J Esthet Restor Dent - 2020 - Fahl - Composite Veneers The Direct Indirect Technique Revisited

Received: 11 November 2020 Revised: 23 November 2020 Accepted: 3 December 2020
DOI: 10.1111/jerd.12696
CLINICAL ARTICLE
Composite veneers: The direct–indirect technique revisited
Newton Fahl Jr, DDS, MS1,2 | André V. Ritter DDS, MS, MBA, PhD3
1
Private Practice, Curitiba, Parana, Brazil
2
Clinical and Scientific Director, Fahl Center,
Abstract
Curitiba, Parana, Brazil Objective: This article provides an update on the direct–indirect composite veneer
3
Professor and Chair, Department of Cariology technique.
and Comprehensive Care, New York
University College of Dentistry, New York, Clinical considerations: Composite veneers have long been used as a conservative and
New York esthetic treatment option for anterior teeth. While they are generally performed using a
Correspondence direct technique, there has been renewed interest in the direct–indirect composite
Dr André V. Ritter, Professor and Chair, veneer technique because of its advantages and broad indications for restoration of
Department of Cariology and Comprehensive
Care, New York University College of tooth color and morphology. In the direct–indirect composite veneer technique, the
Dentistry, 354 East 24 Street, Suite 10W, selected composites are initially applied on the tooth using a layering approach, without
New York, NY 10010.
Email: [email protected] any bonding agent, sculpted to a primary anatomic form with slight excess, and light-
cured. The partially polymerized veneer is then removed from the tooth, heat-tempered,
and finished to final anatomy and processed extra-orally before being luted. Advantages
of this technique include enhanced physical and mechanical properties afforded by the
tempering process, unrivaled marginal adaptation, enhanced finishing and polishing, and
the ability to try-in the veneer before luting, enabling a shade verification and modula-
tion process that is not possible with the direct technique. The direct–indirect approach
also affords enhanced gingival health and patient comfort.
Conclusion: This article reviews the direct–indirect composite veneer technique, and
outlines critical steps and tips for clinical success.
Clinical significance: The direct–indirect technique for composite veneers combines
advantages of the direct composite placement technique with those of the indirect
veneer technique, including operator control, single-visit fabrication and delivery,
increased material properties, and excellent esthetics.
KEYWORDS
bonding, composite layering, composite veneers, esthetic dentistry, operative dentistry
1 | I N T RO DU CT I O N tooth, with or without tooth preparation, without any adhesion.

The composite is then shaped to a primary anatomic form with
The direct–indirect composite veneer technique was introduced in slight excess, and then light-cured. After that, the partially polymer-
the 1990s as a means to heat-temper composites in partial and full ized restoration is carefully removed (lifted) from the non-retentive,
veneers.1-4 In the direct–indirect technique, using similar shade non-bonded tooth surface, heat-tempered extra-orally chairside,
selection and layering techniques that are used for the direct tech- and finished and polished to final macro and micro anatomy. After
nique, the clinician applies a light-cured composite material to the shade try-in and confirmation of the overall fit and esthetics, the
veneer is bonded to the preparation using a resin-based luting
agent.1,2,4-6 Figure 1 illustrates the workflow for direct–indirect
Based on N Fahl Jr and AV Ritter (eds), Composite Veneers – The Direct–Indirect Technique,
2020 Quintessence Publishing. restorations.
J Esthet Restor Dent. 2021;33:7–19. wileyonlinelibrary.com/journal/jerd © 2020 Wiley Periodicals LLC 7

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8 FAHL AND RITTER
F I G U R E 1 Steps for Direct–Indirect

Restorations (Reprinted with permission
Fahl et al12)
From a dental materials standpoint, the main advantage of this modulation, the ability to re-do a restoration immediately if the initial
approach over a directly placed composite veneer is the enhanced shade(s) selected were not correct, the possibility of doing the veneer
physical and mechanical properties afforded by the extra-oral in a single appointment, and is potentially less costly.
chairside tempering process due to increased monomer conver- This article summarizes the clinical technique for direct–indirect
sion.7-10 From an operator standpoint, the technique affords greater composite resin veneers with and without preparation. A clinical case
operator control over the final marginal adaptation, surface finishing is used to illustrate the technique step-by-step.
and polishing, and anatomy of the restoration, given that these ele-
ments are created outside of the patient's mouth.5 Finally, the direct–
indirect technique is more comfortable to patients, since many of the 2 | NO - P R EP V E N E E R S
restorative steps involving rotary instrumentation, particularly margin
finishing, occur extra-orally.5 When compared to ceramic veneers, the No-prep Veneers are thin composite veneers with a thickness of more
direct–indirect composite veneer affords the clinician more control than 0.5 mm, used to change the color and/or shape of teeth when
over the entire procedure, including composite shade selection and no tooth preparation is required. Unlike contact lenses (veneers that
COMPOSITE VENEERS: THE DIRECT–INDIRECT TECHNIQUE REVISITED 9
are 0.5 mm or less in thickness, not discussed in this article), no-prep • A Type 1 No-prep Veneer is used when the facial anatomy must be
veneers are normally layered with dentin and enamel shades in vary- restored with composite resins with thicknesses in excess of 0.5 mm
ing degrees of opacity / translucency. and the incisal edge must be augmented to reestablish esthetics and
No-prep veneers are indicated for minor morphological discrep- function. No-prep veneers Type 1 require a Body Enamel (V1A),
ancies that compromise the proportion, size, and volume of the natu- Value Enamel (V1B), or both (V1C), and a Dentin layer, a Milky-
ral dentition. While no-prep veneers are most commonly used in White-Semi-Translucent (MWST) enamel as a lingual shell.
teeth with no discoloration, they can be used when such teeth are lin- • A Type 2 No-prep Veneer differs from a no-prep Veneer Type 1 in
gually positioned or undersized, as in the case that illustrates this arti- the level of internal characterization of the incisal third, and trans-
cle. In these situations, the esthetic improvement is achieved by lucency in particular. Trans Enamel resins with a high degree of
enhancing only the shape of the teeth through composite resin addition translucency, iridescence and opalescence are included as a sub-
(hence the no-prep concept) to achieve the desired tooth morphology. layer to create such effects and render the incisal third more poly-
Examples of indications for no-prep veneers include heteromorphism, chromatic (V2A, V2B and V2C).
mal-alignment particularly for lingually-positioned teeth, and enamel
abrasion/erosion. Figures 2-4 show an example of an indication for a
no-prep veneer. Notice in Figure 3 (incisal view) how the discolored 3 | V E N E E R S WI T H P R E P A R A T I O N
tooth is slightly lingually-positioned.
From a clinical standpoint, it is strategic to classify no-prep Veneers with preparation are required when it is necessary to create
veneers based on the thickness, number or layers, and incisal edge space for the composite material, particularly in discolored teeth when
involvement (Figure 5): the composite needs to mask the discoloration. Whenever possible,
veneer preparations should be intra-enamel to promote high bond
FIGURE 2 Pre-op smile of patient with discolored tooth #8 F I G U R E 3 Pre-op occlusal/incisal view of tooth #8, notice slight
lingual position of the tooth, which allows a direct–indirect veneer
without preparation to be accomplished
strengths and decrease the likelihood of adhesive failure.11 However,

the extent of the tooth preparation is based primarily on the degree
of discoloration (if present) and the position of the tooth relative to
the ideal location of the final facial contour of the veneer.
Various veneer preparation designs have been recommended,
with focus on two main designs according to the involvement of the
incisal edge: overlap or no-overlap (Figure 6):
• A Type 1 Veneer with Preparation preserves the incisal edge and is

totally confined within the facial aspect, hence the term “window
prep”. Clinical indications include extremely dark tetracycline
staining, calcific metamorphosis and congenital erythropoietic por-
phyria, among others, in patients with a normal overbite. The
FIGURE 4 Intraoral view of teeth 6–11 amount of axial reduction will depend on the degree of
10 FAHL AND RITTER
FIGURE 5 (A) and (B) Veneer without Preparation Classification. (Reprinted with permission Fahl et al12)
discoloration, typically varying from 1–1.5 mm. Just as in the no- is at least 2 mm. For short teeth that need to be lengthened by
prep veneer, here a Body Enamel and a Value Enamel will be used, 2 mm or more, no further incisal reduction is necessary. In cases of
but because the veneer with preparation typically requires masking normal occlusion, a 30 - 45 strong bevel is enough to create
of a discolored background, a Dentin and an Opaquer are also macro- and micro-mechanical interlock and achieve adequate
used. As homogeneity of thickness for the layering of composite strength. A shallow chamfer is otherwise indicated when restoring
resins and opaquer is crucial to achieve an even color distribution, the incisal edge of teeth that will be under stress during function.
the window preparation must be evenly carried out throughout the
facial aspect and particularly over lower value areas. The prepara-
tion must follow the intended facial morphology, while allowing
enough room for the amount of composite needed for layering. 4 | SHADE SELECTION
Depending on the degree of translucency and mamelon effect
desired, the incisal third may be thinned out to remove practically It is beyond the scope of this article to present all of the necessary
all of the dentin while leaving a translucent palatal shell of natural information related to material and shade selection for composite
enamel. veneers. Direct–indirect veneers can be fabricated with either the Poly-
• A Type 2 Veneer with Preparation requires an incisal overlap and is chromatic Concept, or the Natural Layering Concept, or with a combina-
recommended when incisal lengthening or anatomic modification tion of both concepts, depending on the tooth shape and color
of the incisal edge is desired. The veneer preparation Type 2 fol- modifications that may be required by the clinical case at hand. The
lows the facial reduction guidelines of Type 1 but requires space selection of one technique over another will depend on the clinician's
for an additional incisal build-up to create natural color and optical own preference and on the available composite resin systems. Never-
characteristics of dentin and enamel. Type 2 veneers with prepara- theless, it is important that the composite resins used in the fabrication
tion require the same composites used for Types 1A, 1B, and 1C, of these restorations provide the necessary optical and mechanical
namely Body Enamel, Value Enamel, Dentin, and Opaquer; how- properties to accommodate the different layering concepts that may
ever, to achieve an optimal esthetic result at the incisal reduction require the use of materials of varying opacities and strength. Figure 7
aspect, a MWSE is used as the lingual shell and a Trans Enamel is (A),(B) illustrate the clinical process for dentin and enamel shade selec-
used to enhance the opalescence and intensify mamelon character- tion for a no-prep veneer where only one dentin and one value enamel
istics. The ideal amount of space necessary for the incisal layering shades are used, in combination with various tints.
FIGURE 6 (A) and (B)Veneer with Preparation Classification. (Reprinted with permission Fahl et al12)
5 | COMPOSITE RESIN APPLICATION - restorations remain on the preparation, in which case a surface lubricant
LAYERING should be sparingly applied to isolate the resin from the preparation and
thinned out in order to prevent contamination between layers.
In a direct–indirect veneer, the order with which each of the selected
composite resins is used is the same as in the direct veneer, except
when opaquer and tints are needed, in which case the dentin is the 6 | VENEER REMOVAL
first layer followed by the opaquer/tints, to optimize bond strengths
(Figures 8 and 9). This is because air-borne particle abrasion and silane Once the veneer is completed and light cured intra-orally, flashes of
treatment cannot be optimally performed on opaquers/tints due to composite that might cause locking and prevent cracking or breaking
their chemical composition and relatively thin film thickness. Further- the restoration upon removal should be eliminated. Course finishing
more, the composition and structural arrangement of the resin matrix discs and #12 scalpel blades can be used to remove gross lingual
(organic phase) and fillers (inorganic phase) of restorative resins pro- excess resin, especially around the incisal and lingual embrasures.
vide higher bond strengths, making them the material of choice to be Next, the veneer should be engaged at the faciogingival embrasure
used as the first layer. If used, tints and opaquers are applied between level with an excavator and gentle yet firm pressure should be placed
the dentin and the enamel layers (Figure 10). through a leverage motion on both mesial and distal aspects until the
As a general rule, the last layer (Body Enamel, Value Enamel, or veneer is carefully removed (Figure 12).
both) should be applied with a slight excess (Figure 11). This makes it
easier to remove the veneer prior to extra-oral finishing and polishing,
avoiding breakage especially with thin no-prep veneers. 7 | CONTOURING, FINISHING AND
Another important recommendation, particularly for veneers with POLISHING
preparation, is that the tooth preparation must be properly finished and
polished to facilitate veneer removal after initial curing and before The step by step protocol for contouring, finishing, and polishing of
extra-oral processing. This step is especially important if composite the direct–indirect veneer will be summarized here; for a more
12 FAHL AND RITTER
FIGURE 7 (A) Dentin shade selection. (B) Value enamel shade selection
F I G U R E 8 An appropriately-sized dry retraction cord is carefully FIGURE 9 The dentin-shaded composite is applied and light-
packed to allow gingival displacement and moisture control cured
complete description please refer to Fahl and Ritter, 2020.12 Once the 8 | SUPPLEMENTAL LIGHT-CURING AND
restoration is removed from the tooth, the imprinted margins should HE AT TE MPE R IN G
be outlined with a red pencil (Figure 13). Aluminum oxide discs are
used sequentially to remove the gross excess, and to finish and polish The finished veneer is then submitted to supplemental extra-oral
the margins to ideal contour, smoothness, and gloss. The veneer is light-curing and heat tempering, which optimizes monomer conver-
subsequently positioned back on the tooth and checked for precision sion while avoiding deleterious pulp overheating. This can be accom-
of fit and stability (Figure 14). The incisal one third is flattened until plished with a high-power chairside light curing unit, or with a number
the facioincisal line angle is in proper alignment both in facial volume of other heat-tempering methods.12
and incisal length. Next the emergence profile and facial planes are
established while the restoration is seated (prior to bonding). Course
discs are again used to anatomically blend the cervical and incisal 9 | S H A D E T R Y - I N A N D LU T I N G A G E N T
thirds thereby establishing the correct facial contours. The veneer SELECTION
should then be in full facial alignment with the adjacent teeth. With
the veneer still in place, the facioproximal transitional line angles are One the greatest benefits of the direct–indirect technique is that
outlined with a pencil to match their ideal position. The veneer is minor color changes can be realized through the use of luting
removed and the facial embrasures are finished to proper morphology. resins of varying shades and degrees of opacity. This is very bene-
Finally, finishing and polishing is accomplished with discs of varying ficial especially when trying to match a single veneer to adjacent,
grits until the primary anatomy of the veneer is achieved (Figure 15). untreated teeth, and when doing multiple units and the patient's
Secondary anatomy is not carried out preferably until the veneer is input is needed to determine the color matching alternative that
bonded because it is easier to mimic micro and macro texture through best pleases her or him. How much color change can be achieved
direct comparison with the natural dentition. under such thin restorations depends on the thickness, color and
F I G U R E 1 0 (A-C). Given the need to accomplish a high degree of characterization in a relatively thin veneer, tints were used to enhance
these effects. (A) A blue tint is applied; (B) A mamelon tint is applied; and (C) a white tint is applied
F I G U R E 1 1 The value enamel is applied and light-cured. Note F I G U R E 1 2 This image shows the veneer being removed prior to
the value enamel is applied in excess, so as to allow removal and extra oral light curing and heat tempering
handling of the veneer without breaking
opacity level of the veneer and the luting resin. Understanding the 9.1 | Luting resin systems and try-in pastes
parameters that guide the modulation of hue, chroma and value
will allow the clinician to modify a set color by mixing different There are several systems specifically designed for veneer cementa-
shades in varying proportions until the desired color is finally tion. Light-cured luting systems (resin cements) that provide try-in
achieved. pastes are ideal, as they allow for a previsualization of the final color
14 FAHL AND RITTER
FIGURE 13 The veneer margins are outlined prior to finishing FIGURE 14 The veneer is tried on and primary anatomy
and polishing developed
FIGURE 15 Finished direct–indirect veneer FIGURE 16 The path of insertion is verified before adhesive
procedures
prior to seating of the restoration. Try-in pastes are also beneficial

because they are hydro soluble and can be used and rinsed quickly, 10 | BONDING
which expedites the shade try-in stage. Although the actual luting
resin can be used for the try-in, having to clean the veneer with alco- 10.1 | Veneer treatment
hol after try-in(s), or breaking it upon removal, or even the possibility
of the ambient light setting the resin, are inconveniences that make The treatment of the veneer intaglio surface involves airborne par-
this approach less than desirable. ticle abrasion13 and application of 35%–40% phosphoric acid for
10 s (Figures 18 and 19). Next, silane is applied (Figure 20)
followed by a hydrophobic adhesive resin (Figure 21), and air-
9.2 | Shade try-in technique thinned. The restoration is set aside under a light-protective shield
until it is luted. If more than one veneer is being completed, they
The shade try-in protocol will only work if the actual color of the should be organized in the sequence according to which they will
veneer is correct in the first place, as no major color changes are pos- be bonded.
sible if the shades of the selected composites are totally wrong and
the mismatch is significant. The most important feature of a luting
resin is to modulate the value and the chroma, in that order. After the 10.2 | Tooth surface treatment
path of insertion is confirmed (Figure 16), the veneer is tried in dry,
wet, and, when additional opacity is needed, with opaque try-in pas- The tooth surface treatment will vary depending on the type of sub-
tes (Figure 17). strate involved. Unprepared enamel should be lightly “roughened”
FIGURE 17 Dry (A) and wet (B) try-in. (C) Try-in with opaque try-in paste
FIGURE 18 Using sandblasting on the intaglio veneer surface FIGURE 19 The intaglio surface is etched with phosphoric acid
with phosphoric acid (Figure 23), rinsed, then the adhesive is applied
with a fine grit flame shaped finishing diamond bur or air abrasion (Figure 24).
with 27–50 μm aluminum oxide particles. For intra-enamel veneers,
these steps are not necessary. Veneers with preparation will almost 10.3 | Choice of adhesive
invariably expose a large dentin surface area, particularly for dis-
colored teeth, and therefore the bonding protocol will be considerably A 3-step etch-and-rinse adhesive is preferred for bonding no-prep
more complex (Figure 22). For a no-prep veneer, the tooth is etched veneers because phosphoric acid etching of enamel is very effective
16 FAHL AND RITTER
FIGURE 21 Adhesive is applied to the veneer

FIGURE 20 Silane is applied to the intaglio surface
F I G U R E 2 2 Adhesive Protocol for

Bonding Direct–Indirect Composite
Veneers. (Reprinted with permission Fahl
et al12)
and predictable for enamel bonding. For veneers with preparation

where dentin and/or composite resin is exposed, the choice of adhe-
sive is far more complex and should be matched to the type of resto-
ration and substrate. Because the longevity of the tooth-restoration
complex is highly dependent on the quality of the adhesive interface,
the choice of adhesive application strategy is critical. It is not in the
scope of this article to describe the adhesion protocol in detail; the
reader is encouraged to read Fahl & Ritter, 2020.12 In the direct–
indirect technique, the adhesive should never be light-cured prior to
seating the finished restoration because it may pool if not thinned out
properly, thereby creating a thicker layer that prevents precise fitting
of the veneer.
Once the adhesive has been applied to both the veneer and the
tooth, the veneer is loaded with the resin cement and seated F I G U R E 2 3 The tooth is sandblasted and etched with
(Figures 25 and 26). phosphoric acid
FIGURE 24 Adhesive is applied to the tooth FIGURE 25 Luting resin cement is applied
FIGURE 26 The direct–indirect composite veneer is luted F I G U R E 2 7 Immediate post-op. Notice slight shade mismatch
(lower value) due to dehydration of the adjacent teeth
FIGURE 28 One-month post-op FIGURE 29 Post-op with lips in repose

18 FAHL AND RITTER
proximal boundaries have been previously determined during the

intra- and extra-oral finishing and polishing steps. Anatomic details
that compose the tertiary anatomy, such as split lobes, depressions,
perikymata, and stippling, can be added according to the desired mor-
phological pattern. Multi-fluted carbide and fine diamond burs are
ideal for this purpose. These burs should be used with extra care in
order not to over-reduce the thin veneer enamel layer, causing undue
perforation, especially in extra-thin contact lenses. Also, burs should
be kept away from subgingival margins – a sometimes-hard step to
remember for the operator who is used to finishing subgingival mar-
gins the conventional way with rotary instruments when doing direct
composite resin restorations and is not completely familiar with the
direct–indirect concept.
Because the margin of the restoration is complete finished and
FIGURE 30 Post-op smile
polished extraorally before luting of the veneer, its margins should not
be touched during this post-luting phase, so as to avoid trauma to the
soft tissue and a rough composite margin.
11.3 | Polishing
Polishing should encompass the facial and lingual aspects and promote life-
like surface smoothness and gloss. Over-accentuated texture can be soft-
ened to match the natural adjacent teeth, in the case of a single unit, or to
reach the degree of texture that the dentist and patient have deemed
appropriate, in the case of multiple units. Rubber rotaries of varying levels
of abrasiveness are used for initial polishing and are followed by brushes,
diamond and aluminum oxide polishing pastes, and buffing discs. Again, as
mentioned above, the sub-gingival margin should not be touched.
FIGURE 31 Post-op occlusal/incisal view of tooth #8 Figures 27-31 show immediate and 1-month post-operative
views of the completed case.
11 | P O S T - L U T I NG P R O C E D U R E S
12 | D I S CU S S I O N A N D CO N C L U S I O N
11.1 | Primary anatomy refinement
Recent advances in composite materials, instrumentation, and
Anatomical elements that may require additional finessing usually chairside light-curing have generated renewed interest in the
include transitional line angles, point angles, and incisal and facial direct–indirect composite veneer technique given its advantages over
embrasures. To assist in the visualization of these landmarks, extra- directly-placed veneers. Modern composites, when correctly used,
fine silver powder or glitter is brushed over the veneer. Flash photog- can achieve esthetics that matches that of ceramics in many cases,
raphy will identify the light-reflecting and light-deflecting areas that including surface texture and shade matching and characterization.
were amplified by the silver powder and provide an enhanced visual Additionally, the new generation of curing lights affords energy that
perception of the anatomical details that need to be incorporated. approximates that of laboratory-based composite processing devices.
These symmetry-related modifications are carried out with finishing All of these advances make it possible for clinicians to obtain chairside
discs. At this step, composite resin flashes that overlap the incisal composite veneers that result in an excellent restoration choice for
edge of the tooth are finished and occlusion adjustment is performed. many cases that would otherwise be very challenging to complete
using a direct composite technique.
The direct–indirect composite technique undoubtedly represents
11.2 | Secondary and tertiary anatomy a different (and perhaps initially challenging) paradigm for the man-
agement of certain clinical situations. This approach is not a solution
Once the veneer is bonded at the primary anatomy stage, it becomes for all problems related to composite resins, and certainly has its limi-
easier for the clinician to create secondary and tertiary anatomy with- tations, such as when the tooth/teeth present pronounced undercuts
out having to modify the original contours, as the primary facial and in which case a direct restorative technique would allow more tooth
conservation. Nevertheless, with practice, determination, and atten- 6. Dietschi D, Spreafico R. Adhesive Metal-Free Restorations: Current Con-
tion to detail the clinician will find that this technique will be a great cepts for the Esthetic Treatment of Posterior Teeth. Chicago: Quintes-
sence Publishing; 1997.
addition to his/her armamentarium.
7. Covey DA, Tahaney SR, Davenport JM. Mechanical properties of
As with any evolving clinical technique, further research is neces- heat-treated composite resin restorative materials. J Prosthet Dent.
sary to determine optimal adhesive protocols for the direct–indirect 1992;68(3):458-461.
composite technique, as well as to more properly compare its marginal 8. Ferracane JL, Condon JR. Post-cure heat treatments for composites:
properties and fractography. Dent Mater J. 1992;8(5):290-295.
adaptation and clinical performance with the more traditional direct
9. Ferracane JL, Mitchem JC, Condon JR, Todd R. Wear and marginal
composite technique. breakdown of composites with various degrees of cure. J Dent Res.
1997;76(8):1508-1516.
DIS CLOSURE 10. Wassell RW, McCabe JF, Walls AW. Wear rates of regular and tem-
pered composites. J Dent. 1997;25(1):49-52.
The authors do not have any financial interest in the companies
11. Friedman MJ. Commentary. Survival rates for porcelain laminate
whose materials are included in this article. veneers with special reference to the effect of preparation in
dentin: a literature review. J Esthet Restor Dent. 2012;24(4):
ORCID 266-267.
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André V. Ritter https://orcid.org/0000-0003-2266-4302
Chicago, IL: Quintessence Publishing Co; 2020.
13. Ritter AV, Sulaiman TA, Altitinchi A, Baratto F, Gonzaga CC, Correr
RE FE R ENC E S GM. Effect of tribochemical coating on composite repair strength. Oper
1. Birnbaum NS. Direct oven-tempered hybrid composite-resin laminate Dent. 2020;45(6):E334-E342.
veneers. Pract Periodontics Aesthet Dent. 1992;4(5):23-31.
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4. Fahl JN. The direct/indirect composite resin veneers: a case report. veneers: The direct–indirect technique revisited. J Esthet
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Received: 11 November 2020 Revised: 23 November 2020 Accepted: 3 December 2020

Composite veneers: The direct–indirect technique revisited

1 | I N T RO DU CT I O N tooth, with or without tooth preparation, without any adhesion.

J Esthet Restor Dent. 2021;33:7–19. wileyonlinelibrary.com/journal/jerd © 2020 Wiley Periodicals LLC 7

F I G U R E 1 Steps for Direct–Indirect

strengths and decrease the likelihood of adhesive failure.11 However,

• A Type 1 Veneer with Preparation preserves the incisal edge and is

prior to seating of the restoration. Try-in pastes are also beneficial

FIGURE 21 Adhesive is applied to the veneer

F I G U R E 2 2 Adhesive Protocol for

and predictable for enamel bonding. For veneers with preparation

FIGURE 28 One-month post-op FIGURE 29 Post-op with lips in repose

proximal boundaries have been previously determined during the

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