In these cases, the conservative approach, of which the veneer is a part, is a solution to be favoured but which must be part of a global and medical management. Moreover, the reflection must be focused on the whole of the arches and not only on the aesthetic sector.
An alternative to root canal treatment followed by a prosthetic crown is the creation of a veneer. When these traumas concern the young patient, a reasonable attitude consists in carrying out in the first instance a direct restoration in composite which will be resumed at the end of the adolescence if the aesthetic request is motivated.
Type 3a : Extensive enamel loss by erosion and/or wear
The rehabilitation of the smile in these clinical situations is complex. An alternative to peripheral crowns is to exploit the available enamel to make veneers.
Finally, such wear is often associated with bad habits that need to be identified and treated. This is often the case with abrasions due to traumatic brushing or acid attack erosions due to a diet rich in acidic foods and/or drinks.
Type 3b : Fluorosis type 3 (with porosity)
As with tetracyclines, an overdose of fluoride between the 4th month of pregnancy and in children up to 8 years of age leads to an alteration in the metabolism of the ameloblasts (cells used to make enamel), which can cause the appearance of whitish veils and stains as well as brown discolouration.
Type 3c : Congenital and acquired enamel defects
Amelogenesis imperfecta. This is a group of enamel developmental anomalies that is linked to a mutation in the gene coding for amelogenesis proteins or proteases.
In young children, the aesthetic management of permanent teeth must be done with a temporary solution in order to allow time for facial growth to position all the aesthetic determinants of the face.
During this transitional period, composite resin veneers can be a very interesting therapeutic option as they are not very invasive. As the bonding protocol is modified, the composition of this pathological enamel is different, and the risk of detachment must be considered increased in these patients, and they must be informed of this in order to put forward the obvious precautionary measures.
Type 3d : Porosity of enamel, stains on teeth, several colours on the same tooth
HMI (hypo mineralisation) is a qualitative enamel anomaly of systemic origin, preferentially affecting molars and permanent incisors.
The number of cases is increasing and may be caused by various environmental factors affecting enamel formation during the first three years of life. In the permanent incisors, they appear as whitish or yellow spots with variable aesthetic consequences depending on their size and location. Only the most severe forms can be treated with veneers.
