Dental Veneers & Laminates

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Dental Esthetics include the use of bonded ceramic veneers and laminates. This presentation helps to understand various concepts relating to the preparation and utility of such restorations. - Dr. Abhishek John Samuel, MDS (Endodontics)

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  • Therefore with tall teeth, a wider central incisor is preferred resulting in a more dominant central incisor and a smaller RED Proportion. Conversely shorter teeth have a narrower central incisor and the front teeth are more similar in size.
  • The 70% RED Proportion is recommended for average length teeth so the upper lateral incisor should be 70% the width of the central incisor.
  • 1. First degree. Mild tetracycline staining. This staining is minimal expression of tetracycline. Varies from yellow to grey with no banding.
    2. Second degree. Moderate tetracycline staining. Yellow -brown to dark grey banded staining.
    3.Third degree. Severe tetracycline staining. Blue grey or black with significant banding across the tooth.
    4. Fourth degree. Extended and more severe staining
  • Dental Veneers & Laminates

    1. 1. DR.DR. ABHISHEK JOHN SAMUELABHISHEK JOHN SAMUEL MDS, Endodontics & Conservative DentistryMDS, Endodontics & Conservative Dentistry
    2. 2.  VENEER: layer of tooth colored: layer of tooth colored material that is applied to amaterial that is applied to a tooth for esthetically restoringtooth for esthetically restoring localized or generalized defectslocalized or generalized defects or intrinsic discolorationsor intrinsic discolorations -Sturdevants Art & Science of Dentistry Pg. 322  Made of chairside composite, porcelain or cast ceramic materials
    3. 3. 1. Closing spaces. 2. Minor tooth position improvements (correcting rotation or overlap). 3. Lengthening short or worn teeth. Improving tooth shape. 4. Making aged teeth look youthful. 5. Correcting teeth in lingual version. 6. Post orthodontic treatment. 7. Shade change/Brighten shade/Stain Correction
    4. 4. Discoloration leading to deep dentinal defects Enamel defects Large Diastamata Malpositioned teeth Poor restorations on labial sufaces Aging Wear pattern Available enamel Ability to etch enamel Oral habits
    5. 5.  Shape or form  Symmetry and proportionality  Position and alignment  Surface texture  Color  Translucency
    6. 6. Feminine smile Rounded incisal angles,open incisal and facial embrasures and softened facial line angles Masculine smile More closed and prominent incisal angles
    7. 7.  Prominent areas highlighted by light  Depressed areas shadowed  Change in apparent size of a tooth- narrower by positioning mesiofacial and distofacial line angles together
    8. 8.  Sense of balance and harmony – subconscious visulisation  Augmentation of proximal surfaces with composite  Restorations at midline- incisal and gingival embrasure form  Tooth position tooth alignment, arch form, configuration of smile
    9. 9. ‘Golden proportion’ Proportion of smaller tooth to larger tooth 0.618 ‘Repeated ratio’ Golden proportion only in 17% of casts (Preston et al) The golden ratio (also known as the golden mean, golden section or divine proportion) is a height to width ratio that measures 0.618 and manifests itself in nature, art and architecture
    10. 10.  RED- the proportion of the successive widths of the teeth as viewed from the frontal should remain constant as one moves distally.  In other words each tooth becomes smaller by a fixed percentage as you move back in the mouth.  The RED proportion is not limited to one particular proportion but allows the desiredallows the desired RED proportion to be selected and consistently applied for each individualRED proportion to be selected and consistently applied for each individual case.case.  Studies have shown that smiles which maintain a constant 78% width/height ratio of the upper central incisors are preferred.  The taller the teeth the smaller the RED Proportion usedThe taller the teeth the smaller the RED Proportion used. The shorter the teeth the larger the RED Proportion used.
    11. 11.  YOUNG TEETH AND OLD TEETH  ANATOMICAL FEATURES
    12. 12.  Cervical areas darker than incisal areas  Young patients-lighter teeth  Older- incisal edge enamel thinned due to wear and is darker  Shade selection  Metamerism
    13. 13.  Esthetics and function  Anterior guidance and occlusal harmony  Physiologic contours  Emergence Profile
    14. 14. Mayekar (2001) Laminate maintains colour. Usually requires no Tooth Prep. Veneer- change in colour, requires Prep. (endodontically treated teeth and tetracycline stained teeth) Constructing a veneer and bonding it to tooth structure is referred to as laminating
    15. 15. 1930-40s- Charles Pincus- Thin porcelain veneers 1970-80s- Direct composite resin laminates- No tooth preparation 2nd evolution- Preformed veneers/crowns 1980- Etching of glazed porcelain with hydrofluoric acid and silane coupling agents
    16. 16. Partial Veneers- Localized defects or as areas of discoloration Full Veneers- More generalized defects/ intrinsic staining Direct Indirect - less technique sensitive - more esthetic -longer lasing - multiple teeth
    17. 17.  For opaque, tinting, bonding or veneering material for maximum esthetics without overcontouring/overprep  Remove acid resistant, fluride rich enamel  Rough surface for bonding – diamond abrasives  Definite finish line
    18. 18.  Preferred in Direct Composite Veneers.  Preserve lingual and incisal surfaces  Significant occlusal function  Preservation of functional surfaces  Reduces wear of opposing tooth
    19. 19. Lengthening of tooth Incisal defect Facilitates seating of veneer Lower anteriors not veneered
    20. 20.  Outline extent of defect  Coarse elliptical/round diamond  0.5-0.75mm  Subgingival extention- if defect is subgingival  Microfilled or more opaque composite depending on remaining defect
    21. 21.  Half the depth of enamel-0.5-0.75mm mid facially and 0.2-0.5mm along gingival margin  Chamfer for definite cavity margin  Incisal edge not included.  If included for anterior guidance, tooth reduction of at least 1mm.  Shade selection- very important (3D Master)  No.212 retainer  Margin at crest of gingival tissue
    22. 22. 1. Processed composite 2. Feldspathic porcelain (+++esthetics) 3. Cast or pressed ceramic (+++ fit and finish)
    23. 23.  Superior properties- Light, heat , vacuum, pressure etc.  Superior shading and characterizing  Better control of facial contours  Easily repaired  Children and adolescents as interim restorations  Wear pattern  Lower cost  Window-Prep is ideal!
    24. 24.  Limited bonding- surface conditioning or sand blasting required  Multiple large existing restorations compromise bonding
    25. 25.  Window preparation recommended due to limited bond strength  Incisal lapping if incisal defect  Intraenamel preparation  Elastomeric impressions  No temporization First Appointment
    26. 26. 1. Evaluate fit of veneer 2. Tooth side of veneer (preetched) is primed 3. Tooth etched, rinsed and dried. Adhesive is applied but not cured 4. Adhesive cement applied 5. Veneer placed and excess cement removed 6. Check for fit with no.2 explorer 7. Light cured for 40-60sec facial & lingual Second Appointment
    27. 27. ADVANTAGES  Color  Bond strength  Periodontal health  Resistance to abrasion  Inherent porcelain strength  Resistance to fluid absorption  Esthetics +++ DISADVANTAGES  Repair difficult  Technique sensitive  Color modification not possible  Tooth preparation required  Extremely fragile & difficult to manipulate  Expensive PORCELAIN VENEERS
    28. 28. 0.3-0.6mm/ half enamel thickness of available enamel  Adequate space for porcelain veneer  Remove convexities  Space for opaquer  Enamel surface conducive to etching & bonding  Definitive seat  Margin placement clarified
    29. 29.  Labial- LVS no.1 and LVS no.2 Depth guide  Interproximal- Margin halfway into proximal contact area - Wrap around effect - Procelain bulk  Sulcular – 0.05-0.1mm into sulcus - retraction cord - chamfer/ bevelled shoulder  Bi-Planar Reduction: 0.5-0.75mm – Facio-Gingival margin 1-1.2mm – Facio-Incisal margin
    30. 30.  A) The facial surface should be reduced in two planes; one nearly parallel with the path of insertion, and one parallel with the incisal two- thirds of the facial surface of the tooth  B) One plane reduction parallel with the path of insertion may result in insufficient space for porcelain in the incisal 1/3 of the tooth  C) One plane reduction which creates adequate space for the restoration both in the shoulder and the incisal areas, will endanger the pulp entity and produce overtapered restoration.
    31. 31.  Featheredge or knife edge  Pointed end tapered fissure bur to provide this type of margin.  It’s the most conservative type.  But the margin is weak. Impression tearing  It form >135 cavo surface line angle.  Therefore a definite finish line (chamfer) is adviced.  Should stop just facial to the proximal contact point – easier placement
    32. 32.  Incisal - definite stop - 0.5mm if restoration of original length  Lingual - rounded/heavy chamfer 1. Prevent shearing of porcelain 2. Bulk of porcelain of at least 1mm 3. Increased strength  Elastomeric impression
    33. 33.  Silane coupling agent – increases wettability  Etching ceramic with Hydoflourous acid 7-10%  Porcelain polishing paste • NX3 from Kerr, Variolink • Veneer or Variolink II from Ivoclar • Vivadent or RelyX Veneer Cement system from 3M ESPE
    34. 34.  5-15% opaque porcelain  Deeper tooth preparation  Die spacer (engage the cement’s shade)
    35. 35.  IPS empress  Mild to moderate discoloration  Better marginal fit  Little marginal finishing necessary
    36. 36.  Thinness and fragility of ceramic veneers  Computer programmed oversized dies  Highly sintered high purity alumina-0.25mm  Simple to use  Excellent esthetics
    37. 37.  Pre-fabricated nano-hybrid- composite enamel-shells  Attractive teeth and a new smile after only one visit  Very little removal of healthy tooth structure – 0.3mm max  Individual, customized shaping of the front teeth  Shine can be refreshed by polishing at any time  Unlike porcelain veneers, they can be easily repaired
    38. 38. Modeling MB5 Contour Guide
    39. 39.  Unesthetic facial portion of metal restoration  No.2 carbide bur  Mechanical retention in no.1/4 bur- 0.25mm  4-META
    40. 40. Always place centrals, then laterals, and so on
    41. 41.  Repair with composite resin.  Preparing surface to resist functional stresses and thermocyclic loading  High-energy ceramic reparative surface (the exposed chipped ceramic) and a chemical/mechanical link to the restorative composite resin.  micro-etcher (20-µm aluminum oxide under 35 psi)  etch the ceramic surface with 5% to 9% hydrofluoric acid  This is completed by applying a minimal amount of a pre-hydrolyzed silane  the ceramic surface should still have a "frosty" appearance as it did after etching. If the surface is "shiny" then the silane is too thick and should be removed by sandblasting and re-applied in a lesser amount  The last step is to apply a bonding adhesive which should be light-polymerized before application of the restorative composite resin.
    42. 42. Condition Whitening Veneers Teeth stained by tobacco Y Y Teeth stained by coffee/tea Y Y Teeth stained by fluorosis N/Y Y Age-related staining Y Y Teeth that have been dark since childhood N Y Teeth darkened by trauma N Y Teeth darkened by root decay N Y Stained teeth with extensive gum recession N Y Gapped teeth N Y Crooked teeth N Y
    43. 43.  Same function and benefits.  When placing lumineers, the structure of the tooth remains unchanged.  Are as thick as a contact lens, but this does not make them less durable.  Might feel a little bulkier than the classic porcelain veneers.  The tooth is still protected by its natural enamel, even if the lumineers need to be taken off.  In terms of costs, lumineers have similar costs as the porcelain veneers.  Not

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