09/07/2026
Correction of Defective Direct Veneers with Occlusal Management
A Beautiful Expression Dental and Facial Esthetics
By: Dr. Abraham Culbengan
A male patient, 62, was referred to our clinic with a chief complaint of recurrent fractures of previously placed direct composite veneers. The patient reported having sought treatment from 3 different clinics previously with no long-term improvement. He also complained of a deep bite that was not addressed by prior providers.
Clinical Findings & Diagnosis
Patient was required to have CBCT and other needed examinations prior to treatment. Pre-operative ocular examination revealed fractured and defective direct composite veneers on the maxillary anterior teeth #13-22. Significant incisal and occlusal attrition was observed, consistent with a deep bite and parafunctional loading. Upon removal of the defective restorations, the underlying natural dentition presented with reduced clinical crown height and minimal remaining tooth structure. We diagnosed the etiology of the repeated failures as: 1. Untreated deep bite with traumatic anterior occlusion, and 2. Inadequate occlusal scheme and material support from previous restorations.
Treatment Planning
Several treatment options were presented to the patient including indirect restorations. Given the patient’s naturally small teeth and preference for a conservative approach, the patient elected for a minimally invasive direct composite veneer rehabilitation. The treatment goal was to restore function, correct the occlusal load, and achieve the patient’s esthetic request for increased anterior tooth length.
Clinical Procedure
Removal of Defective Veneers: All previous composite veneers were conservatively removed to assess the remaining tooth structure.
Smile Design & Mock-up: A direct mock-up was fabricated to preview the proposed increase in length and proportions of the maxillary anteriors. The patient was very satisfied with the preview and approved the final design.
Minimally Invasive Restoration: A new set of direct composite veneers, 5 units #13-22, were fabricated. Clinical protocol included: surface preparation, selective etching, bonding, and stratified layering of composite resin using a silicone index for proper contour and incisal length.
Occlusal Adjustment & Finishing: Occlusion was carefully adjusted to minimize traumatic contacts given the deep bite. Finishing was done with multi-step composite finishing burs, polishing wheels, and interproximal strips to achieve optimal anatomy, surface luster, and emergence profile.
Result
The patient achieved a more stable anterior guidance, functional, and esthetic result with increased anterior tooth length as requested. Post-operative photos show improved smile proportions, healthy gingival response, and harmonious occlusion. The patient expressed high satisfaction. A night guard and occlusal follow-up were advised to maintain longevity given the initial deep bite presentation.
To be continued: Phase 2 for additional units and lower teeth.
