A dual-matrix technique for direct composite veneers using liquid dam and pull-through contouring: a case report.

BACKGROUND: Direct composite veneers for multiple anterior diastemas still present a challenge for a predictable palatal contour and controlled interproximal emergence profiles for interproximal emergence. Conventional matrices are not positionally stable and do not allow for morphological control, thereby leading to a technique-dependent procedure with the risk of inter-tooth asymmetry. PURPOSE: To present a dual matrix technique using liquid dam stabilization and a pull-through interproximal contouring while placing direct composite veneers in multiple anterior diastemas. TECHNIQUE AND CASE DESCRIPTION: A 22-year-old female patient presented with bilateral peri-central diastemas (between teeth 12-11 and 21-22) and required a full aesthetic rehabilitation. The 2D-Digital Smile Design template was helpful for treatment planning. Composite veneers were placed on teeth 15 to 25. The isolation was performed using a rubber dam, and a palatal shell was fabricated using a transparent matrix modified extraorally and stabilized using liquid dam material. A pre-curved celluloid matrix was pulled from the facial to the palatal surface to form the interproximal forms and contact points. Composite resin was placed incrementally in dentin and enamel layers. The 10 restorations were evaluated at baseline (one week after the procedure) and at 12 months by both the modified United States Public Health Service (USPHS) and Fédération Dentaire Internationale (FDI) clinical performance grading criteria. RESULTS: All restorations showed Alpha (USPHS)/FDI Score 1 criteria for all parameters examined at baseline. Marginal integrity, marginal adaptation, surface texture, color match, postoperative sensitivity, secondary caries, and tooth integrity were all Alpha/FDI Score 1 at the 12-month follow-up. Mild staining was found at three interproximal sites (15%) and marginal discoloration at one restoration (10%) (Bravo/FDI Score 2-3). Two restorations (20%) had a modest loss in surface luster, and one restoration (10%) had mild gingival marginal redness (both Bravo/FDI Score 2). One restoration had a localized incisal chip graded Bravo (USPHS)/FDI Score 3, which was successfully corrected chairside. No secondary caries or other biological problems were noted. CONCLUSIONS: The dual-matrix technique is a conservative single-visit procedure for the closure of anterior diastemas that can improve morphological control and reduce technique sensitivity. Concurrent use of USPHS and FDI criteria enabled comprehensive exploration and direct comparison with current studies.