Porcelain laminates/ orthodontic continuing education

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Porcelain laminates/ orthodontic continuing education

  1. 1. PORCELAIN LAMINATES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Contents Introduction Tooth preparation Laboratory procedures Placement of veeners Conclusion References www.indiandentalacademy.com
  3. 3. INTRODUCTION A captivating smile showing an even row of natural gleaming white teeth is a major factor in achieving that elusive dominant characteristic known as personality. Dr.charles pincus in the early 1930 developed thin facing made of air fired porcelain which were temporally held in place with adhesive denture powder and created the Hollywood smile for actors,which was an integral part of image personality and opinion Since then the art of veneering teeth has progressed over 30 yrs to current generation of concepts and materialswww.indiandentalacademy.com
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  5. 5. Types of Veneers Directly fabricated veneers Indirectly fabricated veneers www.indiandentalacademy.com
  6. 6. Porcelain Laminates They can be considered to be very much the state of art in cosmetic dentistry. They are wafer thin shells of porcelain like custom made artificial fingernails www.indiandentalacademy.com
  7. 7. Advantages Color Bond strength Resistance to abrasion Periodontal health Inherent porcelain strength Resistance to fluid absorption Esthetics www.indiandentalacademy.com
  8. 8. Disadvantages Time Repair Technique sensitive Fragility Cost www.indiandentalacademy.com
  9. 9. Indications Discoloration Enamel defects Diastema Malpositioned teeth Malocclusion Poor restorations Ageing Wear patterns Agenesis of lateral incisor www.indiandentalacademy.com
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  14. 14. Contraindications Available enamel Ability to etch enamel Oral habits Periodontally compromised teeth www.indiandentalacademy.com
  15. 15. Tooth Preparation There are different schools of thought for tooth preparation for porcelain laminates some clinicians are of the school of thought that little or no tooth reduction is required while the opposite end of spectrum advocate a full deep chamfer preparation If it is possible to place veneers without tooth preparation and still develop a good esthetic form, no subsequent periodontal changes then it is obviously the ideal if not some form of enamel reduction becomes essential www.indiandentalacademy.com
  16. 16. Biological and technical factors for tooth preparation Esthetics Relative tooth position Masking of tetracycline stains Marginal placement Age Potential for periodontal changes www.indiandentalacademy.com
  17. 17. Rationale for Enamel Preparation To provide for an adequate dimension of available space for porcelain material To remove convexities and provide for a path of insertion in those situations where either the incisal or interproximal areas are to be included in the veneers To provide space for adequate opaquing where necessary and for composite resin luting agent www.indiandentalacademy.com
  18. 18. To provide definite seal to help position the laminate during placement To prepare receptive enamel for etching and bonding the laminate To facilitate sulcular margin placement in severally discolored teeth www.indiandentalacademy.com
  19. 19. Enamel Reduction Labial reduction Inter proximal extension Sulcular extension Incisal or occlusal modification Lingual reduction www.indiandentalacademy.com
  20. 20. Labial Reduction The preparation should remain within the enamel wherever possible and most certainly at all the peripheral marginal areas to ensure an adequate seal to enamel A general rule may well be to ensure that over 50 % of preparation is on enamel In general 0.3 to 0.6 mm or about half thickness of available enamel www.indiandentalacademy.com
  21. 21. Depth Guide Is one of the method to gauge the amount of enamel removed The LVS depth cutter diamond will create horizontal striations or depth cut grooves on the labial aspect of tooth An alternative method for gauging the amount of enamel reduction is use of a no 1 round bur www.indiandentalacademy.com
  22. 22. The problem with this approach is that these depth cuts can vary depending on the angle the bur is held at and the amount of time is considerably greater www.indiandentalacademy.com
  23. 23. Reduction of remaining enamel  Following the creation of depth cut or striations the remaining enamel must be reduced to the depth of these initial cuts  Labial reduction should encompass 2 aspects 1) The bulk of reduction should be done with a coarse diamond to get added retention and better refraction of light 2) The marginal area it is desirable to use a fine grid diamond that will create a definitive, smooth finish line to enhance the peripheral seal www.indiandentalacademy.com
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  30. 30. Interproximal Extension The margin should be generally hidden within embrasure area, extension of the laminate beyond the mesiobuccal and distobuccal line angle of the tooth gives a wraparound effect with etched resin bonds at right angles to the labial surface for increased bond strength www.indiandentalacademy.com
  31. 31. Contact Areas The contact points are modified by very fine one sided diamond abrasive strip through the adjacent teeth . the abrasive strip is used in an S configuration so that the abrasive side will reshape the contact areas rather than separate them www.indiandentalacademy.com
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  33. 33. Sulcular Extension Preparation ends right at the gingival margin. Extension is carried out with a LVS diamond. A narrow gingival chord is placed to slightly displace the tissues for about 8 to10 minutes. This system of first developing the preparation confluent with the gingival and then placing the retraction chord prior to refining and extending into the sulcus ensures a) access for diamond b) less gingival trauma c) direct vision of margins during all procedures www.indiandentalacademy.com
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  35. 35. Sulcular Extension Preparation ends right at the gingival margin. Extension is carried out with a LVS diamond. A narrow gingival chord is placed to slightly displace the tissues for about 8 to10 minutes. This system of first developing the preparation confluent with the gingival and then placing the retraction chord prior to refining and extending into the sulcus ensures a) access for diamond b) less gingival trauma c) direct vision of margins during all procedures www.indiandentalacademy.com
  36. 36. Finish Line Configurations Feather or knife edge is most conservative form of preparation There is difficulty in fabricating thin porcelain margins so invariably a poor marginal fit occurs Inevitable increased thickness subgingivaly and resultant gingival problems Laboratory problems in delineating the exact end of the preparation line www.indiandentalacademy.com
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  38. 38. Modified Chamfer Finish This provides increased bulk of porcelain at margins so increased strength Correct enamel preparation is achieved for increased bond strength Laboratory procedures are easy with better fit of porcelain Greater ease for dentist to obtain correct gingival finish line A definitive stop to aid in seating the laminate to correct position A sound marginal sealwww.indiandentalacademy.com
  39. 39. Incisal Reduction Fabrication of porcelain lapping the incisal edge makes the placement of restoration much easier by virtue of having a definitive stop However when added length is needed it is necessary to actually prepare the incisal aspect www.indiandentalacademy.com
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  42. 42. Lingual Reduction Reduction of the incisal edge may require reduction of lingual surface so that there is no butt joint at this incisal/lingual junction but rather a rounded chamfer This ensures increased thickness of porcelain, enamel bonds at right angles to those at incisal edge, and increased strength www.indiandentalacademy.com
  43. 43. Impression Technique Tissue management tissue displacement is achieved by retraction cord Impression Elastomers –light material and tray material www.indiandentalacademy.com
  44. 44. Temporization Direct composite veneer Direct composite resin veneer utilizing vacuum formed matrix Indirect composite resin/acrylic resin veneer www.indiandentalacademy.com
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  47. 47. Laboratory Procedures The refractory investment technique The platinum foil technique www.indiandentalacademy.com
  48. 48. The refractory investment technique Fabrication of master cast Application of die spacer Fabrication of refractory model Preparation of refractory model Degassing the refractory investment Sealant application Removal of veneers from refractory material www.indiandentalacademy.com
  49. 49. Platinum Foil Technique Choosing the foil Model and die preparation Platinum matrix placement Removal of foil www.indiandentalacademy.com
  50. 50. Porcelain application First application of 0.3 to 0.4 thick is made. Esthetic results of finished veneers are enhanced if the porcelain mix is applied in four stages-gingival third, body, incisal third, enamel shading Finishing and contouring-microfine diamonds & sandpaper discs are used www.indiandentalacademy.com
  51. 51. Glazing – seals any microporosities & gives more natural luster. Stains can be applied to add chroma Adjustment and placement on the master model Etching – 7.5% hydrofluoric acid is etchant,10% of baking soda is neutralizer, surface is air abraded and washed in detergent in ultra sonic bath www.indiandentalacademy.com
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  54. 54. Placement of Veneers Three stage porcelain veneer try in Stage 1: check for individual fit Stage 2: collective fit try in Stage 3: color check www.indiandentalacademy.com
  55. 55. Procedure of Placement  Tissue management  Retraction cords  Local anesthesia www.indiandentalacademy.com
  56. 56. It is important to realize that no modification for shape is done until the final seating and curing are completed The bonding of porcelain laminate is in fact a series of links : etched enamel- to enamel/dentin bonding agent- to luting composite resin- to unfilled resin- to hydrolyzed saline – to etched porcelain www.indiandentalacademy.com
  57. 57. Silanation The etched surface is treated with silane coupling agent to enhance adhesive properties Pre activated silane or hydrolyzed form Non hydrolyzed form www.indiandentalacademy.com
  58. 58. Enamel Activation To remove all surface coatings Slurry of fine pumice and water with a non webbed rubber cup or brush www.indiandentalacademy.com
  59. 59. Cheek retractors Cotton rolls Saliva ejector www.indiandentalacademy.com
  60. 60. Enamel Etching 30 to 37 % of phosphoric acid solution 15 to 20 seconds 30 seconds Wash with water www.indiandentalacademy.com
  61. 61. Application of dental bonding agent Apply evenly on the etched enamel and on the internal aspect of the veneer All excess bonding agent has to be removed www.indiandentalacademy.com
  62. 62. Seating Sequence It is best to seat one laminate at a time In multi unit cases start with the distal most tooth Centrals should always be seated together www.indiandentalacademy.com
  63. 63. Placement Pulsing or gentle rocking motion Prevent suck back The matrix strip must be reinserted between the teeth to prevent them from bonding to one another Curing should be complete for at least 2 minutes each for various areas www.indiandentalacademy.com
  64. 64. Curing Time Angle of contact Shade of the resin Distance www.indiandentalacademy.com
  65. 65. Finishing Magnification and LVS kit finishing instrument Load should be distributed over as many teeth as possible so that any one veneer extension is not responsible for withstanding the entire load www.indiandentalacademy.com
  66. 66. Cosmetic Contouring Is done after several days for esthetic harmony Fine diamonds, micro fine LVS no. 6 or 7 are used Finishing is done with porcelain polishing wheels and/or diamond polishing paste www.indiandentalacademy.com
  67. 67. Cast Ceramic Laminates 2 distinct systems are present  Castable ceramic(dicor)  Castable apatite (cerapearl) www.indiandentalacademy.com
  68. 68. Conclusion Dentistry has long sought for the ideal restorative material to esthetically alter unattractive smile A major breakthrough that facilitated predictable retention of porcelain to tooth structure has added a new dimension to esthetic dentistry.The strength of porcelain laminates will continue to be assessed although relatively technique sensitive the surface texture ,color, fluorescence & overall esthetics have been regarded as exceptional. www.indiandentalacademy.com
  69. 69. REFERENCES David A garber-porcelain laminate veeners Kenneth J Anusavice-phillips science of dental materials Wunder R et al in vitro effect of fluroide on porcelain J.Prosthe.Dent 55.[385] 1986 www.indiandentalacademy.com
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