Veneers/ fixed orthodontics courses

GOOD MORNING
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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.
This entails lack of an inferiority complex due to
crooked, unsightly teeth, which during speech causes a
hand to be raised to cover the mouth or manipulation of
the lips in an unnatural manner to make up for the
defect. It is this lack of confidence in dental equipment
which often spells the difference in success and failure

VENEERS

CONTENTS
• INTRODUCTION
• REVIEW OF LITERATURE
• TYPES OF VENEERS
• PREPARATION DESIGN FOR FULL VENEER
• DIRECT VENEERS

• INDIRECT VENEERS
– Processed composite
– Porcelain laminate veneers
– Cast ceramic laminate system
– Veneers for metal restoration
– Veneers for existing metal restoration
• REPAIR OF VENEERS
• CONCLUSION
• MY VIEWS
• BIBLIOGRAPHY

INTRODUCTION
The demand for the tooth color restorations and a
more attractive smile has now passed the boundaries
of exclusive practitioners, specialist and the esthetic
centers all over the world. As esthetically pleasing
restorations of young fractured malformed or
discolored teeth has been a perplexing problem for
dentist, in past few years a conservative approach to
improve the esthetic appearance has led widespread
use of the veneering systems. An idea of covering the
unattractive teeth is not new it goes back to many
decades to the original "Hollywood bridge" and to
more recent porcelain laminate veneers.

HISTORY

It is an out growth of the process described by
Dr.Charles Pinicus in 193029
. At that time it was only
for the temporary esthetic modification and for the
improvement of smile of Hollywood film actresses. The
concept of laminate veneers although existing long
back, got surface in 1975 by Rochette29
who
introduced the use of silane coupling agent with
porcelain laminate veneers of repairing fractured
incisors. Then the popularity of porcelain laminate
skyrocketed in 1980's partly because of its
conservative nature and the dental researches in the
acid etched technique and new bonding methods.www.indiandentalacademy.com

Porcelain has long history in the dental field. It is one
of the most esthetically suitable and biocompatible
material available. Porcelain abrasion and stain
resistance are excellent and well tolerated by gingival
tissues. Thus it makes porcelain laminate veneers
superior to other veneering systems.
Porcelain laminate veneer restoration has a unique
position in today's dental practice. Increase
awareness of veneers and their potential has sparked
the numerous technical variations and there has been
lot of improvement regarding the technical and in the
material aspects.

REVIEW OF LITERATURE
• Highton Ren, Angeco A.Caputo and Joska Matyas
(1987)4
concluded from the photo elastic study on four
design for tooth preparation for porcelain laminate
veneer that incisal, labial, proximal and gingival
reduction is recommended for patients with class I
division I malocclusion. Although modification of
variant tooth condition may be necessary, gingival
tooth preparation was essential to control stress
distribution and provide the best potential for
periodontal health.

• Graber A.David (1989)2
compared direct composite'
veneer versus etched porcelain laminate veneers. He
concluded that inherent weakness in composite
veneer was in the composite itself. The etched
porcelain restoration offered the advantage of
increased strength, color, stability and biocompatibility
for veneering material using composite merely as a
luting agent. He further concluded that the etched
porcelain restoration, in future, will replace direct
bonding composite restoration most clinical situation.
• Tjan M.L., Anthony et al (1989)26
evaluated the micro
leakage of conventional porcelain and Dicor castable
ceramic laminate veneer bonded either entirely on
acid etched enamel or with cervical margin on dentinewww.indiandentalacademy.com

Light cure composite resin cement system were
used to lute the veneers. They concluded that, there
was minimal micro leakage under both type of ceramic
veneer bonded to all enamel preparation and
markedly greater leakage at the dentine composite
resin interface in veneer with cervical margins placed
on dentine.

• Herbert Victor Exner (1991)20
investigated the
predictability of color (hue, value and chroma) on
cervical surfaces, body surfaces and incisal surfaces
of ceramic veneers and the extent to which laminates
may be shade adapted by use of tints and opaquers
on the fitting surfaces. In his study he found significant
discrepancies in the final color match of ceramic
laminate veneers. He concluded that dentist should
opt for a lighter, more translucent shade, which can be
modified before final cementation.

• Magne Pascal et al (1999)8
investigated the
parameters associated with the development of cracks
in porcelain veneers using cyclic thermal fatigue. This
study points out the importance of a controlled and
uniform tooth reduction. A minimal and homogenous
thickness of ceramic will provide the restoration with a
favorable tooth configuration. For enamel surfaces, it
was essential to establish the original volume of the
tooth. Use of an additive diagnostic wax up and
corresponding silicon matrices are imperative. During
laboratory procedures, die spacer should be applied
carefully to avoid an excessive luting composite
thickness at a particular location.

• Hekimoglu Canan, Nesrin Anrl and IIker Etikan
(2000)19
studied the effect of accelerated aging on the
color stability of cemented laminate veneers. This
study investigated the effect of in vitro accelerated
aging of different durations on the color properties of
dual cure, light cure and self cure resin cements. They
concluded that, overall color change, chroma change,
and hue change of the materials tested were not
influenced by prolonged aging time. Overall color
change was not affected by type of cementing
material. Chroma change and hue change were
influenced by the type of cementing material. They
also proposed light cure resin cement as a suitable
material for luting laminate veneers.www.indiandentalacademy.com

• Jacopo Castelnuovo, Anthony H. L. Tjan Dr Dent,
Keith Phillips, Jack I. Nicholls, John C. Kois (2000)22
did
an in vitro study to evaluate fracture load and mode of
failure of ceramic veneers, with 4 tooth preparation
designs, that were bonded on extracted human
maxillary central incisors. Identical parameters were
also measured on unrestored intact teeth for
comparison. Each group was assigned a different
tooth preparation design: (1) no incisal reduction, (2) 2
mm incisal reduction without palatal chamfer (butt
joint), (3) 1 mm incisal reduction and 1 mm height
palatal chamfer, (4) 4 mm incisal reduction and 1 mm
height palatal chamfer, and (5) unrestored (control).
Groups 1 and 2 recorded the greatest fracture loads
that were comparable to an unrestored control.

• Hager BertH, Agneta Oden, Bernt Anderson et al
(2001)18
the use of Procera All Ceram laminates for
patients with discolored teeth has been described. In
their experience, these laminates are simple to use
and provide possibilities for excellent esthetics.
• George P. Cherukara, Graham R. Davis, Kevin
G.Seymour, Lifong Zou,
DayanandaY.D.Samarawickrama (2005)17
did a study
to assess the effectiveness of 3 clinical techniques,
namely, dimple, depth groove, and freehand, in
producing an intraenamel preparation. The relation
between overpreparation beyond the commonly
accepted depth of preparation of 0.5 mm and dentin
exposure was also examined.

• A single operator prepared 3 groups of 5 extracted
maxillary central incisors to a depth of 0.5 mm using
dimple, depth-groove, and freehand methods of tooth
preparation. The prepared teeth were scanned using
an x-ray microtomography scanner. Within the
limitations of this pilot study, the 3 different techniques
tested did not differ significantly in conserving enamel.

• Seok-Hwan Cho, DDS Won-Gun Chang, DDS,
Bum-Soon Lim, Yong-Keun Lee (2006)28
did a study
to evaluate the shear bond strength differences
between enamel and a feldspathic PLV as a function
of die spacer thickness. It was found that the
appropriate application of die spacer exerts a
favorable influence on the shear bond strength of
composite-bonded PLV. The 2-coat application of die
spacer provides suitable space to accommodate the
cement thickness.

• Fernando Zarone, Ettore Epifania, Giuliana Leone,
Roberto Sorrentino, Marco Ferrari, MD, (2006)16
The
purpose of this study was to detect the stress in
maxillary anterior teeth restored with porcelain
veneers and compare the resistance to fracture of
porcelain veneers prepared using different preparation
designs. The SEM analysis showed that both
adhesive and cohesive fractures were primarily
concentrated at the cervical region. Statistical analysis
showed that both the type of tooth and the design of
the preparation significantly influenced the resistance
to fracture of the restored teeth (P<.001).

The chamfer preparation is recommended for
central incisors, whereas the window preparation
showed better results for canines. Both
preparations can be adopted in the restoration of
lateral incisors.

DEFINATIONS
• Complete Crown / Full Veneer Crown: A restoration
that covers the entire coronal tooth surfaces (mesial,
distal, facial, lingual and occlusal)26
• Veneers : A thin sheet of material usually used as a
finish protective or ornamental facing26
• Laminate Veneers : A superficial or attractive display
in multiple layers26
• Partial Veneer Crown: A restoration that restores all
but one coronal surface of a tooth or dental implant
abutment, usually not covering the facial surface26
.www.indiandentalacademy.com

The art of veneering teeth has progressed over 30
years to the current generation or concepts and
materials. Typically veneers are made of chair side
composite, processed composite, porcelain, or cast
ceramic material.
Veneers can be divided into two categories:
I. Directly fabricated composite resin veneers (i.e. free
hand placed), and
2. Indirectly fabricated veneers, such as preformed
laminates or laboratory fabricated acrylic resin, micro
fill resin, or porcelain veneers.

DIRECT VENEERS
• Buonocore's12
research of the acid etch technique in
1955, combined with Bowen's later use of filled resins,
provided the technology enabling mechanical bonding
between etched tooth and filled resins (direct
bonding). Although these were major breakthroughs in
dental research by the early 1960s, little esthetic use
was made of this bonding technology of nearly a
decade. This was partially due to the limitations of the
available self curing resins, which did not allow
sufficient working time for the dentist to recreate a
labial surface before the composite resin chemically
cured itself. www.indiandentalacademy.com

• The introduction of light cured composite resins in the
early to mid 1970s allowed the dentist greater
flexibility. The advantages of visible light cured
composite resins, such as greater working time and
improved chemistry, versus the self cured composite
resins, marked the entrey into the next generation of
esthetic materials. Visible light cured composite resins
were replacing self cured composite resins by the late
1970s and were preferred for esthetic anterior
restorations.
• Direct acid etched bonding proved to be
advantageous, yet a susceptibility to stain, poor wear
resistance, and lack of natural fluorescence spurred
the continued search for improved materials.

INDIRECT VENEERS
The idea of restoring teeth for esthetic purposes
became more widely accepted by the dental
community as new esthetic restorative techniques and
material became available. Faunce12
described a one
piece acrylic resin prefabricated veneer as an
improved alternative to direct acid etched bonding. By
using a chemical primer applied to the veneer and a
composite to lute the veneer onto an etched tooth
both a chemical and mechanical bond contributed to
the attachment. It was more stain resistant than
composite resin veneers, but numerous preformed
acrylic resin laminates suffered from de lamination at
the laminate/composite interface, usually due to the
weak chemical bond.www.indiandentalacademy.com

• Like composite resins, they also exhibited poor
resistance to abrasion. The inherent advantage to
laboratory fabricated veneers is the anatomical
accuracy. Laboratory formed acrylic resin veneers and
laboratory fabricated microfiIl resin veneers offer a
smooth surface, good masking ability, and very little
finishing, if they are completed properly. However,
their esthetics, strength, and longevity can be
surpassed by porcelain laminates.
Veneers are also classified as:
1. Partial Veneers And
2. Full Veneers

• Partial veneers are indicated for the restoration of
localized defects or areas of intrinsic discoloration. Full
veneers are indicated for the restoration of
generalized defect or areas of intrinsic staining
involving the majority of the facial surface of the tooth.

• Full veneers can be accomplished by a direct or an
indirect technique. When a small number of teeth are
involved or when the entire facial surface is not faulty
(partial veneers), directly applied composite veneers
can be completed for the patient in one appointment
with chair side composite. . Placing direct composite
full veneers is very time consuming and labor
intensive. However, for cases involving young
children, a single discolored tooth, or when economics
or patient time are limited precluding a laboratory
fabricated veneer, the direct technique is a viable
option.

Advantages of indirect technique:
• Much less technique sensitive to operator ability.
• Second, if multiple teeth are to be veneered, indirect
veneers usually can be placed much more
expeditiously.
• Third, indirect veneers typically will last much longer
than a indirect veneer, especially if made of porcelain
or cast ceramic.

• Some operators prefer to etch the existing enamel and
apply the veneer over the entire existing facial surface
without any tooth preparation.
• The perceived advantage of this method is, that in
case of failure or in the event the patient does not like
the veneer, it can be removed, thus being reversible.
• However, several significant problems exist with this
approach:
1. First, in order to achieve an esthetic result, the facial
surface of such a restoration must be over contoured,
thus appearing and feeling unnatural. Hyperemia and
bleeding due to bulbous and impinging gingival
contours.

2. Second, the veneer is more likely to be
dislodged when no tooth structure is removed
before the etching and bonding procedures are
done. If the veneer is lost, it can be replaced, but
the patient may live in constant fear that it will
happen again, possibly creating an
embarrassing situation. Removing full veneers
with no damage to the underlying unprepared
tooth is exceedingly difficult if not impossible.

THE EXTENT OF TOOTH
PREPARATION
THAT IS NECESSARY ?

• To consistently achieve esthetic and physiologically
sound results, an intraenamel preparation is almost
always indicated. The only exception is in cases
where the facial aspect of the tooth is significantly
under contoured due to severe abrasion or erosion. In
these cases, mere roughening of the involved enamel
and defining of the peripheral margins are indicated.

• Intraenamel preparation (or the roughening of the
surface in under contoured areas) before placing a
veneer is strongly recommended for the following
reasons;
(l) To provide space for opaque, tinting, bonding and/or
veneering materials for maximal esthetics without over
contouring;
(2) To remove the outer fluoride rich, layer of enamel
which may be more resistant to acid etching;
(3) To create a rough surface for improved bonding; and
(4) To establish a definite finish line.www.indiandentalacademy.com

THE LOCATION OF THE
GINGIVAL MARGIN OF THE
VENEER?

The only logical reason for; extending the margin sub
gingivaIly is if the area is carious or defective,
warranting restoration, or if it involves significantly
dark discoloration that presents a difficult esthetic
problem.

PREPARATION DESIGN FOR FULL
VENEER:
Two basic preparation designs exist;
(I) a "window" preparation, and
(2) An incisal lapping preparation.

• A "window" preparation is recommended for most
direct and indirect composite veneers. This
intraenamel preparation design preserves the
functional lingual and incisal surfaces of the maxillary
anterior teeth, protecting the veneers from significant
occlusal stress. A "window" preparation design also is
recommended for indirectly fabricated porcelain
veneers if the patient exhibits significant occlusal
function as evidenced by wear facets on the lingual
and incisal surfaces. By using a "window" preparation,
the functional surfaces are better preserved in
enamel. This design reduces the potential for
accelerated wear of the opposing tooth that could
result if the functional path involved porcelain on the
lingual and incisal surfaces,' as with an incisal lapping
design.

• Incisal lapping preparation is indicated when the tooth
being veneered needs lengthening or when an incisal
defect warrant restoration. Additionally, the incisal
lapping design is frequently used with porcelain
veneers, because it not only facilitates accurate
searing of the veneer upon cementation, but also
allows for improved esthetics along the incisal edge.
• The preparation and restoration of a tooth with a
veneer should be carried out in a manner that will
provide optimal function, esthetics, retention,
physiological contours, and longevity. All of these
objectives should be accomplished without
compromising the strength of the remaining tooth
structure. www.indiandentalacademy.com

• Discolored mandibular anterior teeth are rarely
indicated for veneers, because the facio incisal
portions are thin and usually subject to biting forces
and attrition. Therefore, veneering lower teeth is
discouraged if the teeth are in normal occlusal
contact, because it is exceedingly difficult to achieve
adequate reduction of the enamel to totally
compensate for the thickness of the veneering
material. Also, if porcelain veneers are placed, they
may accelerate wear of the opposing maxillary teeth
because of the abrasive nature of the porcelain.

DIRECT VENEERS TECHNIQUE:
• Teeth are cleaned and isolated
• The "window' preparation is typically made to a depth
roughly equivalent to half the thickness of the facial
enamel ranging from approximately 0.5 to .75 mm
midfacially and tapering down to a depth of about 0.2
to 0.5 mm along the gingival margin, depending on the
thickness of enamel. A heavy chamfer at the level of
the gingival crest provides a definite cavity margin for
subsequent finishing procedures: The margins are not
extended subgingivally

• The preparation for a direct veneer normally is
terminated just facial to the proximal contact except in
the area of a diastema. To correct the diastema, the
preparations are extended from the facial onto the
mesial surfaces, terminating at the mesio lingual line
angles. The incisal edges are not included in the
preparations
• The teeth should be restored one at a time. After
etching, rinsing, and drying procedures apply and
polymerize the resin bonding agent. Place the
composite on the tooth in increments, especially along
the gingival margin, to reduce the effects of
polymerization shrinkage. Place the composite in
slight excess to allow some freedom in contouring. It is
helpful to inspect the facial surface from an incisal
view with a mirror to evaluate the contour before
polymerization. www.indiandentalacademy.com

• Tetracycline-stained teeth are much more difficult to
veneer, especially if dark banding occurs in the
gingival third of the tooth.
• Margins are placed subgingivally. May indicate (along
with other possible indications) local anesthesia.
• Shade selection is more difficult. The posterior teeth
usually have a more normal shade and can often be
used as a guide.
• To obtain a natural appearance, it is helpful to make
the cervical third of the teeth one shade darker than
the middle or incisal areas. Additionally, the canines
should be one shade darker than the premolars and
incisors.

INDIRECT VENEER TECHNIQUES:
Many dentists find that the preparation, insertion, and
finishing of several direct veneers at one time is too
difficult, fatiguing, and time consuming. Some patients
become uncomfortable and restless during long
appointments. Also, veneer shades and contours can
be better controlled when made outside of the mouth
on a cast. For these reasons, indirect veneer
techniques are usually preferable. Indirect veneers
include those made of (1) processed composite (2)
feldspathic porcelain3
, and (3) cast ceramic6
. Because
of superior strength, durability and esthetics,
feldspathic porcelain and cast ceramic are by far the
most popular materials for indirect veneering
techniques used by dentists.www.indiandentalacademy.com

• Cast ceramic veneers offer comparable qualities, but
require exacting laboratory technique and allow only
limited chair side finishing and alteration of contours;
however, excellent laboratory support and the superb
marginal fit of these veneers can minimize or eliminate
this disadvantage. Although two appointments are
required for indirect veneers, chair time is saved
because much of the work is done in the laboratory.
Excellent result can be obtained when proper clinical
evaluation and careful operating procedures are
followed. Indirect veneers are attached to the enamel
by acid etching and bonding with either a self cured,
light cured, or dual cured resin bonding material.

PROCESSED COMPOSITE VENEERS:
• Composite veneers can be processed in a laboratory
to achieve superior properties. Using intense light,
heat, vacuum, pressure, or a combination of these,
cured composites can be produced which posses
improved physical and mechanical properties
compared to traditional chair side composites.
Additionally, indirectly fabricated composite veneers
offer superior shading and characterizing potential as
well a better control of facial contours. Because their
composition is similar to chair side composite, indirect
composite veneers are capable of being bonded to the
tooth with a resin bonding medium. After acid etching,
bonding agent is applied to the etched enamel as with
any composite restoration. A fluid resin bonding
medium then is used to bond the veneer in place.

• A chemical bond is formed between the bonding agent
and the bonding medium and to a lesser extent,
between the bonding medium and the processed
composite veneer. Excellent mechanical retention
occurs at the interface of the bonding medium and
tooth from the roughened tooth surface resulting from
preparation with a coarse diamond instrument as well
as from tag formation into the etched enamel.
• Most processed composites presently are micro fill
composites. Although significant advantages exist
over direct composite veneers, indirect veneers made
of processed micro fill composites possess limited
bond strength because of the reduced potential to
form a chemical bond with the bonding medium.
Consequently, they should not be used in areas of
high occlusal stress.

• A newly developed processed composite of the hybrid
type, filled with barium glass and colloidal silica, offers
a significant improvement in bond strength. Because
this type of composite contains particles of barium
glass, relatively soft radiopaque filler, it can be
sandblasted and etched in the laboratory with a mild
concentration (9% to 10%) of hydrofluoric acid to
produce numerous areas of microscopic undercuts,
similar to the phenomenon that occurs when enamel
is etched. By producing a surface capable of
micromechanical bonding, "Etched composite veneers
(Herculite XR V Lab) of this type can be strongly
bonded to enamel without relying on significant
chemical bonding.

• Processed composite veneers are easily placed,
finished, and polished. They also can be replaced or
repaired easily with chair side composite. For these
reasons, indirect processed composite veneers are
often recommended for placement in children and
adolescents as interim restorations until the teeth
have fully erupted and achieved their complete clinical
crown length. At that time, usually at age 18 to 20
years, a more permanent alternative such porcelain or
castable ceramic veneers can be pursued.
• Indirect processed composite veneers also are
indicated for placement in patients who exhibit
significant wear of their anterior teeth due to occlusal
stress. www.indiandentalacademy.com

• However, only the "'etched composite" type of veneers
are recommended in cases of occlusal stress because
of their superior bond strength. Because of their lower
cost, indirect processed composite veneers also offer
an esthetic, affordable alternative to more costly
porcelain or castable ceramic types when economic is
the primary consideration. However, it must be pointed
out to the patient that processed composite veneers
typically do not exhibit comparable clinical longevity.

PORCELAIN LAMINATE VENEERS:
• Glazed porcelain has a long history of use in dentistry
as one of the most esthetic and biocompatible
materials available, surpassed only by enamel itself.
Porcelain's abrasion and stain resistance are excellent
and it is well tolerated by gingival tissues. The advent
of porcelain labial veneers as a permanent esthetic
restoration marked the progression of more than 30
years of dental research in acid etch, bonding, and
esthetic restorative techniques. The concept of acid
etching porcelain was cited in the dental literature in
1975 when Rochette described the innovative
restoration of a fracture incisor with an “etched
silanted porcelain block”.

• Essential to the attachment of porcelain veneers is the
ability of porcelain to be etched and bonded to
composite resin and to exhibit a high tensile bond
strength, as reported by Simonsen and Calamia.
Continued research by Calamia and Simonsen also
showed that treatment of the etched porcelain veneer
with a silane coupling agent produced a chemical
bond that enhanced the porcelain/composite resin
mechanical bond7
.
• Although relatively technique sensitive, the surface
texture, color, fluorescence, and overall esthetics of
porcelain laminate veneers have been regarded as
exceptional. In addition, the ability to adjust final color
during placement allows maximum flexibility in final
shade adjustment.www.indiandentalacademy.com

• A recent major break through that facilitated
predictable retention of porcelain to the tooth surface
has added a new dimension to esthetic dentistry.
Porcelain veneers can be considered to be very much
the "state-of-the-art" in cosmetic dentistry because
they offer innumerable advantages over any previous
form of veneering system.
• Horn R.Harold3
stated that porcelain veneering system
is a new modality for oral repair and it is important to
understand the art and science inherent in its
accomplishment as it will bring rewards in the
conservative dental health.
• Grabes A.David2
stated that etched porcelain
restoration, in future, will replace direct bonding
composite restoration is most clinical situation.www.indiandentalacademy.com

ADVANTAGES OF PORCELAIN LAMINATES:
• Color
• Bond strength
• Periodontal health
• Resistance to abrasion
• Resistance to Fluid Absorption
• Esthetics

DISADVANTAGES OF PORCELAIN LAMINATES:
• Time
• Repair
• Color
• Tooth preparation
• Fragility
• Cost

INDICATIONS:
• Discoloration
• Enamel defects
• Diastema
• Malpositioned teeth

• Malocclusion
• Poor restorations
• Aging
• Wear patterns
• Agenesis of the lateral
incisor

CONTRAINDICATIONS :
• Available enamel
• Ability to etch enamel
• Oral Habits
• The System's Inherent Strength

• Gilmour A.S.M. and Stone D.C.19
stated that careful
treatment planning and patient selection is necessary
to avoid problems and to ensure that the best result
was achieved with porcelain veneers.

• Although processed dental porcelain has a high
compressive strength, it is completely non-ductile and
therefore brittle. Also, because of surface irregularities
inherent in the manufacturing process, dental
porcelain restorations have a low tensile strength.
These surface irregularities, even though
microscopic in size, can cause significant stress
concentration. In the non-ductile porcelain, stresses
cannot be relied by plastic deformation (as is possible
in metals) and even minor defects under tensile
stresses may develop into larger cracks by a
mechanism of crack propagation. Ultimately, the
process may cause additional stress concentration
and failure in the form of a brittle fracture.www.indiandentalacademy.com

GOOD MORNINGwww.indiandentalacademy.com

METHODS OF STRENGTHENING
PORCELAIN:
• Because of the inherent weakness of dental porcelain,
different methods to strengthening it have been
developed. The porcelain fused to metal restoration is
probably the most well known example for a porcelain
strengthening system and allow porcelain to be
effectively used in dental restorations. The metal
structure provides, in addition to accurate fit, a
mechanism to prevent porcelain failure under tensile
stresses. Other commonly used porcelain reinforcing
methods are metallic foil substructures, the aluminous
porcelain core, and the more recently introduced
magnesia -alumina spinel.

1.Etched Porcelain: This new treatment modality
employs the fine etching of the porcelain inner surface
both for retention and porcelain reinforcement. With
resin bonding of etched porcelain to tooth, part of the
clinical success can be explained by the
polymerization shrinkage of the resin (a property
inherent in most polymers) which stresses the thin
porcelain in a direction that reduces the chance of
crack formation and propagation. The retentive
qualities of the porcelain surface may well depend
upon the nature of the microscopic pattern produced
during the etching process.

• Etching the porcelain surface with hydrofluoric acid (or
a derivative) produces the microscopic surface
roughness that provides retention when combined with
a flowing resin capable of polymerizing. Early etching
methods for porcelain consisted of either a 15 minute
etch with a 10% hydrofluoric acid or 20 minute etch
with a commercial preparation consisting primarily of
diluted hydrofluoric acid. Initial bond strength values
based on these etching methods were reported to be
around 1,100 psi.

The Effects of Solution and Time on Etching:
• The combination of porcelain etching with a silane
bonding promoter seems to have a cumulative effect
that maximizes the bond strength significantly. The
value of 3,500 psi for the group combining porcelain
etching and silane pretreatment is far better than bond
strengths obtained in early experiments. This bond
also surpasses the resin enamel bond strength.
• In the non etched porcelain groups a gap existed
between the porcelain and resin that was most
probably produced by the polymerization contraction
of the resin. The silane treatment caused a narrowing
of the gap, apparently as a result of improved
chemical attraction.

• In the etched porcelain, silane - treated groups no gap
was found, and the resin seemed to have filled all the
porcelain defects. Apparently, the rough etched
surface treated with silane produced a surface
attraction, causing the resin to wet it well. The good
adaptation of resin to etched porcelain seems to have
produced the highest bond strengths.
• The studies have also established that the etching of
the porcelain is the cardinal element in obtaining good
retention with the resin. Thus the combined etching
and silane treatment produced the highest bond
strengths.

2. Polymerization:
• Complete polymerization of the composite resin is
another essential requirement for obtaining a good
bond between the tooth and porcelain. Polymerization
of light activated composite resins is dependent on the
transmission of light and its penetration through the
porcelain into the composite resin. Several factors can
affect this light transmission, but most important are
the thickness of the porcelain and its opacity, and the
opacity of the composite resin used.

• Systems with a dual polymerization initiation system
(photo and chemical curing) give a significantly better
bond strength with thick porcelain than do systems
that polymerize solely by light. Visible light
polymerization shows a substantial reduction in
effectiveness when the light has to travel through
more than 3 mm of porcelain.
• The subject of resin polymerization is extremely
important because retention and mechanical support
to the brittle porcelain restorations are a direct function
of the degree of polymerization. Incomplete
polymerization reduces bond strength significantly,
and may contribute to early clinical separation and
failure. www.indiandentalacademy.com

• The phenomenon of incomplete polymerization is
more likely to occur in thick etched porcelain
restorations, such as inlays or onlays, where the
thickness of porcelain may approach 4 to 8 mm in
some areas. In the thin anterior porcelain veneers, this
is less likely to occur because the light can easily
penetrate through 0.5 to 1 mm of porcelain. However,
in interproximal regions where the light rays might
enter at an angle to the porcelain surface, the degree
of penetration and degree of polymerization may be
reduced. In both thin and thick etched porcelain
restorations, immediate retention will not be affected
because some thin sections probably exist that will
allow full setting of the resin in those sections.www.indiandentalacademy.com

• The restoration will therefore appear secure in place,
but it may contain much unreacted resin that could
eventually wash out and cause marginal caries.
Longevity of Porcelain Restorations:
• Etched porcelain restorations are not subject to
surface wear, roughness, or discoloration, as may be
the case with some direct composite resins. However,
longevity of these restorations is dependent primarily
on the bond strength between the restoration and the
underlying dental tissue. A weak resin to porcelain
bond (or deterioration of the bond with time) will cause
early failure of the restoration by subjecting it to the
possibility of deformation fracture.

• Hui K.K.K., B.Williams, E.H.Davis5
stated that window
type of preparation was the strongest when compared
with overlapped or feathered, design.
• Highton Ren et al4
stated that gingival tooth
preparation is essential to control stress distribution
and provide the best potential or periodontal health.
• Magne Pascal et al8
pointed out the importance of
controlled and uniform tooth reduction.

Material:
• Pippin David, James M.Mixon and Anton P., Soldon-
Els10
stated that porcelain veneers appeared to be
clinically acceptable, durable restoration for maxillary
anterior teeth.
• There are different opinions regarding the type of tooth
preparation porcelain laminate veneers requires.
Some clinicians believe that little or no tooth reduction
is required, whereas others, at the opposite end of the
spectrum, advocate a full, deep chamfer preparation
on the labial aspect of the teeth and most or all of the
way through the interproximal contact areas.

The decision of whether to reduce enamel should
depend on the following biological and technical
factors:
• Esthetics
• Relative tooth position
• Masking of tetracycline stain
• Marginal placement
• Age
• Psychology
• The potential for periodontal changes
• Plaque removal
The amount of enamel reduction necessary, based on
the needs, is in the realm of 0.3 to 0.6 mm or about
half the thickness of available enamel

ENAMEL REDUCTION PROCEDURE:
1. Labial Reduction:
• The labial preparation should encompass the amount
of reduction necessary to facilitate the placement of an
esthetic restoration. Ideally, one would like to replace
the same amount of enamel that is removed by the'
preparation. However, in certain situations, such as
rotated teeth or teeth in I labial version, it may be
advantageous to first bring the offending teeth into,
alignment with the rest of the arch by reducing their
labial contour.
• There may be situations where in small areas, to
facilitate cosmetic alignment, some amount of dentin
will be exposed by the preparation of the tooth. This is
not that critical if it is limited to only small areas and
the margins remain on enamel.www.indiandentalacademy.com

• Dental bonding, however, provides only a fraction of
the bond strength possible with enamel bonding and a
less effective seal. Therefore, a good general rule may
well be to ensure that over 50% of the preparation is
on enameL A problem with fresh dentin exposure is
the potential of the acidic etching solution and the
bonding material itself to cause pulpal hyperemia or
even necrosis.

2.Depth Guide:
• The depth cutting diamond comes in two sizes
(laminate Veneer System (L VS) No.1 and L VS No.2)
one of which would be appropriate for the tooth to be
prepared. These dimensions are 0.5 mm reduction
foremost situations and 0.3 mm for small teeth such
as mandibular incisors where the thickness of enamel
is considerably less.

Reduction of the Remaining Enamel:
The labial reduction should encompass two aspects
I. The bulk of the reduction should be done with a coarse
diamond in order to facilitate added retention and
better refraction of the light being transmitted back out
through the laminate and
2. At the marginal area, it is desirable to use a fine grit
diamond that will create a definitive, smooth finish line
to enhance the seal at the periphery.

• Move the diamond across the labial surface from a
mesial to distal direction, following the curvature of the
gingiva from the top of the mesial inter proximal
papillae down to the most apical extent of the free
gingival margin and back up to then tip of the distal
inter proximal papillae. The finish line should be right
at the gingival margin in most instances.
• Depending on the path of insertion, it may be
necessary to remove some extra tooth substance to
facilitate a path of insertion from the incisal edge
toward the cervical margin. If, however, the veneer
does not lap the incisal edge it can be placed from the
buccal direction, and removal of all convexities will not
be as critical. www.indiandentalacademy.com

3. Inter proximal Extension:
The margin of the porcelain laminate should generally
be hidden within the embrasure area. Depending on
the individual form of the tooth, it is usually desirable
to extend this margin about half way into the inter
proximal contact area. Extension of the laminate
beyond the mesio buccal and disto buccal line angle
also ensures the wraparound effect with etched resin
bonds at right angles to the labial surface for
increased bond strength

Proximal seat without breaking contactProximal seat without breaking contact

4. Dentin Exposure:
• Dentin may be exposed during tooth preparation when
dealing with a labially placed tooth that needs to be
brought back into harmonious alignment with the rest
of the arch. A rotated tooth poses similar problems, as
does the clinical situation in which there has been
gingival recession when the preparation extends
apically beyond the cemento enamel junction onto
exposed cementum or dentin. If the dentinal area
exposed is surrounded by enamel to provide a
peripheral marginal seal, it can be managed with a
dentin bonding agent. This may be a conventional
dentin bonding agent, a phosphorous ester of the BIS-
GMA molecule, or one of the newer systems such as
the aluminium oxalates or glutaraldehydes.www.indiandentalacademy.com

• If the dentin exposure occurs at the periphery, such as
the cervical region, it is advisable to prepare a little
deeper into this area so that a layer of glass ionomer
can be used as a base. This glass ionomer base will
bond to the dentin and seal it.
• During the enamel etching procedures use a gel form
of the acid and confine it solely to the enamel. If in
doubt cover the dentin with a film of dentin bonding
agent to seal it prior to acid etching.

5. Sulcular Extension and Marginal Placement:
At this stage the preparation ends right at the gingival
margin. It is, however, desirable to place it just within
the sulcus. Place a narrow gingival displacement cord
in the sulcus for about eight to ten minutes to slightly
displace the tissue. This system of first developing a
preparation line confluent with the gingival margin. and
then placing a retraction cord prior to refining and
extending it into the sulcus ensures:
I. Access for the diamond.
2. Less gingival trauma andwww.indiandentalacademy.com

• Because of the tissue displacement, this refined
margin will appear to supra gingival until the effect of
the astringent wears off. This preparation remains a
considerable distance from the biologic width so there
is little potential for violating it and developing
untoward gingival reactions.
6. Finish Line Configuration:
A feather or knife edge finish line is the most
conservative preparation but is inordinately complex
because of:
1. The difficulty in fabricating porcelain to the required
degree of thinness accurately and there is invariably a
poor marginal fit or seal.www.indiandentalacademy.com

2. The invariable increased thickness subgingivally and
resultant potential for gingival problems.
3. Laboratory problems in delineating the exact end of
preparation line.
• It would appear that the most desired form of finish
line is a modified chamfer of nominal depth (±0.25
mm) near the cemento enamel junction. The
preparation of a chamfer in this cervical area aids in
sealing the restoration by removing the acid resistant
surface enamel and exposing subsurface enamel
which is more readily etched.www.indiandentalacademy.com

Benefits of the Modified Chamfer Finish Line:
1.An increased bulk of porcelain at the margin and
hence increased strength without over contour.
2. Correct enamel preparation exposing correctly aligned
enamel rods for increased bond strength at the
cervical margin.
3. A well defined finish line for the laboratory yet without
too great a potential for porcelain sintering shrinkage -
increased accuracy of fit.
4. Greater ease for the dentist to obtain a correct
gingival finish line after insertion.
5. A definitive stop to aid in seating the laminate in the
correct position on the tooth.

7. Incisal or Occlusal Reduction:
The fabrication of a porcelain veneer lapping the incisal
edge makes :
1. Placement of the restoration that much easier by
virtue of having a definitive stop during seating.
2. Gives the clinician a specific relationship from which
to evaluate whether the restoration is correctly
positioned.
3. The preparation should be a definitive flattening of the
incisal edge to create increased enamel width and
potential bonding surface for the laminate.
4. The sharp line angles created on the buccal and
lingual surfaces must be rounded, however, which will
again increase the surface area of enamel and
prevent the propagation of microcracks in the
porcelain. www.indiandentalacademy.com

• The reduction should be at least 1 mm if it is desired
to restore the original length. If the incisal edge is not
to be included it is still useful to increase the amount
of horizontal tooth reduction at the periphery of the
preparation, the inter proximal areas, and the incisal
edge.
• In general, never end the incisal edge where excursive
movements of the mandible will cause shearing
stresses across the junction of porcelain laminate and
tooth. This potentiates fracture of the porcelain, de
bonding, and ongoing exposure of the composite resin
in this crucial area.

• The incisal preparation design is somewhat
controversial. Gilmour and Stone19
and Glyde and
Gilmour19
have classified the preparation of this site
into four types. They are;
I. Window or intraenamel preparation labially with intact
incisal enamel (results in an inferior appearance).
2. Feathered incisal preparation labially (porcelain is
prone to fracture)
3. Incisal edge preparation of 0.5 to 1.0 mm tooth
reduction incisally (if no tooth lengthening needed) to
form a butt joint lingually, and .
4. Incisal edge preparation as in 3, but overlapped onto
the lingual surface by using a heavy chamfer
preparation the most versatile.www.indiandentalacademy.com

Freedman and Mc Laughlin classified the preparation into six
basic types:
Type 1 : Minimal Preparation
Type 2 : Incisal Preparation

Type 4 : Over The
Incisal Edge With A
Lingual Ledge
Type 3 : Over The Incisal Edge

8. Lingual Reduction:
Any reduction of the incisal edge may necessitate
some lingual enamel modification so that there is no
butt joint at this incisal I lingual junction but rather a
rounded chamfer. This modification will help to
prevent the porcelain from shearing away from the
incisal edge during function. It also ensures:
1. Increased thickness of porcelain in this critical
lingual area that is being used for incising and
guidance.
2. Enamel bonds at right angles to those on the incisal
edge, and
3. Increased strengthwww.indiandentalacademy.com

Impression

ETCHING

• Place the labial surface of the veneer on a clay strip,
allowing the concave inner aspect of the veneer to act
as receptacle. Then fill the interface of the veneer with
the etching gel (e.g. 7.5% hydrofluoric acid) and allow
it to stand for seven to ten minutes. The gel must
occasionally be brushed up to the margins to ensure
etching in this critical area. Different porcelain systems
require different etching times with various etching
mediums. Individual manufacturer's instructions must
be followed for optimum results.

• When the etching phase is completed, lift the entire
clay strip by both edges and completely submerge the
veneers in a 10% solution of baking soda and water
until the acid is neutralized. The gel will bubble and
rise to the surface of the solution. Remove the veneer
from the solution and dry. Air abrade the interface until
it is free of etched ceramic debris.
• Clean the veneers in a detergent solution in an
ultrasonic bath for three minutes each and dry with an
oil free air syringe or a jet of warm air.
Prior to the final luting of the porcelain veneers, It is
important to go through a try-in stage, which is a three
phase process:

1. The intimate adaptation of each individual porcelain
laminate to the prepared tooth surface must be
checked.
2. The collective fit and relationship of one laminate to
another and the contact points need to be evaluated.
3. The color needs to be assessed and, if necessary,
modified.
• Stage 1 : Check for Individual Fit:
• Stage 2 : Collective Fit Try-In:
• Stage 3 : Color Check:
Exner Victer Herbert stated that dentist should opt for
a lighter, more translucent shade, which can be
modified before final cementation.

Luting Agents:
Desirable Features for Luting l1aterial :
• Thin film thickness, 10 to 20 micrometers
• High compressive strength
• High tensile strength
• Relatively low viscosity
• Ability to opaque
• Low polymerization shrinkage
• Color stability

Veneer Placement Procedure:
1. Tissue management:
2. Layout:
3. Silantation : The silane bond enhancer may be
preactivated and hydrolyzed or it may need to be
activated with an acid. A preactivated silane is painted
onto the etched porcelain surface and allowed to dry
for about one minute. The excess alcohol vehicle is
then gently evaporated by passing a stream of air
parallel to and approximately 6 inch above the surface
of the laminate. This will leave a dry, silane coated
veneer.
4. Enamel Activation:
5. Isolation:
6. Enamel etching:

• The tooth is isolated on both sides by placing either
mylar strips or a matrix band mesially and distally. The
tooth is etched with 30% to 37% phosphoric acid
solution for 15 to 20 seconds. The etchant must reach
the very periphery of the preparation where a seal is
highly critical to the long term success of the
restoration. Gingival displacement is important to
expose this margin and prevent contamination. The
etching material (gel or liquid) is washed from the
enamel surfaces with copious amounts of water for a
full 30 seconds.
• Do not let the patient rinse or in any way contaminate
this etched enamel surface with saliva. If this occurs
the surface must be re-etched for ten seconds,
washed, and dried again to redevelop a reactive
enamel surface.

• Application of dental bonding agent: Again isolate the
underlying etched tooth surface with matrix strips and
oat it with a combined enamel dental bonding agent of
the light activated type, which is gently air dispersed
into a thin, even layer. All excess bonding agent must
be gently blown aside. Light cure this evenly dispersed
layer to seal the tooth surface.
• Next coat the internal aspect of the veneer (which has
been silanated) with an unfilled resin bonding liquid:
blow it into a thin layer but do not light cure it. Place
the composite resin luting agent on the laminate,
using some form of syringe and express the material
into the center so that it spreads laterally, without
trapping air bubbles.

• Seating sequence: It is best to seat one laminate at a
time. In multi unit cases, start with the distal most
tooth on each side of the arch and work mesially to the
canine. Next seat the two central incisors
simultaneously to ensure that they match. The two
lateral incisors are then seated one at a time, to
accommodate any discrepancies in overall fit.
• Placement: Rotate the veneer onto the buccal surface
of the tooth and then gently manipulate it until contact
is made in the region of the gingival finish line. The
motion must be a gently rocking or "pulsing" motion
that slowly allows the excess material to escape from
all sides of the veneer. The gross excess may be
removed with a firm, pointed paintbrush or a curette. It
is important not to slide the veneer into place.www.indiandentalacademy.com

• Passing it over the incisal edge may wipe the internal
aspect of the veneer clean of the composite resin,
leaving a void. This can be prevented by rotating it
about the incisal edge into place. Hold the laminate
firmly in position to prevent "suck-back" and begin the
polymerization process with the light unit.
• During the curing process, it is essential to maintain
complete stability of the relationship between the
veneer and the underlying tooth. The polymerization
process is completed by curing the various areas of
the veneer for at least two minutes each. This extra
time is important due to the fact that the light has to
travel through the porcelain to reach the underlying
composite resin.

10. Curing:
• Time:
• Angle of Contact:
• Shade of the resin:
• Composite resin composition:
• Distance:
II. Finishing:
12. Occlusal Assessment:
13. Cosmetic Contouring:

INSTRUCTIONS TO THE PATIENTS
FIRST 72 HOURS :
• The resin bonding process takes at least 72 hours to
cure in its entirety. During this time, one should avoid
any hard foods and maintain a relatively soft diet.
Extremes in temperature (either hot or cold) should
also be avoided. Alcohol and some medicated mouth
washes have the potential to affect the resin bonding
material during this early phase and should not be
used.
MAINTENANCE:
• Routine cleaning are a must, at least every four
months with a hygienist, who should avoid using an
ultrasonic scaler and the air abrasion systems.www.indiandentalacademy.com

• Use a soft tooth brush with rounded bristles and floss
as one does with natural teeth. If daily cleaning of
plaque is a problem, use a mechanical plaque
removal device, because plaque free maintenance of
these restorations is essential to their longevity and
the health of teeth and supportive tissues.
• Use a less abrasive tooth paste and one that is not
highly fluoridated. Although laminate are strong, avoid
excessive biting forces and habit patterns; nail biting,
pencil chewing etc.
• A void biting into hard pieces of candy, chewing on
ice, etc.
• Use a soft acrylic mouth guard when involve in any
form of contact sport.

MOUTH RINSES:
• Acidulated fluoridated mouth rinses can damage the
surface finish of laminates and should be avoided.
Chlorhexidine antiplaque mouthrinses may stain
laminates, but the stain can be readily removed by a
hygienist.

CAST CERAMIC LAMINATE SYSTEM
• Easy to fabricate since it uses the familiar lost wax
method of processing
• More translucent than alumina based core material
• Stronger than feldspathic porcelain
• Can be built to full contour and shade stained or
coping made and layered with porcelain
• More translucent than alumina based core material

• Marginal fit very good similar to metal casting
• Can be etched with hydrofluoric acid so bonding with
resin most reliable
• Aesthetics excellent because of translucency similar
to natural enamel
• Has good record of clinical success.

VENEERS FOR METAL RESTORATIONS :
• Esthetic inserts (partial or full veneer) of a tooth
colored material can be placed on the facial surface of
a tooth previously restored with a metal restoration.
For new castings, plans are made at the time of cavity
preparation and during laboratory development of the
wax pattern to incorporate a veneer into the cast
restoration.

VENEERS FOR EXISTING METAL
RESTORATIONS:
Occasionally the facial portion of an existing metal
restoration (amalgam or gold) is judged to be
distracting. A careful examination, including a
radiograph, is required to determine that the existing
restoration is sound before an esthetic correction is
made. The size of the offensive area determines the
extent of the preparation. Anesthesia is not usually
required, since most of the preparation is in metal or
enamel.

• Preliminary procedures
• A No.2 carbide bur rotating at high speed with an air
water spray is used to remove the metal, starting at a
point midway between the gingival and occlusal
margins. The preparation is made perpendicular to the
surface approximately 1 mm deep at a minimum,
leaving a butt joint at the cavosurface margins. The 1
mm depth and a butt joint should be maintained as the
preparation is extended occlusally. All of the metal
along the facial enamel is removed, and the
preparation is extend into the facial and occlusal
embrasures just enough for the veneer to hide the
metal. The contact areas on the proximal or occlusal
surfaces must not be included in the preparation. To
complete the outline form, the preparation is extended
gingivally approximately 1 mm past the mark
indicating the clinical level of the gingival tissue.www.indiandentalacademy.com

• The final cavity preparation should have the same
features as those for veneers is new cast restorations.
Mechanical retention is placed in the gingival area with
a No. 1/4 carbide bur (air coolant to enhance vision)
0.25 mm deep along the gingivo axial and linguo axial
angles. Retention and esthetics are enhanced by
beveling the enamel cavosurface margin (bevel
approximately 0.5 mm wide) with the coarse, flame
shaped diamond instrument oriented at 45 degrees to
the external tooth surface. After it is etched, rinsed,
and dried, the cavity preparation is complete. New
adhesive resin lines containing a chemical called 4-
MET A, capable of bonding composite to metal, also
may be used but are quite technique sensitive. The
composite material is inserted and finished in the
usual manner.

REPAIR OF VENEERS
• Failures of esthetic veneers occur because of
breakage, discoloration, or wear. Consideration should
be given to conservative repairs of veneers if
examination reveals that the remaining tooth and
restoration are sound. It is not always necessary to
remove all of the old restoration. The material most
commonly used for making repairs is light cued
composite.
• Veneers on tooth structure: Small chipped areas on
veneers can often be corrected by re contouring and
polishing. When a sizable area is broken, it can
usually be repaired if the remaining portion is sound.

• Indirect processed composite veneers are repaired in
a similar manner. However, in order to repair porcelain
veneers, a mild hydrofluoric acid preparation, suitable
for intraoral use, must be used to etch the fractured
porcelain. Hydrofluoric acid gels are available in
approximately 10% buffered concentrations which are
intended for intraoral porcelain repairs. Although
caution still must be taken when using hydrofluoric
acid gels intraorally, the lower acid concentration
allows for relatively safe intraoral use.
• A lightly frosted appearance, similar to that of etched
enamel, should. be seen if the porcelain has been
properly etched. A silane coupling agent may be
applied to the etched porcelain surface prior to the
application of the resin bonding agent. Chair side
composite material is then added, cured, and finished

FAULTY VENEERS IN METAL
RESTORATIONS :
• The teeth are cleaned with a slurry of pumice and the
shade selected before isolation by cotton rolls and
retraction cords
• All of the old resin material is removed with an
appropriate instrument such as a No.1558 carbide
metal cutting bur.
• Should endeavor to create a chamfered finish line.
Retention is placed with a No.33 carbide bur in
selected areas in the metal along the line angles
approximately 0.25 mm deep.

• It is usually better to place the veneers one at a time.
A light cured composite is recommended because of
the extended working time. The preparation is cleaned
with acid etchant for 30 seconds, then rinsed and
dried to remove debris and obtain a clean, dry surface.
• A masking material (opaquing resin) is artfully placed
with a small brush over the metal areas of the
preparation by applying and curing successive thin
layers. These materials should be placed directly over
the prepared metal surface. Next, a small amount of
composite material (gingival shade) is placed at I the
cervical area with a hand instrument, adapted with the
tine of a No.2 I explorer, and cured with visible light.
New material of the pre selected lighter shade is
added to restore the middle and incisal portions.www.indiandentalacademy.com

CONCLUSION
• New emerging concepts in esthetic dentistry with
regards to materials, technology and public awareness
has made veneers on demand. It has been less than a
decade since the phenomenon of fusing porcelain
directly to tooth was first described in 1980's since
then the growth and development in this field has
been nothing short of humungous. Yet because the
science is still in its infancy caution is required. The
average dentist has a tendency to think only in terms
of articulation also and function with a little thought to
esthetics. www.indiandentalacademy.com

We should always keep in mind that we are dealing
with organs, which can change an individuals entire
visual personality. A captivating smile showing an
even row of natural gleaming white teeth is a major
factor in achieving that elusive dominant characteristic
called personality. The objective of cosmetic dentistry
must be to provide the maximum improvement in
esthetic with the minimum trauma to the dentition.
There are a number of procedure that begin in
approximate the ideal parameter of cosmetic dentistry,
most notably that of porcelain laminate veneers.

MY VIEWS
Lot of propagation of various dental products regarding
the porcelain laminate veneer with each heralding to
be more esthetically pleasant, stronger, better and
requiring less lab work and insertion steps, force us to
"quantum expansion of dental knowledge of porcelain
laminate veneering system" .
Perfect smile improves the self confidence,
personality; social life and have psychological effect
on improving self image with enhanced self esteem of
the patient.

• Improvement of smile makes us gratifying and opens
door in the new dimension of dental treatment using
veneers. As we are in the new era of resin bonded
porcelain (ceramic and esthetic dentistry), this
seminar has tried to enlighten and emphasize upon
newer information regarding materials, methods and
techniques regarding veneers.

BIBLIOGRAPHY
1. Alastair C.McLundie 1991 : "Localised palatal tooth
surface loss and its treatment with porcelain
laminates". Restorative Dentistry.
2. Graber A.David 1989: "Direct composite veneers
versus etched porcelain laminate veneers". DCNA.
Vo1.33 (2),301-304.
3. Harold Horn R. 1983 : “Porcelain laminate veneers
bonded to etched enamel.” Dent Clin North Am. 27 :
671-684.
4. Highton Ren et al 1987 : "A photoelastic study of
stresses on porcelain laminate preparations'. JPD.
Vol.58 (2), 257-260.
5. Hui K.K.K., Williams B., Davis E.H. and Holt R.D.
1991 : "A comparative assessment of the strength of
porcelain veneers for incisor teeth dependent on their
design characteristics". Br J Dent. 50-55.

6. Lang S.A., Starr C.B. : Castable glass ceramics for
veneer restorations. J Prosthet Dent. 67 (5) : 590-594.
7.Kenneth Anusavice J. 1996: "Philips' Science of
Dental materials". W.B.Saunders Co., Philadelphia,
10tb Edition, 510.
8.Magne Pascal et al1999 : "Crack propensity of
porcelain laminate veneers - A simulated operatory
evaluation". JPD. 81,327-334.
9.Nathanson Stangel D. and Hsu C.S. 1987 : "'Shear
strength of the composite bond to etched porcelain". J
Dent Res. 66 (9), 1460-1465.
10.Pippin David J., James M. Mixson and Anton P.
Solan Els 1995 :"Clinical evaluation of restored
maxillary incisors : Veneers vs PFM crowns". J Am
Dent Assoc. 126, 1523-1528.
11.Sterling Ronk L. 1981 : "Dental Lamiantes, which
technique?" JADA. Vol. 102, 186-188.

12.Sturdevant C.M. et al . : The Art and Science of
Operative Dentistry, Fifth Edition, C.V. Mosby Co.
1995.
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