this document will supply you with all you need to know about laminate veneers : 1) Advantages and disadvantages of laminate veneers. 2) Indications and contraindications of laminate veneers 3) Types of laminate veneer and their advantages and disadvantages. 4) Porcelain laminate veneers : features and preparations. 5) lumineers

1. By : Menna Allah Ashraf
Department of fixed prosthodontics

2. 1
Laminate veneers
Abstract:
Esthetics have been a matter of concern in our age and also
the conservation of tooth structure which we call “tooth
banking “has been a matter of importance for all dental
practitioners.
Changing trends and treatments for dental disease have
made it necessary to diversify dental services.
Introduction of laminates as an effective esthetic
alternative has overtaken all the conventional options and
most importantly its conservative approach towards its
preparation will always make a sensible dentist to think
before going on to any alternative esthetic procedure.
This review gives an insight about the scientific definition,
evolution and spread, types, indications,
contraindications, advantages, and disadvantages of the
laminates, as an effective esthetic restoration.
Also, my research will include specific information about
porcelain veneers its features and its different
preparations because porcelain veneers are the most
commonly used, most successful, most esthetic and they
are of prime concern in fixed prosthodontics.

3. 2
Laminate veneers
Introduction:
What are laminate veneers?
Dental laminate: is a wafer-thin shell (0.3-0.7 mm) usually made of
porcelain that is bonded onto the front side of teeth figs (1 & 2)
Nowadays, laminate veneers have widely spread and have been of
great importance in different uses like smile design, correction of
malformed or disfigured tooth and also they are used to hide
chipped and discolored teeth. Veneers also are very famous
between celebrities as many Hollywood celebrities have applied
veneers on their teeth to mimic more natural and pleasant
appearance (fig 1 & 2 ).
Also, laminate veneers are used in children. They are used to
replace the traumatic injuries in the teeth of the school children.
Fig 1 : laminate veneers
maintain beautiful smile
Fig 2 : translucency of laminates.

4. 3
Both Laminate veneers and crowns have esthetic purpose but a
crown involves most surfaces of the tooth or all of it and requires
more tooth reduction.
Objectives:
1) Advantages and disadvantages of laminate veneers.
2) Indications and contraindications of laminate veneers
3) Types of laminate veneer their advantages and disadvantages.
4) Porcelain laminate veneers : features and preparations.
Advantages of laminate veneers:
1) Restoration of natural color, shape and translucency of
tooth
2) Good fixation because of adhesive system.
3) Conservative preparation.
4) Alternative to full coverage restoration in case of incisal
fractures and tooth discolouration.
5) Color stability.
Fig3 : advantages of laminates Fig 4 : advantages of laminates
re
r

5. 4
Disadvantages of laminate veneers :
1) More time is required than direct restoration, more laboratory
work, several appointments (time-consuming).
2) Impossible to change the color of laminate after cementation.
3) Laminates are much more expensive than fillings.
4) Brittle margins.
5) Cannot be repaired easily
6) Can sometimes be difficult to temporize
7) Difficult to finish (especially margins of porcelain).
8) Placement is difficult.
9) Potential for over-contouring.
Indications of laminate veneers:
Veneers can be used for functional and cosmetic
Correction of the following conditions:
1) Stained or darkened teeth as in fluorosis and tetracycline
staining.
2)Hypocalcification.
3) Multiple diastemas (fig 5 & fig 6 ).
4) Peg laterals or disfigured teeth (fig 6)
5) Chipped or fractured teeth.
6) Misaligned teeth; if a person's misalignment isn't too severe,
(instant orthodontics).
Contraindications:
1) Abnormal bite.
2) Bruxism.
3) Highly destructed tooth ( if more than 60 % of the enamel is
highly destructed as the enamel thickness is necessary in
bonding ).
4) Deep discoloration extending to dentin.
5) Very large diastemas..
6) Severely malposition teeth.
7) Unfavorable wear pattern.
Teeth that have lost a significant amount of structure due to
wear, decay or fracture, and those that have large fillings don't
make good candidates..

6. 5
8) patients with existing compromised periodontal condition
and high plaque index are poor candidates for such
restorations.
9) Endodontically treated teeth: a full veneer crown would hold
the integrity of the non- vital tooth better than a
laminate veneer.
Fig 5 : indications of laminates ( diastema
closure )
Fig 6 : indications of laminates
( disfigured teeth and diastema closure )
Fig 7 difference between porcelain and
composite veneers in esthetics.
Fig 8: upper figure is ( composite
veneered teeth ) lower figure is
porcelain veneered teeth )

7. 6
The following table includes different types of veneers their general
advantages and disadvantages :
veneers Advantages Disadvantages
Direct
composite
veneer
-Available for all
dentists
- Conservative.
- High esthetics
- Excellent gingival
reply.
- Easy reparation
- Acceptable price
-T - Technical difficulties
-Requires experience
-Unsuitable for highly
discolored teeth.
Indirect
porcelain veneer
-Conservative.
-Excellent esthetics
-Very good gingival
reply.
(fig 7 & 8)
-Requires two appointments
- Requires more preparation
-Technical difficulties.
- Difficult reparation.
- High price.
Direct-indirect
composite veneer
-Conservative.
-High esthetics
- Excellent gingival
reply.
- complete
polymerization
- Easy reparation
- Acceptable price.
- Requires technical skills.
- Requires prolonged time.
- Requires extra appliances.

8. 7
Veneers can be placed directly or indirectly. Composites are used
for directly placed veneers, and a variety of ceramic materials can
be used for indirectly placed veneers.
These include:
1. Conventional powder-slurry ceramic (Feld spathic porcelain).
This type of porcelain is layered on the refractory die by the lab
technician. ( fig: 9 )
2. Heat-pressed ceramic: These products are melted at high
temperatures and pressed into a mold created using the lost-wax
technique (castable porcelain)
3. Machineable (CAD/CAM) ceramics (fig 10 ).
Creating lifelike ceramic veneers has been difficult skill reserved
for great ceramists using Feld spathic porcelain or meticulous
waxers using the hot press technique, but now CAD/CAM is giving
technicians the ability to easily create veneers with a few clicks of
a mouse.
Fig 9 : porcelain layered on
refractotry die.
Fig 10: Designing laminates using
(CAD/CAM).

9. 8
Any deviation from this design can result in numerous problems
with acceptance, aesthetics, phonetics and function.
Small details and surface characteristics can be improved and
minor design changes can be made to improve the artistic and
aesthetic.
The ZFX System has the ability to adapt the design to fit or
duplicate the wax-up scan exactly With conventional techniques,
this duplication was difficult to achieve; wax injection into
silicone putties made from the diagnostic wax-up can create exact
duplication but this is still time consuming and technique
sensitive.
Now with the click of the mouse duplication is achieved. The
shapes are minimally altered to ensure proper contacts,
embrasures and interdental spaces ( fig 11 & fig 12 )
Fig 11 : CAD / CAM design anteriorly Fig 12 : CAD/CAM design laterally

10. 9
Features of porcelain laminates :
Advantages of Porcelain Laminates over other laminate systems:
Porcelain as a replacement for unaesthetic tooth substance has
been used for the following reasons:
. Color stability: There is a dual fold advantage, as porcelain offers
better inherent color control and a natural look as well as the
ongoing stability of these colors.
· Bond Strength: The bond of the etched porcelain veneer to the
enamel surface along with the silane coupling agent is
considerably stronger than other veneering systems.
· Periodontal Health: because of the highly glazed porcelain
surface, there is less depository area for plaque accumulation as
compared to other laminate systems.
Another advantage of this system is the option of placing
supragingival margins (can be placed 0.5 mm above the gingival
margin).
.Resistance to abrasion: The wear and abrasion resistance is
exceptionally high compared to composite and acrylic resins.
· Inherent Porcelain Strength: The veneer itself is rather fragile,
but once it is luted to enamel, the restoration develops high
tensile and shear strengths. The cohesive strength of porcelain is
considerably greater than the bond between resin particles and
filler in a composite resin.
· Resistance to fluid absorption: Porcelain absorbs fluids to a
lesser degree than other laminate veneering materials.
· Esthetics: there is a greater possibility to control color and
surface texture with ceramic than other materials.

11. 10
Porcelain can be stained both internally and superficially giving
vitality to the restoration. Texture can be developed on the veneer
surface to simulate that of adjacent teeth
· Conservation of tooth structure: most of the preparations have
their margins on enamel (depth of reduction between0.3 -0.7mm),
with / without involving the incisal edges)
· Transmission of light: porcelain allows transmission of light
which gives a naturalistic appearance. Ceramic buildup done by
layering or lateral segmentation can reproduce all the
characteristics' of natural enamel, like cracks, fissures and
opalescence.
· Disadvantages of Porcelain Laminates:
· Time: The placing of Veneers is technique sensitive and therefore
time consuming.
· Repair: The veneers cannot be easily repaired once they are luted
to enamel. Removal of the restoration will require grinding it off
the tooth surface
· Technique Sensitive: the entire procedure is to be followed in a
sequential manner Carelessness at any stage can have a
disastrous outcome.
· Change of shade: It is difficult to modify color once the veneers
are luted in position on the enamel surface.
· Tooth Preparation: Some tooth preparation may be required to
prevent potential problems associated with over contouring.
· Fragility: The veneers are extremely fragile and difficult to
manipulate.

12. 11
· Cost: The dental fee for a porcelain laminate can generally be
equal to even more than the normal fee for an anterior full crown.
· Color of the luting agent: restoration will be a failure if it does
not coordinate with the shade of the restoration Thickness of the
luting agent is also a determining factor.
· Post firing modifications: modification after the firing procedure
will not be possible
· Time required for Temporization: if temporization is required the
procedure is time consuming.
There are 2 types of porcelain laminate veneers:
1) Conventional porcelain veneers (fig 13)
2) LUMINEERS (fig 14 )
1) conventional porcelain veneer:
They are veneers with various preparation shapes, techniques and
they have different styles according to smile design.
Fig 13: conventional porcelain
veneer
Fig 14: LUMINEERS

13. 12
steps of conventional porcelain laminate preparation:
1) Case report: example for a patient suffering from:
Wear of the central incisor edges creating a flat anterior occlusal
plane.
Discolouration and marginal staining of the existing composite
restorations.
2) Impression for study models/bite registration record.
3) Radiographs/photographs.
4) Shade selection (fig 17 and fig 18 ).
Fig 15: lateral view of preoperative smile Fig 16: frontal view of preoperative smile
Fig 17: shade selection
Fig 18 : shade guides

14. 13
5)Visualization: The first step in this visualization process is the
diagnostic wax-up this wax-up should be highly indicative of the
final result (fig 19 & 20 ).
In the previous case : From the wax-up, it was determined that
only four veneers would be required.
silicone matrices would be used for making an intra-oral
diagnostic mock–up, a tooth preparation guide and the temporary
veneers.
An intra-oral mock up of the final proposed result was made using
Bis-acryl resin temporary resin material in a silicone matrix once
the resin had polymerized, the matrix was removed and an
aesthetic and functional analysis was made of the result.
6)Preparation: Depth Guide Cuts – Prior to preparation always
examine study models in order to avoid over-reducing areas of the
tooth that may be rotated or lingually inclined. Hence, the use of a
reduction guide is recommended. ( fig 21 & 22)
A diamond depth cut bur can be used to discribe horizontal depth
cut grooves on the labial surface of any anterior tooth Extend
these grooves from mesial to distal, taking care not to damage the
adjacent teeth that are not being prepared.(fig22)
Fig 19: original study cast Fig 20: diagnostic wax up

15. 14
It may be necessary to angle the bur in relation to the contour of
the labial surface to achieve the appropriate depth for these guide
cuts.
The finish lineof the preparation could end gingivally or
supragingivally, approximately 0.5 mm incisal to cemento-enamel
junction (CEJ). gingival depth shouldn’t cut the cemento enamel
junction area.
Types of Veneer Preparation:
a) Window preparation :in which the veneer is taken close to but
not up to the incisal edge.(fig23&24)
This has the advantage of retaining natural enamel over the
incisal edge, but has the disadvantage that the incisal edge
enamel is weakened by the preparation. Also, the margins of the
veneer would become vulnerable if there is incisal edge wear
whilst the incisal lute can be difficult to hide ( least restricted path
of insertion).
b) Incisal Chamfer Preparation (Interlock prep) : The incisal edge
is not reduced in length.
Fig 21 : placing depth cuts Fig 22 : depth cutter or depth cut
diamond bur

16. 15
This type of preparation is done in order to preserve the natural
guiding palatal surface of the tooth, which is important as it
1) Adds an additional space for the incisal porcelain by creating a
chamfer along the facial incisal margin using the tip of a tapered
diamond.
2) This intraenamel preparation design preserves the functional
lingual and incisal surfaces of the maxillary anterior teeth,
protecting the veneers from significant occlusal stress but it has
the least restricted path of insertion. (fig25).
c) Bevel: in which a bucco-palatal bevel is prepared across the full
width of the preparation and there is some reduction of the incisal
length of the tooth. This gives more control over the incisal
aesthetics and a positive seat during try in and luting of the
veneer. The margin is not in a position that will be subjected to
direct shear forces except in protrusion. (fig26).
Fig 23 : window preparation Fig24: window preparation

17. 16
d) Incisal Butt-Joint Preparation : Prepare 0.5 mm depth cut
grooves in the incisal edge. Using the tapered diamond remove the
remaining incisal tooth structure. Then round the facial incisal
line. is indicated when an incisal defect warrants restoration (
more restricted path of insertion ) (fig 25 ).
Fig 25: incisal butt joint
preparation
Fig 26 : incisal lingual wrap preparation
Fig 25: incisal chamfer preparation Fig 26: bevel prep

18. 17
e)Incisal Lingual Wrap Preparation:
Prepare 0.5 mm depth cuts in the incisal surface of tooth. Reduce
the incisal surfacein a manner similar to incisal butt-joint
preparation.
Reduce the mesial incisal and the distal incisal corners an
additional 0.5 mm.
Then using a diamond bur, extend the incisal chamfer to the
palatal surface This palatal chamfer should be a straight line
mesial to distal.
All incisal edges should be rounded.
The lingual chamfer line on the wrap around preparation should
be above or under the centric lingual contacts to avoid occlusal
contact on the interface between porcelain and tooth structure.
Contact should be either all on porcelain or on tooth structure.
The incisal wrap prep is a popular option for several reasons: It
can be used in most patients, easily fabricated by the technician
and easily handled by the dentist due to positive seating on
delivery also the lingual wrap increase the bulk of porcelain and
prevent its shearing ( most restricted path of insertion ) ( more
mechanical retention due to extension of the restoration ) (fig 26 )
Reduction needs to be addressed in three planes with incisal,
middlethird and cervical planes.
provide a minimum of 0.3mm (feldspathic porcelain) or
0.6mm(Empress esthetic, e.max) preparation.
Labial Reduction: Using a tapered diamond,between the depth
cuts Simultaneouslycreate a chamfer ending 0.5 mm incisal to the
CEJ.

19. 18
Incisal edge reduction:
Incisal reduction : Different preparation designs have been
advocated from feather and window preparations that involve no
reduction of the incisal edge or preparation of the lingual
surfaces,to other preparations that involve a reduction of the
incisal edges ( 1.5mm).
Proximal preparation:
This preparation in the interproximal region can be made either
by stopping short of breaking the contact, or by preparing
through the contact point. Breaking the contact (sometimes
called the “slice preparation”.
Cervical margin: The cervical preparation for a veneer is
recommended to be a chamfer design with a maximum depth of
0.4mm. This allows the veneer to reproduce natural tooth
contours and not be over-contoured additional it allows simple
seating of the veneer and minimises stresses, enhancing the future
fracture resistance of the veneer (marginal integrity ,structural
durability, high esthetics) .
In the previous case The teeth were prepared with a marginal
chamfer labially and interproximally, and a butt fit margin
palato-incisally with no wrap around onto the palatal aspect
Fig 27:Canine – Incisal Chamfer
Preparation (Interlock Prep)
Right lateral incisor– Incisal Butt-joint
Preparation
Right central incisor – Incisal Lingual
Wrap Preparation
Left central incisor – Depth Cut

20. 19
Contact points were not preserved as the teeth had natural
diastema between them. This also allowed for the changing of the
tooth widths in the final restorations (fig28)
. Following tooth preparation, the final impression is made
Even though the preparation margins were the level of the
gingival margins, a retraction cord was used to allow an
impression of the tooth.
surface beyond the margins to be captured This ensures accurate
and complete capture of the entire margin and aids the dental
technician in obtaining the correct cervical profile for the
restorations. An impression was taken using a well-designed
custom tray and a single stage impression technique.
Polyvinyl siloxane impression material was used, with heavy body
material placed in the tray and light bodied material syringed
around (fig29).
The path of insertion for veneers is in the labial or incisal-labial
All undercuts and unsupported enamel in relation to this path
must be removed
silicone reduction guide ( index ) is used in order to check the
amount of reduction required .
The reduction guide is designed to evaluate the amount of
reduction at the incisal middle third and cervical third of the
tooth.

21. 20
7)Laboratory Instructions : A detailed prescription is written to
the technician.
The prescription should include:
• Teeth number and Required shade
•The type of ceramic required to make the veneers.
• If any changes in anatomy are required for the final result e.g.
increasing length.
• Make a note of any requests made by the patient
8)Temporization.
9) etching of the veneers : The internal surface of the porcelain
veneers were etched for 90 seconds with 9% Hydrofluoric Acid
Hydrofluoric etching generates a significant amount of crystalline
debris that contaminates the porcelain surface and may reduce
bond strength by 50%. To remove this debris, the veneers were
rinsed with water for20 seconds, then cleaned with 37% Phosphoric
acid (gentle brushing with microbrush for a minute), re-rinse with
water for 20 seconds and then finally immersed in 95% alcohol in
ultrasonic bath for five minutes.
Fig 28 : finished preparations Fig 29 : polyvinyl siloxane impression

22. 21
veneer surface should appear clean and have a similar
appearancetobe etched veneer surface preparation. Silane
coupling agent is then applied ( increase wetting of the porcelain).
10) Total etch technique for the preparation : using 37%
phosphoric acid.
Etching of the preparation from 10 to 15 seconds
Fig 30:Etching of the
laminate.
Fig 31 : Internal
surface of the
laminate after etching
Fig 32 : Etching of the
preparation .
Fig 33: preparation
after etching .
Fig 34 : bonding
laminate veneer.
Fig 35: adaptation of
laminate view palatal
surface.
N.B: we never start etching the preparation before try in stage and
ensuring that the restoration is seated, well fitted no marginal
thinning and ensuring that the shade selection is right.

23. 22
11) bonding and cementation of the restoration : The application of
rubber dam is recommended to achieve adequate isolation, which helps
to provide a clean, dry environment and minimises contamination from
saliva and blood . Light curing composite resin is preferred for
cementation of the veneers as they have a longer working time than
dual cure or chemically cured composites .This allows sufficient time to
remove excess composite prior to curing and thus reduces the finishing
procedures. The colour stability of light curing resin cements are much
better compared to dual or chemical cure composites. Dual cure resin
cements contain tertiary amines which may undergo long term colour
change with overall darkening and thus are normally contraindicated
with veneers due to their thin nature and translucency.
Fig 38&39 : The smile of the patient could be with different designs such as masculine ,
feminine, Hollywood, softened , functional and focus.
Fig 36: post operative smile (lateral
view)
Fig 37: post operatve smile ( frontal
view)

24. 23
12) finishing and polishing :using yellow color coded finishing stones
and hand instruments ( blade #12) ( sharp carvers to remove excess
cement)
if excess porcelain is found at the margin extra fine finishing diamonds
are used .
also, disks,carbides and rubber points can be used in finishing.(fig 43 )
Fig 40 : finishing and removal of excess
cement using a blade ( hand instrument )
Fig 41: finishing and polishing using
finishing cups and finishing burs.
Fig 42: finishing tapered
stones with yellow color
code.
Fig 43 : different finishing stones

25. 24
2) No preparation veneers ( LUMINEERS ) :
What’s the difference between LUMINEERS and conventional
porcelain veneers?
The main difference is the LUMINEERS are fabricated from certain
type of porcelain (cerinate porcelain ) that’s very strong but much
thinner than laboratory fabricated veneers (fig 44 &45 )
They are very thin their thickness is comparable to contact lenses.
Advantages:
1. Painless.
2. no anesthesia.
3. Fast technique.
4. Conservation of the tooth structure.
5. No harm to the pulp and therefore elimination of post operative
sensitivity.
6. Ease of impression, because tissue management is not needed.
7. No need for provisionals.
8. Permanently whiten teeth.
Fig44 : thickness of LUMINEER Fig 45 : thin thickness of LUMINEER

26. 25
9. Bonding to enamel.
10. Longer-lasting restorations due to enamel bonding.
11. Minimal flexing stress due to bonding to enamel.
12. Higher level of acceptance by the patients, specifically patients
with dental phobia or refuse to remove sound tooth structure.
13. Excellent esthetics.
14. Resistant to permanent staining
15. Easy to clean and maintain when placed supragingivally.
16. Can be placed over unattractive crowns and bridges without
replacing them.
Disadvantages:
1. Bulky appearance.
2. Periodontal problems due to overcontouring of the veneer
(biological principles).
3. Teeth width being restored cannot be altered significantly.
4. Difficult to mask severe staining and discoloration with thin
veneers (Such as severe tetracycline staining.
Steps of preparation of LUMINEER :
There are 2 techniques for LUMINEER preparation :
1) No-Prep Technique: allows LUMINEERS to be placed over the
existing teeth without the removal of any form of tooth structure.
Therefore, anesthesia and temporaries are also not required

27. 26
2) The lumineers Minimal Contouring Technique: requires slight
modification of the enamel but never touches dentin during
LUMINEERS placement. Only .3 mm-.5 mm enamel is removed,
causing no sensitivity for the patient and therefore no need for
any anesthesia.
Steps of LUMINEERS preparation :
1. Polishing: Clean the teeth with Porcelain Laminate Polishing
Paste and rinse.
2. Refresh the Enamel: Perform minimal enamelplasty with a
prep diamond bur, using light pressure Use the whole length of the
bur keeping contact with the teeth.
3. Interdental Strips
Isolate the teeth receiving LUMINEERS from the teeth not
receiving LUMINEERS by applying Paint-On Dental Dam or
placing metal interdental strips in order to prevent etchant from
contacting adjacent teeth (fig 46).
4. Etching:
1) Etch the teeth with Etch ‘N’ Seal For 20 seconds.(fig47)
2) Rinse thoroughly with water, then dry.
5) bonding: using a bonding agent + ulrabonding agent.

28. 27
6) Insert the LUMITray:
1. Remove the Paint-On Dental Dam or interdental strips.
2. Center the LUMITray (midline).
3. Insert the tray in one smooth movement.
4. Apply light and continuous buccal pressure.
5. Remove excess resin cement from the gingiva with a
microbrush.
7) Cure LUMINEERS Through LUMITray.
8) Clean-Up and Open Interdental Spaces.
9) Remove excess cement using the finishing bur kit.
Fig 48 : insertion of laminates Fig 49: light curing through LUMI
tray
FIG 46 : isolation of teeth using
a paint
Fig 47: etching

29. 28
10 ) light curing the restoration.
Conclusion : laminate veneers are from the most popular
restoration in the cosmetic dentistry nowadays .every kind of
laminate has its own advantages and its own preparation
according to the case .
Fig 50: light curing the LUMINEER Fig 51: LUMINEERS after insertion

30. 29
References and links:
http://www.wattpad.com/23011-indications-and-contraindication-for-laminates
http://www.nature.com/bdj/journal/v189/n5/full/4800739a.html
http://www.nature.com/bdj/journal/v193/n2/full/4801489a.html
http://jonfrankeldentistry.com/veneers-and-lumineers.php
http://www.slideshare.net/ahmedalrashedi39/the-veneer-step-by-
step?next_slideshow=1
http://www.realself.com/question/comparison-dental-veneer-brands
http://www.animated-
teeth.com/porcelain_veneers/t3_porcelain_veneers_how.htm
http://www.jcda.ca/article/b143
Scientific papers:
Porcelain veneers: Treatment guidelines for optimal aesthetic by dr
Christopher Ho , Mr Brad Gobler.
A Review on Ceramic Laminate Veneers By Mathew, Sebeena Mathew,Karthik
KS .
PORCELAIN VENEERS: TECHNIQUES AND PRECAUTIONS BY BAZIL MIZRAHI.
Do’s and Don’ts of Porcelain Laminate Veneers by Chad.J.Anderson.Gerard
Kugel
No-Preparation Porcelain Veneers by Afnan El Zain.
Porcelain veneers – preparation design: A retrospective review.

31. 30