Replacing old composite bonding with porcelain veneers (Lumineers) Minimal Prep Veneers

By: Russell McFarlane

In 2011, we completed composite bonding on the patient’s peg laterals. A peg lateral is a tooth that naturally is smaller due to a genetic variation. Peg laterals or even missing laterals (Tooth #7 and #10) are very common. So, patients with peg laterals or missing laterals are often looking for a solution. Minimal Prep or No Prep Veneers can work very well on a case like this, so, for this case we used Lumineers with a guided minimal prep.

Photo from 2/7/2019 showing composite bonding (completed 2011) on the laterals.
Photo from 2/7/2019 showing the peg laterals with the composite bonding removed.
Photo from 3/7/2019 case follow-up, after seating the porcelain veneers on 2/26/2019, then, letting the gums heal before the final photos were made.

This case shows how attention to detail and communication with patients is very important. My patient expressed her growing dislike for the composite bonding and we have been discussing the idea of bumping up to porcelain veneers for the past 8 years. While we were discussing fixing the laterals, the patient expressed that the central teeth were rotated and the patient wanted to know if we could fix that.

We fixed the rotations and improved the overall look of the peg laterals. This case shows a major upgrade for a well-deserving patient, whom has been thinking about doing this for a long time. In this case we used Lumineers ‘030’ with ‘B1’ shading to add warmth in the neck.

We used the A.R.T. technique, which is promoted through DenMat Laboratory, which allows a patient to see a “Trial Smile” version of their teeth before we prep and allows prepping the teeth to be done with the minimum reduction necessary using a reduction guide.

Bicycle Accident – Dental Implant Replacement Case

X-ray: Patient presents after bicycle accident with fractured teeth. (2/19/18) One tooth was completely avulsed and the others adjacent were fractured in half.
X-ray: Patient presents after bicycle accident with fractured teeth. (2/19/18) One tooth was completely avulsed and the others adjacent were fractured in half.

The patient was in a bad bicycle accident, which left her severely injured. Her most notable injuries were the fracture of her front teeth. One tooth (a central) came out completely, while the other three anterior teeth were fractured off. It was determined that the other central (think: front middle tooth) would also have to be extracted as the tooth was fractured in the root. The other teeth, the laterals would need crowns to restore them, but, could be saved. So, we proceded to extract and bone socket preservation graft the sites for #8 and #9.

NOTE: If you are looking for the blurred out picture from the Instagram video, it can be found below in the gallery of images.

X-ray: showing the bone graft in the site replacing the missing central teeth.
X-ray: showing the bone graft in the site replacing the missing central teeth.

The bone graft was placed into the site of the missing teeth. In this case we used cortical bovine bone, covered with a collagen plug and sutured with 3-0 Chromic Gut, resorbable suture. These grafts typically take 4-months to turn into “your bone.” After your body discovers the graft bone, it determines that it should replace it with its own bone. This starts a two-tiered process of osteoclasts, which break down the grafted bone, followed immediately by osteoblasts, which replace the old bone with your own brand new bone.

Feel free to flip through the other images of the case in her gallery. Note: the bone graft photos that show the area immediately after extraction and grafting show a little blood, and the laterals were not yet restored with crowns. So, feel free to skip the fractured image if you have a delicate stomach for even a minimal amount of blood. The patient waited longer than the normal 4-months before implant placement. We elected to wait 7 months to let the bone solidify, since the facial plate was destroyed during the accident. After implant placement, we allowed the implants, plenty of time to heal, as they required careful and adequate healing. Today we finished the case and delivered the two computer designed custom-
titanium abutments with Zirconia crowns.

Smiling Patient: thrilled to have her smile back, and she now has something fixed that does not have to come in and out.
Smiling Patient: thrilled to have her smile back, and she now has something fixed that does not have to come in and out.

This was a challenging case due to bite and spacing considerations. But, we were able to give her back a fixed solution that allows her to floss these teeth separately. You will be pleased to know she is still an avid cyclist. Thanks,

Dr. Russell McFarlane

(below you will see the original censored Instagram version, then, the uncensored YouTube version of the photos immediately following)

Unedited Version

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