Case study : Componeer-A case study

*Corresponding Author: Dr. Akanksha Bhatt BDS, MDS Assistant Professor, Department of Conservative Dentistry &Endodontics, Babu Banarasi Das College of Dental Sciences, BBD University , Lucknow, INDIA E-mail: dr.a.bhatt@gmail.com UpDCJ: 2016;6(1), Dr. Akanksha Bhatt et al. 41 | P a g e Intra-oral periapical radiographs were taken to exclude any pathological sign. A provisional diagnosis of Fluorosis was made.


Background
The purpose of this article is to report a case of generalized fluorosis in a 23 year old boy with its management by noble, new, minimal invasive procedure involving recently introduced aesthetic material "Componeer".

Case Presentation
A 23 year old boy reported to our private dental clinic with a chief complain of ugly looking front teeth.On general examination, the boy was apparently healthy.There was no significant medical history.The patient gave history of his residence in Pratapgarh, (U.P, India) area where he used to drink hand pump drinking water.Intraoral examination revealed severe grade II (According to Nathoo's classification) fluorosis stains (Figure 1).The pulp vitality tests showed that all his teeth were vital with no abnormal mobility.On intraoral examination, it was observed that there were generalized stains involving incisal, middle and cervical areas of the teeth.A series of Intra-oral periapical radiographs were taken to exclude any pathological sign.A provisional diagnosis of Fluorosis was made.

Treatment
Proper shape, size and colour of individual teeth was recorded and Componeer veneer was chosen the material of choice.The Componeer Contour and teeth size guide was used to determine the appropriate Componeer sizes.For eight upper and eight lower teeth."L" size componeer was selected for the central incisors, "M" size for the lateral incisors, "L" size for canine and "M" size for premolar was chosen.(Figure 2)  The White Opalescence shade of Componeer was selected and the dentine composite shade Synergy D6 White Bleach was chosen.(Figure 3) Figure 4: Trimming the prefabricated veneer with an abrasive disk.
Minimal preparation (0.2mm -0.3mm) was done on labial surface of the tooth involving incisor edge.35 % phosphoric acid was used to etch the teeth for 30 seconds.
The One Coat Bond (ColteneWhaledent, Switzerland) was then applied to the enamel surfaces and before light-curing for 10 seconds per tooth, transparent matrices were placed in the interdentally spaces.The Componeer were wetted with One Coat Bond and briefly blow-dried with air, but without lightcuring.White Bleach dentine composite was then applied to the fitting surface of each Componeer.(Figure 4) One by one, the Componeer were pressed onto the teeth surfaces using the Placer instrument, beginning with the two central incisors.
Each Componeer was subsequently cured after alignment was corrected.Any peripheral defective areas were filled using Synergy D6 White Bleach dentine composite resin.The finishing was made by using finest finishing diamond points as well as flexible discs and strips.(Figure 5)

Outcome And Follow up
After 1 week, 3 months, 6 months and 1 year follow-up the patient was healthy and happy with his aesthetically treated teeth without complain of any stain and sensitivity.

Discussion
In the early 1980's, pre-fabricated acrylic veneers were introduced as mastique laminate veneer system.Mastique veneer shade limited success because of technological limitation sand poor surface qualities. 1,2Clinical studies have confirmed good performance of porcelain veneer restorations, with excellent aesthetics, overall patient satisfaction, and no adverse effects on the periodontal tissues. 2 The main reason for its failure was fracture of the ceramic.
The clinical outcome of indirect veneer depends on the strength of two interfaces: the tooth/resin cement and the veneer/resin cement interface.A recent bond strength study reported that componeer prefabricated veneer resulted in microshear bond strengths statistically similar to those of etched IPS E maxpress. 3e novel clinical technique described in this paper has the potential for being used routinely to lengthen anterior teeth, to correct malpositioned teeth, to mask discolorations and to close diastema.The technique can be used to restore extensive carious lesions and tooth fractures and to refurbish large old anterior restorations especially when other treatment options are out of reach for the patient.