CLINICAL ARTICLE

Prefabricated Composite Resin Veneers A

Clinical Review
GEORGE GOMES, DMD,*, JORGE PERDIGO, DMD, MS, PhD

ABSTRACT
Objective: This clinical technique article is focused on the use of prefabricated veneers to enhance the esthetic
appearance of the anterior dentition in patients who needed an alternative esthetic solution more affordable than
traditional porcelain veneers.
Clinical considerations: Because prefabricated composite veneer systems have been recently introduced, they are not
widely used. The Componeer system (Coltene, Altsttten, Switzerland) contains thin pre-polymerized hybrid composite
shells, several shades of a direct hybrid composite resin, an etch-and-rinse adhesive system, and restorative accessories
including finishing points and disks. The prefabricated restorations can be customized in the mouth for color and shape.
The technique described in this article can be used to restore function and esthetics in one office visit.
Conclusions: The prefabricated composite veneer technique has some of the advantages of direct composite
restorations, as only one session is required without the need to take impressions to send to the dental laboratory.
This new treatment option may open new opportunities for dental professionals and their patients. However, it is
paramount to carry out controlled clinical studies with this restorative technique prior to recommending it without
restrictions in general practice.

CLINICAL SIGNIFICANCE
The clinical technique described in this paper has the potential for being used routinely to lengthen anterior teeth, to
correct malpositioned teeth, to mask discolorations, and to close diastemas. The technique can also be used to restore
extensive caries lesions and tooth fractures, and to refurbish large old anterior restorations, especially when other
treatment options are out of reach for the patient for financial reasons.
(J Esthet Restor Dent 26:302313, 2014)

INTRODUCTION
The increasing demand for esthetic restorative
treatments and recent advances in adhesive dentistry
have led to the development of materials and
techniques aimed at restoring the natural tooth
appearance, especially in the anterior segment.
Ceramic crowns have been considered a predictable
and durable treatment option for anterior teeth.

However, crowns require an aggressive tooth

preparation that may cause adverse eects to the pulp
and periodontal tissues.1 Dental ceramic materials have
demonstrated excellent properties, such as
biocompatibility, esthetics, and chemical and wear
resistance.2 Nevertheless, their mechanical limitations
such as brittleness, low fracture toughness, low tensile
and exural strengths, and the wear inicted to the
opposing dentition have been described as potential
shortcomings.3

*Private Practice, CCDO, Oeiras, Portugal

Clinical Professor, Post-Graduate Program in Esthetic Dentistry, University Rey Juan Carlos, Madrid, Spain

Professor, Department of Restorative Sciences, Division of Operative Dentistry, University of Minnesota, Minneapolis, MN, USA

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PREFABRICATED COMPOSITE RESIN VENEERS Gomes and Perdigo

After the pioneer work of Dr. Pincus in 19384 to

enhance movie stars smiles, the turning point in
porcelain veneer technique optimization started with
the work by Rochette5 and, thereafter, improved by
Simonsen and Calamia.6 The introduction of ceramic
etching and adhesive cementation became a standard
procedure for porcelain veneers. This treatment
modality gained widespread popularity because of its
esthetic outcome, as well as durability, biocompatibility,
and minimal tooth preparation.7 Bonded porcelain
restorations mimic the biomechanical properties and
structural integrity of the original tooth8 resulting in
good clinical performance.1
Some of the mechanical properties of indirect
composite resin veneers versus ceramic veneers are the
lower elastic modulus and higher capacity to absorb
functional stresses of composite restorations.9 Indirect
composite veneers may allow better absorption of the
polymerization stresses generated by the cement during
cementation procedures.10 In spite of being considered
less esthetic than ceramic veneers, indirect composite
veneers are easy to nish and polish, can be modied
before luting without compromising either their
adhesive potential or their mechanical properties.
Additionally, the corresponding laboratory procedures
are easier, thus lowering the manufacturing cost.11 New
laboratory-made composite restorations with improved
wear resistance have widened the indications of
composite resins to extensive restorations.1113
Prefabricated composite resin veneers have been
recently introduced. Componeer (Coltene, Altsttten,
Switzerland) prefabricated veneers are thin composite
resin shells (0.3 mm cervically and 0.61.0 mm to the
incisal edge). These prefabricated veneers are made of a
pre-polymerized hybrid composite resin, Synergy D6
(Coltene). The veneers 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 unit. These veneers can be trimmed and
bonded to the tooth structure using direct hybrid
composite resin. One Coat Bond (Coltene) is the dentin
adhesive included in the system, which is used to bond
the prefabricated composite shells to the tooth
structure using an etch-and-rinse bonding strategy.

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The purpose of this case report paper is to describe

clinical cases step-by step, in which the patients smiles
were restored with prefabricated composite veneer
shells.

CASE PRESENTATIONS
Shade and Size Selection
The shade is selected with the use of the Componeer
Synergy D6 Shade Guide (Coltene). The color guide
comes with six dentin cores and two enamel shells
(Figure 1). After teeth are cleaned, the enamel and
dentin shades are evaluated separately. The enamel
shell guide is superimposed over the dentin core to
determine the approximate nal color. The size of the
composite shell for a specic patient is selected with
Componeer Contour Guides (Figure 2). A wider and
longer size is recommended 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 match the shape of the natural
tooth as close as possible (Figure 3).

Tooth Preparation
The tooth preparation must be uniform and, whenever
possible, restricted entirely to the enamel. A #2 round
bur is used to delimit the cervical margin (Figure 4).
Subsequently, the buccal surface is prepared as for
porcelain veneers using a tapered-cylinder, round-end
diamond bur. Metal abrasive strips may be used to
create a separation between the teeth in the proximal
area to facilitate the denition of the proximal margin
and the correct positioning of the composite shells. It is
important to try the prefabricated composite shells on
the teeth a few times to guide the gradual tooth
reduction.
Abrasive aluminum oxide disks and an extrane,
tapered-cylinder, round-end diamond bur are used to
smoothen the preparation and round the angles
(Figure 5). After making adjustments to the
prefabricated composite veneer, the nal try-in is
carried out. If it is deemed necessary to mock-up the

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FIGURE 1. Componeer Synergy

D6 shade guide.

FIGURE 2. Componeer contour

guides.

nal esthetic result, the composite shells can be lled

with Synergy D6 according to the dentin shade
previously chosen, without light-curing.

patients medical history, a radiographic assessment was

performed. Teeth #7, 8, and 10 were root canal treated
(Figure 7), with multiple composite restorations in need
of replacement.

Clinical Case 1
A 24-year-old female patient had major complaints
about the appearance of her smile. This patient
specically requested an improvement in the
appearance of her discolored maxillary anterior teeth
(Figure 6). After clinical examination and taking the

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Patients oral hygiene and periodontal condition were

excellent. The ideal treatment included ber posts and
composite build-ups, followed by all-porcelain crowns
for teeth #7, 8, and 10. However, due to nancial
limitations, patient declined this treatment plan.
Prefabricated composite veneers were then proposed as

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FIGURE 3. Trimming the prefabricated veneer with an

abrasive disk.

FIGURE 4. The cervical margin is delimited with a #2 round

bur.

FIGURE 5. An extra-fine diamond is used to finish the

preparations.

FIGURE 6. Clinical case 1preoperative frontal view. Note

the discolorations and multiple old restorations. Both upper
canines have localized yellow-brown enamel stains.

an alternative and the respective limitations were

explained to the patient.
The dentin shade selected from the Synergy D6 color
guide was A1/B1, while the enamel shade was white
opalescent (Figure 8). With the help of the contour
guides, size L was selected (Figure 9). After local
anesthesia and rubber dam application, teeth were
prepared (Figure 10). The prefabricated veneers were
customized with abrasive discs (SwissFlex, Coltene) and
tried-in. One Coat Bond was applied to the intaglio and
left undisturbed without light-curing (Figure 11). After
the preparations were etched with 35% phosphoric acid
for 15 seconds (Figure 12), the etchant was thoroughly
rinsed for 20 seconds. The bonding substrate was gently

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air-dried followed by the active application of One Coat

Bond for 15 seconds (Figure 13). The adhesive was then
gently air-dried from cervical to the incisal aspect and
light-cured for 20 seconds (Figure 14). An opaquer
(Paint-on Color, Coltene) was applied to mask the
tooth discolorations (Figures 15 and 16). The white
opaque tint was mixed with the yellow tint in a
proportion of 50/50 and applied with a sable brush over
the cured adhesive. The same mixture was applied to
the yellow-brown enamel spots of teeth #6 and 11
(Figure 17). After the masking agent was light-cured for
40 seconds, Synergy D6 dentin composite was applied
on to the tooth surface (Figure 18), while the enamel
composite was applied on the intaglio surface of the

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FIGURE 8. Shade selection with the enamel shade tab

superimposed over the dentin shade tab.

adapted to the Componeer with a sable brush. The

entire restorative complex was then light-cured from
the lingual side for at least 40 seconds, and from the
facial side for 40 seconds cervically and 40 seconds
incisally. For the nishing steps, the margins can be
adjusted with Proxoshape oscillating diamond-coated
les (Intensiv SA, Montagnola, Switzerland) as shown
in Figure 21. Finishing and polishing strips were used
for the interproximal areas. Flexible aluminum oxide
discs are ideal to adjust the incisal angles. Silicone
rubber polishers (prepolishers and polishers or
two-stage polishers) were used for the polishing steps
(Figure 22).

FIGURE 7. Radiographies of upper central and lateral

incisors.

veneers (Figure 19). Starting with teeth #8 and 9, the

prefabricated veneers were gently placed (without
excessive pressure). The restorations were then aligned
with the midline and the incisal position was
double-checked for symmetry (Figure 20). If spaces are
created between the composite shell and the tooth
structure, they are lled with the same enamel hybrid
composite resin used to seat the prefabricated
composite shells.
While holding the veneers in position, the obvious
excess was removed and the composite smoothly

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The other veneers were inserted in pairs as described

for teeth #8 and 9 (Figures 23 and 24). Figure 25 shows
the patients smile 2 weeks after the restorative
procedure.
In case any old restorations are removed rst,
the direct dentin-shaded composite resin is
used to restore the corresponding preparations
as in a conventional direct composite restoration,
prior to cementing the prefabricated veneer. The same
dentin-shaded composite resin is then applied to the
buccal surface of the tooth and the prefabricated veneer
loaded with the enamel composite and inserted as
described above. If needed, direct composite resin may
be applied to the interproximal areas that are not
covered with the prefabricated veneer, especially when

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FIGURE 9. Size selection using the contour guide.

FIGURE 10. Preparation for the prefabricated composite

veneers.

FIGURE 11. Adhesive was applied to the intaglio and left

uncured.

FIGURE 12. Preparations were etched with 35% phosphoric

acid for 15 seconds.

FIGURE 13. Application of the dentin adhesive to the

preparations.

FIGURE 14. Adhesive was light-cured for 20 seconds on

each surface.

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FIGURE 15. The masking agent was applied with a sable

brush to mask the discoloration of the upper right central
incisor.

FIGURE 16. The masking agent was light-cured for 40

seconds.

FIGURE 17. The same masking agent was applied on the

localized enamel discolorations of the upper canines.

FIGURE 18. Dentin-shaded composite was applied on to the

tooth surface.

closing a diastema. Sable brushes may be used to

smoothen the composite and adapt it to the margins.

composite veneers to reestablish the size and

the shape of the teeth and enhance the esthetics of his
smile.

Clinical Case 2
A 34-year-old male patient, extremely unhappy with his
smile, had a major concern with the space between his
front teeth. A clinical examination revealed several
diastemas, multiple carious lesions, discolored
restorations, and a size and shape discrepancy
(Figure 26). After the treatment options were discussed
with the patient, and taking into account the patients
nancial restrictions, the decision was made to restore
the six maxillary anterior teeth with prefabricated

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The dentin shade selected was A2/B2 and the enamel

shade white opalescent (Figure 27). As with clinical case
1, size L was chosen with the help of contour guides
(Figure 28). After local anesthesia and rubber dam
application, teeth were prepared. After etching, rinsing,
and application of the adhesive (Figures 29 and 30), the
adhesive was light-cured. Dentin-shaded composite
resin was free-handed and recontoured from the lingual
aspect of the veneers to close the diastema, followed by
light-curing from the lingual for 40 seconds. All the

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FIGURE 19. Enamel-shaded composite was applied on the

intaglio surface of the prefabricated veneer.

FIGURE 20. Restorations were aligned with the midline and

the incisal position checked prior to light-curing.

FIGURE 21. Margins were adjusted with Proxoshape

diamond files.

FIGURE 22. Finishing and polishing the restorations using

silicone rubber points.

subsequent clinical steps were identical to those of

clinical case 1, except for the restorative steps to close
the midline diastema. Postoperative views are shown in
Figures 31 and 32. Figure 33 shows a non-retracted view
2 weeks after the bonding procedure.

DISCUSSION

fewer appointments compared with

laboratory-processed veneers, as no impression is
required for direct composite veneers. Several clinical
reports have corroborated the success of composite
resins in direct veneers and large anterior
restorations.1618 However, direct composites have been
reported to suer from surface and marginal
discoloration, wear, and marginal chipping.16

Composite resins are available in dierent shades and

opacities to match the optical characteristics of enamel
and dentin. Most current composite resins replicate the
appearance of a natural tooth when used with the
natural layering technique.14,15 One of the advantages of
free-handed direct composite veneers is the need of

The concept of one-visit prefabricated resin-based

veneers is not new. In the early 1980s, prefabricated
acrylic veneers were introduced as Mastique Laminate
Veneer System (Caulk, Milford, DE, USA). The intaglio
surface of Mastique veneers was etched with polyacrylic
acid and then adapted to acid-etched enamel using a

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FIGURE 23. Postoperative frontal view.

FIGURE 24. Postoperative frontal view.

FIGURE 25. Non-retracted view 2 weeks after insertion.

FIGURE 26. Clinical case 2frontal preoperative view

showing a moderate midline diastema between the upper
central incisors, caries lesions, discolored restorations, and
discrepancy in size and shape.

light-curing composite and an unlled bonding resin.

Mastique veneers had limited success because of
technological limitations and poor surface
qualities.19,20
Clinical studies have conrmed good performance of
porcelain veneer restorations, with excellent esthetics,
overall patient satisfaction, and no adverse eects on
the periodontal tissues.1 A recent study21 evaluated 318
ceramic veneers in 84 patients over 10 years. The
estimated survival probability was 93.5% at 10 years.
Whereas the main reason for failure was fracture of the
ceramic, increased failure rates were associated with
bruxism and nonvital teeth.

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FIGURE 27. Frontal view with the selected color guides.

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FIGURE 28. Componeer size selection.

FIGURE 29. Preparations were etched with 35% phosphoric

acid.

FIGURE 30. Application of the dentin adhesive One Coat

Bond.

FIGURE 31. Postoperative frontal view.

No signicant dierences in absolute failures were

found between indirect composite veneers and ceramic
veneers at up to 36 months. Surface quality changes
were more frequently observed in the composite veneer
material, which required more maintenance over time.22
The group of composite laminate veneers in this study22
had two cohesive fractures indicating that the adhesive
strength of the interface was greater than the cohesive
strength of the indirect composite material. An in vitro
study23 had also described cohesive fractures as being
the predominant failure mode for the same indirect
resin composite tested in the clinical study.22

and the veneer/resin cement interfaces. A recent bond

strength study reported that Componeer prefabricated
veneers resulted in microshear bond strengths
statistically similar to those of etched IPS e.max Press
(Ivoclar Vivadent, Schaan, Liechtenstein)24 when the
respective adhesive and luting composite were applied
to the intaglio surfaces.

The clinical outcome of indirect veneers depends on

the strength of two interfacesthe tooth/resin cement

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The high bond strengths obtained between the

Componeer intaglio surface and the respective hybrid
composite may be a result of two mechanisms:
1 A strong adsorbed layer of polymer material
forms on the intaglio surface. This adsorption is a
consequence of an initial increase in the ionization

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FIGURE 32. Postoperative frontal view.

rate of the carboxylic groups in One Coat Bond

because of the production of acid via the
photoinitiator.24,25
2 Residual reactive methacrylate functionalities on
the intaglio surface may form a network with the
bonding agent after polymerization, which, along
with the wetting characteristics of 2-hydroxyethyl
methacrylate26,27 in One Coat Bond, may explain the
relatively high bond strengths associated with the
adhesive joint formed by the prefabricated veneer,
the dentin adhesive, and the direct hybrid composite
resin.
The clinical technique described in this paper has the
potential for being used routinely to lengthen anterior
teeth, to correct malpositioned teeth, to mask
discolorations, and to close diastemas. The technique
can also be used to restore extensive caries lesions and
tooth fractures, and to refurbish large old anterior
restorations, especially when other treatment options
are out of reach for the patient. Although this
technique has shown promising results, controlled
clinical studies are essential to validate the general use
of this technique in clinical practice.

FIGURE 33. Non-retracted view 2 weeks postoperatively.

impressions or laboratory work. Additionally, the

restorations can be customized (color and shape) and
are more aordable than other indirect restorations,
resulting in a very esthetic outcome. It is crucial to
assess the clinical behavior of this restorative technique
prior to recommending it in general practice.

DISCLOSURE STATEMENT
Author Jorge Perdigo has received two research grants
from Coltene.

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CONCLUSION

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Prefabricated composite veneers have some of the

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Reprint requests: Jorge Perdigo, DMD, MS, PhD, Professor, University of

Minnesota, Department of Restorative Sciences, Division of Operative
Dentistry, 515 SE Delaware St, 8-450 Moos Tower, Minneapolis, MN
55455, USA. Tel.: 612-625-8486; Fax: 612-625-7440; Email:
perdi001@umn.edu.

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