraction of the time when compared to traditional freehand sculpting and contouring. For cases where the templates are not a perfect fit, minor contouring and polishing may be required; however, the time savings in placement is significant due to the preformed facial anatomy.
Uveneer templates are constructed from a non-stick tempered plastic, so they are autoclavable and reusable. Any type of composite can be used with the Uveneer system and the dentist can use a single or multiple layer technique depending on the desired outcome.
A Direct Composite Bridge with Fiber Reinforcement
A common problem orthodontists and restorative dentists face is how to handle young post-orthodontic patients with congenitally missing teeth after completion of orthodontic treatment (Figure 1). Removable type “flippers” or “Essix” style prostheses can be problematic and can lead to loss of soft tissue and bone over time, creating a difficult esthetic issue when implants are eventually placed. Direct composite in conjunction with fiber reinforcement can offer a better intermediate or long-term solution for this restorative dilemma, which can be fabricated in one patient visit with no additional laboratory costs.
The 15-year-old patient shown in Figure 1 presented after her orthodontic appliances were removed. She had bilateral congenitally missing mandibular lateral incisors and needed an esthetic restoration that could carry her into her twenties and beyond for eventual implant placement. The restorative plan was to place a resin-bonded fiber reinforcement material (everStick® C&B, GC America Inc, www.gcamerica.com) on the lingual surfaces of the mandibular anterior teeth to serve as a fixed orthodontic retainer and as a framework on which to build composite pontics to “grow” teeth in the edentulous spaces. Once the fiber is bonded into place, the “dentin” portion of the pontic is placed freehand on the lingual and labial aspects of the fiber, light-cured, and shaped with a flame-shaped carbide composite finishing bur (H274.016, Komet USA, www.kometusa.com). This can be done quickly, making sure that when finishing, the gingival embrasures are open for cleansability with floss threaders.
The “enamel” portion of the labial surface can now be added using the Uveneer template in conjunction with the appropriate shade of composite. The template was first “painted” with flowable resin on the internal surface to help eliminate the possibility of surface porosities. Next, the selected shade of composite was placed into the internal surface of the template, positioned, and then “pressed” onto the “dentin” portion of the pontic (Figure 2). In this case, the correct mesio-distal width was chosen for the Uveneer template. The excessive length from the incisal edge would be trimmed during the finishing process to match the heights of the incisal edges of the adjacent teeth. Figure 3 shows a 1.5-years postoperative photograph of the direct fiber-reinforced bridges replacing teeth Nos. 23 and 26.
An Emergency Composite Provisional Restoration
The patient in Figure 4 presented for an emergency visit with a missing porcelain veneer from tooth No. 24. The restoration had been lost, and there was no existing study model available from which to make a stent to construct a provisional restoration. After removing the remaining resin cement from the preparation using a microetcher (PrepStart, Danville Materials, www.danvillematerials.com), the adjacent proximal surfaces were protected with Teflon tape to avoid bonding to the adjacent teeth. The preparation was etched for 15 seconds using 37% phosphoric acid (Ultra-Etch®, Ultradent Products, Inc) then thoroughly rinsed and dried. Adhesive resin (Peak® Universal, Ultradent Products, Inc) was applied to the preparation using a microbrush, and then air-thinned and light-cured. The Uveneer template was then loaded with composite resin and placed onto the cured adhesive (Figure 5). Figure 6 shows the postoperative provisionalization with composite and Uveneer for this patient. The entire process took about 15 minutes.
In Figure 7 the patient shown presented for an emergency appointment with a Class IV fracture of the porcelain veneer on tooth No. 9. There was not enough time in the schedule to reprepare, impression, and provisionalize the tooth, and the patient was going out of town for a conference the next day. The broken veneer was prepared into the existing ceramic using a coarse diamond (5850.FG.016, Komet USA) just enough to create a minimal amount of space in the labial direction for placement of composite resin. After preparation, the ceramic surface was etched with 9% hydrofluoric acid (Ultradent Products, Inc) for 90 seconds, thoroughly rinsed, and air-dried. Next, silane (Ultradent Products, Inc) was applied to the ceramic surface, then air-dried. After application of adhesive resin (Peak Universal), air-thinning, and light-curing, the Uveneer template was loaded with, in this case, bleach-colored composite and applied to the prepared surface. This was followed by light-curing and minor finishing. The finished “temporary” veneer is shown in Figure 8. The entire process took less than 15 minutes.
Uveneer templates can be used in various clinical situations such as those described above, to give the dentist a unique tool to quickly and efficiently restore labial surfaces of anterior teeth with composite resin. The effectiveness of this matrix goes far beyond the designed use and has many unique applications for use in dentists’ restorative armamentarium.
About the Author
Robert A. Lowe, DDS
Charlotte, North Carolina
American Board of Aesthetic Dentistry