10.59987/ads/2015.3-4.113-118
Aim. Re-establishing a patient’s lost dental aesthetic appearance is one of the most important topics for contemporary dentistry. New treatment materials and methods have been coming on the scene, day by day, in order to achieve such an aim. Most dentists prefer more conservative and aesthetic approaches, such as direct or indirect veneer restorations, instead of full-ceramic crowns for anteriors where aesthetics is really important. The aim of the study is to evaluate clinically the effectiveness of a direct composite veneering system in resolving aesthetic problem of an upper incisor with a multidisciplinary treatment approach.
Methods. Patient with a severe discolored upper incisor came to our attention; at the X-ray exam there was an evidence of a past not good root canal treatment and also old and incongruent composite obturation. After removing all the material inside the root canal was performed a new correct endodontic filling, then Authors tried to bleach the tooth trough “walking-bleach” technique with a hydrogen peroxide (30 volumes) and sodium perborate solution without excellent results. So it was decided to insert a glass-fiber post and than to perform a direct composite veneer with Componeer System (Coltene). Componeer System is a system of prefabricated composite veneers that are abled to be applied directly in the first appointment: after a conservative preparation of the tooth, it must be used an adhesive agent (for example a “three steps”) and then with composite stratification it’s possible to apply the componeer veneer (choosing the right measure, modified as necessary) as the last covering aesthetic layer.
Result. The evaluation of result of this multidisciplinary treatment was essentially clinical and radiological; in fact it’s possible to observe, from a clinical point of view, the good aesthetic aspect of the direct composite restoration with componeer veneer that offers also some advantages: conservative preparation with minimal lost of tooth tissue, easy standardized technique, low cost and immediate restoration of the tooth (without provisional passage). From a radiological point of view it’s possible to check the good quality of endodontic retreatment on the post-operative periapical X-ray. To verify the long-term result Authors consider follow up at six months and one year.
Conclusion. A multidisciplinary approach is always necessary to program a treatment plan in dentistry; in the case reported Authors decide to perform an endo-conservative treatment with different steps: - root canal therapy to resolve endodontical problem - glass fiber post to reinforce the conservative restoration - direct composite veneer restoration (after bleaching) to obtain the resolution of anterior aesthetic problems.
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en
U. Romeo
https://creativecommons.org/licenses/by-nc-nd/4.0
Annali di stomatologia
componeer
Endo-restorative treatment of a severly discolored upper incisor: resolution of the “aesthetic” problem through Componeer veneering System
Text.Serial.Journal
https://www.annalidistomatologia.eu/ads
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Review article
2022-08-11
2022-08-11
2015-12-01
2023-12-04
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Ann Stomatol (Roma)
U. Romeo
2015
10.59987/ads/2015.3-4.113-118
113
Department of Oral and Maxillo Facial Sciences, School of Dentistry, “Sapienza” University of Rome, Italy
1971-1441
3-4
componeer
en
118
Endo-restorative treatment of a severly discolored upper incisor: resolution of the “aesthetic” problem through Componeer veneering System
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                                                                                                  Review article



    Endo-restorative treatment of a severly discolored
    upper incisor: resolution of the “aesthetic” problem
    through Componeer veneering System




                                                                                                   i
                                                                                                 al
                                                                                              on
    Guido Migliau, MD, DDS, PhD                             sive agent (for example a “three steps”) and then
    Laith Konstantinos Besharat, DDS, MSc, PhD              with composite stratification it’s possible to apply
    Afrah Ali Abdullah Sofan, DDS, PhD                      the componeer veneer (choosing the right mea-
    Eshrak Ali Abdullah Sofan, DDS, PhD                     sure, modified as necessary) as the last covering
    Umberto Romeo, MD, DDS, PhD                             aesthetic layer.




                                                                                     zi
                                                            Result. The evaluation of result of this multidisci-
                                                            plinary treatment was essentially clinical and ra-
    Department of Oral and Maxillo Facial Sciences,         diological; in fact it’s possible to observe, from a




                                                                        na
    School of Dentistry, “Sapienza” University of Rome,     clinical point of view, the good aesthetic aspect
    Italy                                                   of the direct composite restoration with com-
                                                            poneer veneer that offers also some advantages:
    Corresponding author:                                   conservative preparation with minimal lost of
                                                            tooth tissue, easy standardized technique, low




                                                              er
    Laith Konstantinos Besharat
    Department of Oral and Maxillo Facial Sciences,         cost and immediate restoration of the tooth (with-
    School of Dentistry, “Sapienza” University of Rome      out provisional passage). From a radiological
    Via Caserta, 6                                          point of view it’s possible to check the good qual-
    00161 Rome, Italy


                                                        t   ity of endodontic retreatment on the post-opera-
    E-mail: besharatlk84@yahoo.it
                                                     In     tive periapical X-ray. To verify the long-term re-
                                                            sult Authors consider follow up at six months and
                                                            one year.
    Summary                                                 Conclusion. A multidisciplinary approach is al-
                                                            ways necessary to program a treatment plan in
                                               ni
    Aim. Re-establishing a patient’s lost dental aesthet-   dentistry; in the case reported Authors decide to
    ic appearance is one of the most important topics       perform an endo-conservative treatment with dif-
    for contemporary dentistry. New treatment materi-       ferent steps:
                                    io

    als and methods have been coming on the scene,          - root canal therapy to resolve endodontical
    day by day, in order to achieve such an aim. Most           problem
    dentists prefer more conservative and aesthetic ap-     - glass fiber post to reinforce the conservative
    proaches, such as direct or indirect veneer restora-        restoration
                          iz



    tions, instead of full-ceramic crowns for anteriors     - direct composite veneer restoration (after
    where aesthetics is really important.                       bleaching) to obtain the resolution of anterior
    The aim of the study is to evaluate clinically the          aesthetic problems.
          Ed




    effectiveness of a direct composite veneering
    system in resolving aesthetic problem of an up-         Key words: restorative dentistry, componeer.
    per incisor with a multidisciplinary treatment ap-
    proach.
    Methods. Patient with a severe discolored upper         Introduction
    incisor came to our attention; at the X-ray exam
IC




    there was an evidence of a past not good root           Increasing demands for aesthetic restorative treat-
    canal treatment and also old and incongruent            ments and recent advances in adhesive dentistry
    composite obturation. After removing all the ma-        have led to the development of materials and tech-
    terial inside the root canal was performed a new        niques aimed at restoring the natural tooth appear-
C




    correct endodontic filling, then Authors tried to       ance, especially in the anterior segment.
    bleach the tooth trough “walking-bleach” tech-          Anterior tooth discoloration is one of the most frequent
    nique with a hydrogen peroxide (30 volumes) and         causes of dental treatment. In the past years, dentists
    sodium perborate solution without excellent re-         had been using several techniques and materials,
©




    sults. So it was decided to insert a glass-fiber        such as resin and porcelain to correct aesthetic prob-
    post and than to perform a direct composite ve-         lems caused by various clinical conditions. Porcelain
    neer with Componeer System (Coltene). Com-              and other all-ceramic veneers are rated as the best
    poneer System is a system of prefabricated com-         veneer restorations (1-3) for discolored or malformed
    posite veneers that are abled to be applied direct-     anterior teeth. Veneers have evolved over the last
    ly in the first appointment: after a conservative       several decades becoming one of the most popular
    preparation of the tooth, it must be used an adhe-      restoration tools in aesthetic dentistry. The veneer is

    Annali di Stomatologia 2015; VI (3-4): 113-118                                                              113
    G. Migliau et al.


    considered as an alterative to full coverage and en-                  1) (8). Importantly, the accurate diagnosis of discol-
    hances the aesthetic appearance of the anterior denti-                oration is a condition with multifactorial etiology; it is
    tion. Veneers can be divided into 3 categories: 1) free-              classified as extrinsic and intrinsic and can occur due
    hand layering with direct composite resins; 2) pre-                   to a number of metabolic diseases, systemic condi-
    formed acrylic laminates; 3) laboratory-fabricated ve-                tions and local factors (Tab. 2) (9).




                                                                                                                    i
    neers (acrylic resins, composite resins, porcelains,




                                                                                                                  al
    and glass ceramic veneers) (4-6). Excellent results
    can be achieved with the modern advanced composite                    Classification of tooth discoloration
    resin and adhesive systems; in contrast to conserva-




                                                                                                               on
    tive restorations they are able to correct existing ab-               Intrinsic discoloration: intrinsic discoloration oc-
    normalities, aesthetic deficiencies (fractured, mal-                  curs following a change to the structural composi-
    formed or malposed teeth), and discolorations where                   tion or thickness of the dental hard tissues. The
    it is difficult to recreate harmonious tooth shape and                normal color of teeth is determined by the blue,
    color. Disadvantages of the direct composite veneers                  green and pink tints of the enamel and is reinforced




                                                                                                     zi
    include long term color changing, less wear resis-                    by the yellow through the brown shades of dentine
    tance, which means that they often require repair or                  beneath. A number of metabolic diseases and sys-
    replacement, whereas disadvantages of ceramic ve-                     temic factors is known to affect the developing den-




                                                                                       na
    neers include irreversible removal of tooth structure,                tition and cause discoloration as a consequence. In
    technique sensitivity, cost and length of time needed                 addition, local factors such as injury are also recog-
    from the initial stage of tooth preparation until the                 nized.
    restoration is finally seated (7).                                    Extrinsic discoloration: extrinsic color discoloration




                                                                            er
    The tooth can be discolored by deposition of pig-                     is outside the tooth substance and lies on the tooth
    ments in its internal structure and on its surface (Tab.              surface or in the acquired pellicle.

    Table 1. Causes of tooth discoloration and types of stains.



                                                               t
    Intrinsic discoloration
                                                            In
                                                Extrinsic discoloration       Internalized discoloration          Types of stains
    11. Alkaptonuria                            1. Metallic                   1. Developmental defects            1. Brown stain
    12.Congenital erythropoietic porphyria      2. Non-metallic               2. Acquired defects                 2. Black stain
    13.Congenital hyperbilirubinaemia                                         1a) Tooth wear and gingival         3. Orange stain
                                                                              1a) recession
                                              ni
    14. Amelogenesis imperfect                                                1b) Dental caries                   4. Green stain
    15.Dentinogenesis imperfect                                               1c) Restorative materials           5. Metallic stain
                                                                              1a) (Manuel et al., 2010)
                                    io

    16. Tetracycline staining                                                                                     6. Yellowish brown
                                                                                                                     stains
    17. Fluorosis                                                                                                 7. Violet to black
    18. Enamel hypoplasia                                                                                         8. Red-black
                          iz



    19.Pulpal hemorrhagic products
    10. Root resorption
    11. Ageing
           Ed




    Table 2. Extrinsic and intrinsic factors and their characteristics.

    Extrinsic factors                 Characteristics                        Intrinsic factors              Characteristics
    Chromogenic bacteria stains       Green, black-brown and orange          Dentinogenesis imperfecta      Yellow or grey-brown
    Tobacco                           Black, brown                           Amelogenesis imperfecta        Yellow-brown
IC




    Amalgam                           Black, grey                            Dental fluorosis               Opaque white to
                                                                                                              yellow-brown patches
    Medicaments                       Silver-nitrate: Grey black             Sulphur drugs                  Black staining
                                      Stannous-fluoride: Black brown
C




                                      Chlorhexidine: Black brown
    Foods and beverages               Coffee, tea, wine, berries, etc.:      Tetracyclines:
                                      Color of corresponding food item        Chlortetracycline             Grey-brown hue
                                                                              Oxytetracycline               Brown-yellow to yellow
©




                                                                              Tetracycline HCL              Brown-yellow to yellow
                                                                              Dimethylchlortetracycline     Brown-yellow to yellow
                                                                              Minocycline                   Blue-grey to grey
                                                                              Doxycycline                   No change
    Iron                              Black cervical discoloration            Dental trauma                 Transiently red through
                                                                                                              to black
                                                                               Ochronosis                   Brown


    114                                                                                   Annali di Stomatologia 2015; VI (3-4): 113-118
    Endo-restorative treatment of a severly discolored upper incisor: resolution of the “aesthetic” problem through
    Componeer veneering System

    Internalized discoloration: internalized discoloration         1. Pre-restorative stage
    is the incorporation of extrinsic stain within the tooth
    substance following dental development. It occurs in           a) Endodontic retreatment:
    enamel defects and in the porous surface of exposed            After the anamnesis collection of data and an overall
    dentine.                                                       examination of oral status to exclude existing patholo-




                                                                                                             i
                                                                   gies, the tooth needing retreatment was diagnosed.




                                                                                                           al
                                                                   The diagnosis for retreatment was made according
    Composite veneer                                               to the signs and symptoms reported by the patient
                                                                   and the preoperative radiographs showing apical ra-




                                                                                                        on
    Several Authors have suggested the use of compos-              diolucency. The crucial factor for achieving success-
    ite resin veneers as direct or indirect method for             ful retreatment is thorough reshaping and cleaning
    restoring anterior teeth instead of full-ceramic crowns        of the canals to eliminate bacteria (18-20). During
    which provide well-functioning and aesthetic results           retreatment the operators used bio orange solvent
                                                                   (OGNA) with hand K-file and ultrasonic device (Mec-




                                                                                               zi
    (10-12). Nevertheless, to date, no restorative material
    has been more effective than the properties of the             tron) to remove the broken instrument, gutta-percha
    natural dental structures themselves. Prefabricated            and sealer (Fig. 3). Subsequently the tooth was pre-
                                                                   pared with Mtwo (Sweden & Martina) rotary Ni-Ti in-




                                                                                 na
    composite resin veneers have been recently intro-
    duced (13). Specifically Componeer (Coltene, Altstat-          struments to working length and irrigated with 5.25%
    ten, Switzerland) prefabricated veneers are thin com-          NaOCl and refilling with the Thermafil system
    posite resin shells (0.3 mm cervically and 0.6-1.0 mm          (Dentsply; Tulsa Dental, Tulsa, OK, USA) (21) the
    to the incisal edge), made of a pre-polymerized hy-            Canal orifices were sealed with temporary material




                                                                      er
    brid composite resin, synergy D6 (Coltene). The ve-            (Fig. 4).
    neers are cemented with the same hybrid composite
    resin that they are made from, which has the potential
    of making the complete restoration as a monoblock              b) Chemical bleaching technique:
    unit (14). These veneers can be trimmed and bonded

                                                           t
    to the tooth structure using direct hybrid composite
                                                        In         Given the appropriate indication, the bleaching of
                                                                   non-vital teeth is a relatively low-risk intervention to
    resin. One Coat Bond (Coltene) is the dentin adhe-
                                                                   improve the aesthetics of endodontically treated teeth
    sive included in the system, which is used to bond the
                                                                   (22-24). Depending on the situation, the walking
    prefabricated composite shells to the tooth structure
                                                                   bleach technique can be an uncomplicated and con-
    using an etch-and-rinse bonding strategy (15, 16).
                                               ni
    Composite veneers take on special importance in
    Restorative Dentistry, as they are less expensive,
    which makes this practice a feasible option, mostly to
                                    io


    people with a lower income and satisfy the patient’s
    restorative needs and aesthetic desires (17). This
    case report describes a clinical case performed by
                          iz



    means of prefabricated Composite veneers to correct
    a variety of generalized color defects on the upper
    central incisor, aimed at the aesthetic and functional
          Ed




    reconstruction with a multidisciplinary treatment ap-
    proach.
                                                                   Figure 1. Preoperative view of central incisor.

    Case report
IC




    A 45-year-old female patient came to our Department
    with a discolored tooth, a maxillary left central in-
    cisor, which was compromising the aesthetic of her
    smile (Fig. 1). On elaborating the medical history of
C




    the patient, it was noted that the same tooth had
    been traumatized previously. The tooth has an old in-
    congruous root canal therapy (short filling), with a
    broken instrument inside the canal, observed through
    pre-treatment X-ray (Fig. 2). Furthermore, by clinical
©




    examination the defect of an old composite obtura-
    tion was evident.
    From the above mentioned findings, in agreement
    with the patient, a conservative aesthetic rehabilita-
    tion was decided.
    The treatment was divided into two stages:                     Figure 2. Pre-treatment X-ray.

    Annali di Stomatologia 2015; VI (3-4): 113-118                                                                     115
    G. Migliau et al.


    venient method for both patients and dentists: the         the access cavity after each operation (26-28). The
    bleach agent is collocated inside the pulp chamber,        procedure was repeated tree times.
    after putting a seal with glass-ionomeric cement at
    the coronal portion of the canal.
    Some tooth discolorations in endodontically treated        2. Restorative stage




                                                                                                        i
    teeth are caused by dental treatments. In this case




                                                                                                      al
    the type of root-canal filling material and medication     Discolored anterior teeth are often perceived as an
    agent, played a role in the discoloration tendency of      aesthetic detraction. An array of treatment, like ce-
    the tooth (25).                                            ramics or composite veneering, is available for the re-




                                                                                                   on
    The walking bleach technique was carried out by in-        maining discoloration after the bleaching technique.
    ternal whitening treatment with an Opalescence endo        In this case a glass-fiber posts (Sweden & Martina)
    (Ultradent) respectively, in the pulp chamber then us-     was placed into the root canal to achieve retention for
    ing Cavit as temporary filling material to properly seal   the restoration (29), before performing the composite
                                                               veneer.




                                                                                         zi
                                                               The treatment consists of prefabricated Componeer
                                                               direct Composite veneering System (coltene) to en-
                                                               hance the aesthetics of smile (14). This technique is




                                                                           na
                                                               less traumatic and more conservative for patients
                                                               with the additional advantage that it can be performed
                                                               efficiently in just a single session.




                                                                 er
                                                               a) Preparatory phase:

                                                               Shade and size selection: the shade is selected



                                                         t     with the use of the Componeer synergy D6 shade
                                                      In       guide (Coltene). The color guide comes with six
                                                               dentin cores and two enamel shells (Fig. 5). After the
                                                               teeth are cleaned, the enamel and dentin shades are
                                                               evaluated separately. The enamel shell guide is su-
                                                               perimposed over the dentin core to determine the ap-
                                         ni
    Figure 3. Intraoperative X-ray.                            proximate final color. The size of the composite shell
                                                               for a specific patient is selected with Componeer con-
                                                               tour Guides. A wider and longer size is recommended
                                      io

                                                               rather than a short and narrow shape, as the clinician
                                                               will have the possibility of trimming and customizing
                                                               the prefabricated veneer with an abrasive disk to
                         iz


                                                               match the shape of the natural tooth as close as pos-
                                                               sible.
          Ed




                                                               b) Tooth preparation:

                                                               After local anesthesia and rubber dam application,
                                                               the old restoration is removed first by using a ta-
                                                               pered-cylinder, round-end diamond bur. Tooth mar-
                                                               gins and prepared surfaces were then etched for 15
IC




                                                               seconds with a 37% phosphoric acid etchant gel
                                                               (Scotchbond Universal, 3M ESPE). The tooth were
    Figure 4. Postoperative X-ray.                             rinsed and dried, and thereafter separated by inter-
C




                                                                              Figure 5. Componeer synergy D6 shade
                                                                              guide.
©




    116                                                                       Annali di Stomatologia 2015; VI (3-4): 113-118
    Endo-restorative treatment of a severly discolored upper incisor: resolution of the “aesthetic” problem through
    Componeer veneering System

    proximal matrices. A dental bonding agent (One                 durability. Further investigation is needed to deter-
    Coat Bond, Coltène Whaledent) was applied to all               mine the longevity of this new treatment from six
    prepared surfaces, followed by gentle air-drying from          months to one year at least (Figs. 7, 8) in order to re-
    the cervical to the incisal aspect and light-curing for        port that no failure of the restoration was detected.
    20 seconds. Dentin shaded composite was free-




                                                                                                              i
    handed and then used to restore with the corre-




                                                                                                            al
    sponding preparations of a conventional direct com-            Conclusion
    posite restoration and light-curing for 40 seconds.
    The size and mould required were re-checked, and               On the basis of the results, it can be concluded that in




                                                                                                         on
    the corresponding veneers adjusted. A similar layer            anterior aesthetic problems it’s important to under-
    of adhesive was applied to the bonding surface of              stand the etiology of the discoloration: in the case pre-
    the veneers and thereafter a thin layer of composite           sented the corrosive products of the broken instru-
    (Synergy D6, A1 enamel shade, Coltène Whaledent)




                                                                                               zi
    evenly distributed with accurate marginal adaptation.
    The veneer was transferred to the corresponding
    tooth. The prefabricated veneer was pressed gently




                                                                                 na
    into position and shielded (without excessive pres-
    sure). While holding the veneer in position, the obvi-
    ous excess was removed and the composite smooth-
    ly adapted to the Componeer with a sable brush. The
    entire restorative complex was then light-cured from




                                                                      er
    the lingual side for at least 40 seconds, and from the
    facial side for 40 seconds cervically and 40 seconds
    incisally. Contours and occlusal interferences were
    adjusted with a high speed bur and margins were re-
    fined and polished by strips for interproximal areas,

                                                           t
                                                        In
    flexible aluminum oxide discs, which are ideal to ad-
    just the incisal angles, and silicone rubber polishers
    were used for the polishing steps.
                                                                   Figure 6. Periapical X-ray postoperative.
                                               ni
    Discussion

    The facial anatomical shape template in the form of a
                                    io


    thin composite shell simplifies direct veneering of one
    or more front teeth. The extremely thin veneer coat-
    ings from 0.3 mm allow a high level of conservation of
                          iz



    hard tooth substance during preparation. The shiny
    and naturally designed surface adds a look of vitality
    to the restoration.
          Ed




    The Componeer system is an affordable and less
    time consuming alternative for patients who cannot
    sustain the cost of porcelain veneers and presents
    many advantages:                                               Figure 7. Postoperative clinical vision.
    1) minimally invasive (30);
    2) simple and versatile application;
IC




    3) no impression required;
    4) cementation using high quality permanent venee-
        ring material;
    5) highly polished surface giving long-lasting, natural
C




        looking aesthetic clinical results (31);
    6) shine can be refreshed by polishing at any time,
        unlike porcelain veneers and they can be easily
        repaired (31).
    The other major advantage of this “different” veneer-
©




    ing approach is straightforward solution in only one
    appointment with the same outcome. It has also been
    reported that a good quality of endodontic retreat-
    ment on the postoperative periapical X-ray (Fig. 6)
    may enhance the long-term aesthetic results of this
    method, resulting in good aesthetics, function and             Figure 8. Follow up after 1 year.

    Annali di Stomatologia 2015; VI (3-4): 113-118                                                                      117
    G. Migliau et al.


    ment inside the canal were the cause of the grey ap-                   15. Perdigão J, Sezinando A, Muñoz MA. Prefabricated veneers-
    pearance of the left superior incisor. A multidiscipli-                    bond strengths and ultramorphological analyses. J Adhes
    nary approach is to consider it necessary to resolve                       Dent. 2014;16:137-46.
                                                                           16. Sahin G, Albayrak AZ, Bilgici ZS, Avci D. Synthesis and eval-
    the problem: at first endodontic retreatment, succes-
                                                                               uation of new dental monomers with both phosphonic and car-
    sively bleaching and coronal restoration. To improve




                                                                                                                          i
                                                                               boxylic acid functional groups. J Polym Sci Part A Polym
    the aesthetic result a prefabricated adhesive compos-




                                                                                                                        al
                                                                               Chem. 2009;47:1953-65.
    ite veneer was applied. Prefabricated composite ve-                    17. Pontons-Melo JC, Furuse AY, Mondelli J. A direct composite
    neers are useful adjuncts to dentist armamentaria and                      resin stratification technique for restoration of the smile. Quin-
    they help in resolving aesthetic problems, in a single                     tessence Int. 2011;42:205-11.




                                                                                                                     on
    appointment, minimizing the dental tissue reduction.                   18. Ingle JI, Bakland LK, Beveridge EE, Dudley H. Glick,
                                                                               Hoskinson AE. Modern Endodontic Therapy. In: Ingle JI, Bak-
                                                                               land LK. Endodontics, 5th Edition. Bc Deckler. 2002;16-17.
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                                                                               reaction identification of microorganisms in previously root-




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     1. Peumans M, Meerbeek BV, Lambrechts P, Vanherle G.                      filled teeth in a South Korean population. J Endod. 2004;
        Porcelain veneers: a review of the literature. J Dent. 2000;           30:504-8.
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                                                                                          na
     2. Conrad HJ, Seong WJ, Pesun IJ. Current ceramic materi-                 infection at the time of root filling on the outcome of endodontic
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     4. Christensen GJ. A veneering of teeth: state of the art. Dent           Canal Treatment of Anterior Teeth: An in vitro Study. Int J




                                                                             er
        Clin North Am. 1985;29:373-391.                                        Clin Pediatr Dent. 2014;7:1-5.
     5. Meijering AG, Creugers NHJ, Roters FJM, Mulder J. Survival         22. Fasanaro T S. Bleaching teeth: history, chemicals and meth-
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     6. Lin CY, Lee BS, Lee MS. Patients with discolored and


                                                                    t      23. Amato M, Scaravilli MS, Farella M, Riccitiello F. Bleaching

        improvement after restoration with CAD/CAM (Cerec 3D)
                                                                 In
        malaligned anterior teeth able to obtain significant esthetic          teeth treated endodontically: longterm evaluation of a case
                                                                               series. J Endod. 2006;32:376-378.
        porcelain veneers - case report. J Dent Sci. 2006;1:88-93.         24. Marongiu N, Cochran T. Conservative cosmetic dentistry post-
     7. Ritter AV. Porcelain Veneers. J Esthet Restor Dent. 2002;              trauma. Gen Dent. 2014;62:26-31.
        14:55.                                                             25. Krastl G, Allgayer N, Lenherr P, Filippi A. Tooth discoloration
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     8. Watts A, Addy M. Tooth discoloration and staining: a review            induced by endodontic materials: a literature review. Dent
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