In the concluding part of his article series, Markus Firla discusses the intraoral repair of chipped ceramic or composite veneers covering fixed crowns and/or bridges.

This article – the last in a trilogy of user reports – aims to discuss an application of direct adhesive composites that falls outside of everyday dental practice.

When the need arises, however, these applications are all the more urgent and challenging – occurring as they do in an unexpected emergency case, such as the intraoral repair of chipped ceramic or com-posite veneers covering fixed crowns and/or bridges.

For this indication, a composite restorative combining the light-optical aesthetic properties of enamel and dentine will prove useful, eg the product described in this series of articles: Beautifil II LS (Shofu).

Chipping or flaking, which may affect both the ceramic or composite veneers of crowns with metal frameworks and the surfaces of all-ceramic crowns, is an unpleasant surprise, and not only for patients. And the newer the restoration, the more annoying the damage.

Material failure

Apart from mechanical or traumatic causes, such as fall or punch injuries or biting on an unexpectedly hard object during eating, the main reason for material failure is excessive accumulation of stresses at the site affected.

Parafunctions in dynamic occlusion (grinding, pressing, bruxing and so on) unnoticed before or during the final seating of the restoration, and/or subtle premature contacts in static occlusion, or habitually traumatic intercuspation, may be the underlying causes of these latent overloads, which often occur only at certain points.

In extreme cases, even a trained eye will not immediately detect such a risk, or not early enough before the damage is done. Restorations may be provisionally cemented so that patients can try them for some time (usually about three months), but this will not reliably prevent the problem, either.

Laboratory costs?

It may not desirable (nor possible) to completely replace the damaged restoration, as the resulting dental laboratory costs would be uneconomical or inappropriate. Since removing the restoration for extraoral repair or complete replacement would do more harm than good to the abutments or the periodontium, then the damage can be remedied only by direct intraoral repair with the aid of suitable bonding systems and adhesive composite restoratives.

With some practice and the right materials, such as the universal composite Beautifil II LS, this kind of reconstruction is actually not that difficult. The clinical case illustrated here will demonstrate this (Figures 1-10).

Figures 1-8 are copyright Dr Markus Firla and Wecomed Consulting & Services GmbH

Figures 1 and 2: Before and after. The disto-incisal edge of the ceramic veneer of this crown on tooth UR1 was intraorally repaired, and the aesthetically insufficient mesio-buccal composite restoration in tooth UR2 was replaced. Thanks to the biomimetic shade and translucency characteristics of Beautifil II LS, the procedure was quick and easy, and the final result was excellent. Only one composite shade (Beautifil II LS A3) was needed to restore these two defects. And one composite increment each was sufficient to achieve the desired result
Figure 2
Figure 3: The fractured ceramic surface and areas adjacent to the defect zone were carefully roughened with a coarse diamond bur
Figure 4: Bonding systems were applied to the areas to be restored, ie the fractured ceramic surface in tooth UR1 and the cavity surface in tooth UR2. Beautifil II LS is compatible with all common adhesive and ceramic/composite repair systems. The small metal surface exposed at the disto-incisal edge of the damaged crown was masked with dentine-coloured Beautifil Opaquer (UO)
Figure 5: Both the small cavity and the large defect were restored using one monochromatic composite increment each (shade A3)
Figures 6-8: The direct restoration and the reconstructed disto-incisal edge of the ceramic veneer were successively contoured, finished, and polished to a high gloss, using carbide finishers, disposable silicone polishers with alumina (One-Gloss, Shofu) and a disposable felt disk impregnated with alumina polishing paste (Super-Snap Superbuff, Shofu)
Figure 7
Figure 8
Figure 9
Figure 10

For further details, contact the Shofu office 01732 783580 or [email protected].

First published in DZW – Die Zahnarzt Woche, issue 28/2017. Email [email protected] for references.