porcelain laminate veneers/ dentistry course in india


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porcelain laminate veneers/ dentistry course in india

  1. 1. Porcelain laminate veneers. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. Table of contents. Introduction. Definitions. History. Review of literature. Indications. Contraindications. Case selection for PLV. www.indiandentalacademy.com
  3. 3. All ceramic systems used for laminate veneers. Tooth preparation. Impression making. Shade selection. Provisional restoration. www.indiandentalacademy.com
  4. 4. Lab communication. Lab Fabrication. Try- in considerations. Luting of porcelain laminate veneers. Finishing and polishing Summary. Conclusion References.www.indiandentalacademy.com
  5. 5. Introduction. The restoration of the unaesthetic anterior teeth has always been a problem, involving large amounts of sound tooth substance, with adverse effects on the pulp and gingiva. The establishment of clear parameters for effective, reliable etching to dental enamel and the development of high quality , microfine composite cements led to introduction of composite veneers for masking discoloration. www.indiandentalacademy.com
  6. 6. Unfortunately composites show polymerisation shrinkage staining andpoor wear resistance. The acrylic laminate veneers was an attempt to overcome some of these problems, but the long term results were clinically unacceptable. www.indiandentalacademy.com
  7. 7. Porcelain as a material for veneering was first reported by Horn , using commercially available porcelain built up in layers on a platinum foil matrix adapted to the model of the tooth. Further Calamia described a modified technique using high temperature investments. www.indiandentalacademy.com
  8. 8. Porcelain is readily etched and the application of the silane couplers to the surface overcame the problem of poor bonding found in acrylic veneer. www.indiandentalacademy.com
  9. 9. Definitions. Veneer: 1. a thin sheet of material usually used as a finish. 2. A protective or ornamental facing. 3.Suferficial or attractive display in multiple layers, frequently termed as laminate veneers. (GPT 8) www.indiandentalacademy.com
  10. 10. Porcelain laminate veneers: a thin bonded ceramic restoration that restores the facial surfaces and part of the proximal surfaces of the teeth requiring esthetic restorations. (GPT 8) www.indiandentalacademy.com
  11. 11. History. 1937: Pincus attached thin labial porcelain veneers temporarily with denture adhesive powder to enhance the appearance of Hollywood stars for close-up photographs. 1955: Buonocore introduced the acid etch technique to increase the adhesion of acrylic filling material to enamel. www.indiandentalacademy.com
  12. 12. 1958: Bowen developed silica-resin direct filling material. 1975: Rochette mentioned the use of a silane coupling agent with porcelain laminate veneers for repairing fractured incisors. www.indiandentalacademy.com
  13. 13. 1976: Faunce and Myers used acrylic resins for preformed laminate veneers. 1983: HORN introduced platinium foil technique. 1983: Calamia introduced refractory die technique. www.indiandentalacademy.com
  14. 14. 1983-1984: Calamia demonstrated good bond strengths for hydrofluoric acid etched porcelain, and that the use of silane coupling agent could further increase the bond strength of resin composite to etched porcelain. www.indiandentalacademy.com
  15. 15. Review of literature. www.indiandentalacademy.com
  16. 16. Ron Highton etal., A photoelastic study of stresses on porcelain laminate veneers. (JPD 1987;58(2):157-161). A photoelastic study of four designs for the tooth preperation for porcelain laminate veneers revealed that incisal, labial, proximal and gingival reduction is recommended for patients with class I, division I occlusions. www.indiandentalacademy.com
  17. 17. Although modifications for variant tooth conditions may be necessary, gingival tooth preparation is necessary to control stress distribution and provide the best potential for periodontal health. www.indiandentalacademy.com
  18. 18. Friedman M.(JADA 1987 Dec). stated that the etch porcelain veneer can provide a restoration that looks natural with minimum tooth preparation. Periodontal response to the veneers , when properly placed has been excellent. www.indiandentalacademy.com
  19. 19. Herbert Victor. Predictability of color matching and the possibilities for enhancement of ceramic laminate veneers. (JPD 1991;65:619-22). www.indiandentalacademy.com
  20. 20. This study investigated the predictability of color on three illustrated surfaces of the ceramic veneers and the extent to which the laminates may be shade adapted by the use of tints opaquers on the fitting surface. www.indiandentalacademy.com
  21. 21. Conclusion: significance discrepancies were found in the final color match. The dentist should opt for a lighter, more translucent shade, which can be modified before final cementation. www.indiandentalacademy.com
  22. 22. Robert E. Rada. Porcelain laminate veneer provisionalization using visible light curing resin (QI 1991;22:291-293). www.indiandentalacademy.com
  23. 23. Placement of PLV has become relatively common procedure. Occasionally it is necessary to fabricate provisional restorations. For these situations, the use of self cure acrylic or composite resin has been described in the literature. www.indiandentalacademy.com
  24. 24. Extensive trimming and finishing procedures are often necessary and due to their inherent fragility they are prone to breakage. To improve the technique , visible light cure acrylic resins are used for fabrication of direct provisional restorations. www.indiandentalacademy.com
  25. 25. J.J. Linden etal., Photoactivation of resin cements through porcelain veneers.( J. Res. Dent 1991;70(2):154-157. www.indiandentalacademy.com
  26. 26. The purpose of the study was to evaluate the effect of porcelain opacity on the curing of composite when porcelain shade and thickness were held constant. Microhardness testing (KNH) was used to test the degree of cure of each material at various intervels. www.indiandentalacademy.com
  27. 27. Concluded that porcelain opacity did not significantly affect hardness. But the chemical catalyst and prolonged curing times might be essential for clinical success. www.indiandentalacademy.com
  28. 28. Sumiya Hobo Porcelain laminate veneers with three dimensional shade reproduction. (int dent J;1992:42:189- 198. www.indiandentalacademy.com
  29. 29. A new system for creating porcelain veneers with three dimensional shade option is described. The development of new porcelain consisting of an intense color which provides natural tooth esthetics in layers of only 0.5mm has made this system possible www.indiandentalacademy.com
  30. 30. In addition a masking porcelain may be used over the discolored tooth. This system claim to supersede the esthetic shade created with other laminate systems, as well as enhancing the marginal integrity of the veneer. www.indiandentalacademy.com
  31. 31. J. G. Wall etal., Cement luting thickness beneath porcelain veneers made on platinum foil. (JPD1992;68:448-50). www.indiandentalacademy.com
  32. 32. The purpose of this investigation was to measure the luting space under porcelain laminate veneers that were fabricated on platinum foils cemented on mandibular incisors. www.indiandentalacademy.com
  33. 33. The study demonstrated that required folds in the platinum folds substantially increases marginal discrepancies around the luted veneers. These discrepancies were apparently smaller than that created with refractory die technique. www.indiandentalacademy.com
  34. 34. S. M. Dunne etal., A longitudinal study of the clinical performance of porcelain veneers. (BDJ 1993;175:317-21). www.indiandentalacademy.com
  35. 35. In this study a total of 315 porcelain labial veneers were fitted in 96 patients and were evaluated after a period upto 63 months. During the evaluation period 17% restorations in 32% of the patients presented with a problem at review. www.indiandentalacademy.com
  36. 36. Increased problem and failure rates were associated with veneers placed on existing restorations, where tooth surface loss occurred prior to the treatment and where inappropriate luting cements were used. www.indiandentalacademy.com
  37. 37. Age , gender, fabrication technique , use of rubber dam were not significant factors. www.indiandentalacademy.com
  38. 38. M. Peumans etal., Five year clinical performance of porcelain veneers. (QI1998;29:211-221). The objective to evaluate overall clinical performance of porcelain veneers evaluated at 5yrs. www.indiandentalacademy.com
  39. 39. Results: 93% were satisfactory. 7% presented recurrent caries, porcelain fracture, clinical microleakage and pulpal reaction. 100% retention rate. 14% presented excellent marginal adaptation. www.indiandentalacademy.com
  40. 40. P. A. Brunton. Tooth preparation techniques for porcelain laminate veneers (BDJ 2000;189: 260-62). The objective of the study was to determine the effect that two guides (silicone index, depth preparation bur) had on operators ability to appropriately and consistently prepare the teeth for PLV.www.indiandentalacademy.com
  41. 41. Concluded that considerations should be given to the use of a silicone index or depth gauge bur when teeth are prepared for PLV. www.indiandentalacademy.com
  42. 42. David G Wildgoose. Dimensional change of refractory materials used for ceramic veneers. (Eur. J. Prosthodont. Rest. Dent 2001;9:101- 105). www.indiandentalacademy.com
  43. 43. The current literature considers a number of clinical factors which affect the fit of PLV. However , little consideration has been given to the refractory die material and the lab techniques used. www.indiandentalacademy.com
  44. 44. This study found a wide range of dimensional change occurred during setting and firing cycles for 7 refractories recommended for construction of PLV. www.indiandentalacademy.com
  45. 45. It is there fore important that the clinician should consider the suitability of the materials offered by the laboratory, in order to obtain optimum marginal integrity. www.indiandentalacademy.com
  46. 46. Bo-Kyoung Kim The influence of ceramic surface treatments on the tensile bond strength of composite resin to all-ceramic materials (J Prosthet Dent 2005;94:357-62.) www.indiandentalacademy.com
  47. 47. The purpose of this study was to evaluate the tensile bond strength of composite resin to 3 different all- ceramic coping materials with various surface treatments. www.indiandentalacademy.com
  48. 48. Alumina and zirconia ceramic specimens treated with a silica coating technique, and lithium disilicate ceramic specimens treated with airborne-particle abrasion and acid etching yielded the highest tensile bond strength values to a composite resin for the materials tested. www.indiandentalacademy.com
  49. 49. Christian F.J. Stappert. Longevity and failure load of ceramic veneers with different preparation designs after exposure to masticatory simulation (J Prosthet Dent 2005;94:132-9.) www.indiandentalacademy.com
  50. 50. This study evaluated the influence of preparation design on longevity and failure load of ceramic veneers bonded to human maxillary central incisors after cyclic loading and thermal cycling in a dual-axis masticatory simulator. www.indiandentalacademy.com
  51. 51. Within the limits of this in vitro investigation, the use of adhesively luted IPS Empress veneers prepared according to the 3 different preparation designs demonstrated adequate stabilization of residual tooth structure. www.indiandentalacademy.com
  52. 52. Crack pattern analysis showed a higher risk of subcritical crack development when the indenter impact was located on the palatal ceramic surface. www.indiandentalacademy.com
  53. 53. Therefore, the palatal contact point position of the antagonist should remain on the natural tooth structure after preparation. In particular, this is important for complete veneer preparations. www.indiandentalacademy.com
  54. 54. George P. Cherukara, Graham R. Davis etal., Dentin exposure in tooth preparations for porcelain veneers: A pilot study (J Prosthet Dent 2005;94:414-20.) www.indiandentalacademy.com
  55. 55. The purpose of this pilot study was 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.www.indiandentalacademy.com
  56. 56. Within the limitations of this pilot study, it was demonstrated that a labial reduction of 0.4 to 0.6 mm resulted in an intraenamel preparation, other than in the cervical region. Even with the use of depth- limiting techniques, a quarter of the prepared labial surface was exposed dentin. www.indiandentalacademy.com
  57. 57. Fernando Zarone Dynamometric assessment of the mechanical resistance of porcelain veneers related to tooth preparation: A comparison between two techniques. (J Prosthet Dent 2006;95:354-63.) www.indiandentalacademy.com
  58. 58. 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. www.indiandentalacademy.com
  59. 59. Conclusion: 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. www.indiandentalacademy.com
  60. 60. Seok-Hwan Cho, Effect of die spacer thickness on shear bond strength of porcelain laminate veneers. (J Prosthet Dent 2006;95:201-8.) www.indiandentalacademy.com
  61. 61. The application of die spacer may affect the shear bond strength (SBS) of porcelain laminate veneer. However, there is no standard for the amount of die spacer necessary for the fabrication of PLV restorations. www.indiandentalacademy.com
  62. 62. The purpose of this study was to evaluate the SBS differences between enamel and a feldspathic PLV as a function of die spacer thickness. www.indiandentalacademy.com
  63. 63. Within the limitations of this study it was found that the appropriate application of die spacer exerts a favorable influence on the SBS of composite-bonded PLV. The 2-coat application of die spacer provides suitable space to accommodate the cement thickness. www.indiandentalacademy.com
  64. 64. Indications of PLV12,3 1. used in patients who wish to have their anterior dental aesthetic problems corrected in terms of tooth shade, morphology and alignment. www.indiandentalacademy.com
  65. 65. 2. if there is sufficient tooth substance for bonding and support, veneers can be used for correcting: - Tetracycline stains. - Stained non-vital teeth. - unattractive restorations. -enamel fluorosis. - Enamel hypoplasia. - Chipped or slightly worn anterior teeth. - Microdontia. - Minor tooth malalignment. - Closure of midline diastema. www.indiandentalacademy.com
  66. 66. -modifying anterior guidance. -providing undercut zones for removable prostheses. In adverse clinical situations like lingual erosion. As substitute for porcelain metals and crowns, especially in mandibular teeth. www.indiandentalacademy.com
  67. 67. Contraindications.12,3 If there is insufficient amount of enamel for bonding such as in extensive caries and tooth fractures, heavily restored teeth, severe enamel hypoplasia and short clinical crowns. If excessive forces are acting on the teeth as with active bruxism, and object biting habits. www.indiandentalacademy.com
  68. 68. Darkly stained teeth. Malocclusions. Extensive periodontal bone loss Large diastemas. www.indiandentalacademy.com
  69. 69. Case selection for PLV. (QI 1995;26:311-315) Static and dynamic Occlusal relationship. The usual mode of failure is fracture of the corners, frequently happens at the incisal edges. The margins should be placed so that they do not contact the opposing dentition during the rest position. www.indiandentalacademy.com
  70. 70. Occlusal interferences and Para functional habits are contraindications for PLV because they result in crack formation. www.indiandentalacademy.com
  71. 71. Periodontal and oral health status: A healthy periodontium forms a strong foundation on which all the restorative work rests. It is therefore important to assess the patient's periodontal and oral health before the procedure is begun. www.indiandentalacademy.com
  72. 72. Healthy periodontium. www.indiandentalacademy.com
  73. 73. Mouth breathers who have poor gingival health are poor candidates for porcelain veneers. www.indiandentalacademy.com
  74. 74. Condition of the tooth. Degree of discoloration: If the tooth is grossly discolored it may be necessary to bleach the tooth before the veneer is placed. www.indiandentalacademy.com
  75. 75. www.indiandentalacademy.com
  76. 76. The discoloration of the tetracycline staining becomes more severe as the enamel reduces. www.indiandentalacademy.com
  77. 77. www.indiandentalacademy.com
  78. 78. Extent of caries:  if little or no enamel is present after caries removal placement of veneers is contraindicated. The veneer –tooth complex is weakened when the surface area of the enamel available for bonding is decreased by 50%. www.indiandentalacademy.com
  79. 79. Extent of restorations: A restoration if present , should be small enough that the area for bonding with enamel is not compromised. www.indiandentalacademy.com
  80. 80. www.indiandentalacademy.com
  81. 81. Quality of the tooth. Structural defects like amelogenesis imperfecta, dentinogenesis imperfecta are contraindicated. Large areas of exposed dentin are also unsuitable. www.indiandentalacademy.com
  82. 82. Amelogenesis imperfecta. www.indiandentalacademy.com
  83. 83. Dentinogenesis imperfecte www.indiandentalacademy.com
  84. 84. Large areas of exposed dentin. www.indiandentalacademy.com
  85. 85. Patient’s motivation to maintain. The patient’s attitude towards the dental health care should be assessed before porcelain veneers are attempted. www.indiandentalacademy.com
  86. 86. Patients expectations. The patient’s expectations should be realistic. www.indiandentalacademy.com
  87. 87. Oral habits. Nail or pencil biting is contraindication for veneers because shearing stress may be too great for the ceramics to withstand. www.indiandentalacademy.com
  88. 88. All ceramic systems used for PLV.13,11,1 Conventional (powder- slurry) ceramics. Castable ceramics. Machinable ceramics. Pressable ceramics. Infiltrated ceramics. www.indiandentalacademy.com
  89. 89. Conventional powder slurry ceramics. These products are supplied as powders to which the technician adds modulator liquid to produce a slurry, which is built up in layers on the die material to form the contours of the restoration. www.indiandentalacademy.com
  90. 90. The powders are available in various shades and translucencies and are supplied with characterizing stains and glazes. www.indiandentalacademy.com
  91. 91. Optec HSP: Has greater strength than conventional feldspathic porcelain as a result of an increased amount of Lucite. Because of its increase strength it does not require a core when used to fabricate all ceramic restorations. www.indiandentalacademy.com
  92. 92. The body and the incisal porcelains are pigmented to provide desired shade and translucency. www.indiandentalacademy.com
  93. 93. Advantages. They fit accurately. Does not require special processing unit. www.indiandentalacademy.com
  94. 94. Disadvantages. Increased content of Lucite contributes to high wear of opposing teeth. www.indiandentalacademy.com
  95. 95. Duceram LFC. Is referred to as “hydrothermal low-fusing ceramic”. Composed as an amorphous glass containing hydroxyl ions. Greater density. High flexural strength. Greater fracture resistance. Cause less abrasion against tooth structure. www.indiandentalacademy.com
  96. 96. Restoration is made in two layers: 1. Base layer: is a Duceram metal ceramic . Placed on a refractory die using powder slurry technique and then baked at 930degree C. www.indiandentalacademy.com
  97. 97. 2. Second layer: over the base layer , Duceram LFC is applied using powder- slurry technique and baked relatively at 660 degree C. Material is supplied in different shades . No special lab technique or equipment. www.indiandentalacademy.com
  98. 98. Castable ceramic systems. Dicor: Polycrystalline glass ceramic material. The fabrication uses lost wax technique and centrifugal casting techniques similar to those used to fabricate alloy castings. www.indiandentalacademy.com
  99. 99. To achieve appropriate shade , the colorant shades are baked on the surface of the glass-ceramic material. It is less abrasive to the opposing teeth. www.indiandentalacademy.com
  100. 100. www.indiandentalacademy.com
  101. 101. Dentsply introduced Dicor Plus. Which is shaded feldspathic porcelain veneer applied to the dicor substrate. www.indiandentalacademy.com
  102. 102. Machinable ceramics. The ceramic ingots used in CAD- CAM restorations donot require further high temperature processing. They are placed in the machining appartus to produce desired contours. www.indiandentalacademy.com
  103. 103. The different types of systems are: 1. Cerec system (Sirona dental systems, Germany.) This system uses Vita Mark II (Vivdent), Dicor (Dentsply Int), Procad (Ivoclar North America). www.indiandentalacademy.com
  104. 104. www.indiandentalacademy.com
  105. 105. 2. Procera AllCeram system (Nobel Biocare). The procera system involves an industrial CAD-CAM system. www.indiandentalacademy.com
  106. 106. www.indiandentalacademy.com
  107. 107. Celay system: in this system the pattern is fabricated directly on the prepared tooth or on the master die, then the pattern is used to mill porcelain restorations. www.indiandentalacademy.com
  108. 108. www.indiandentalacademy.com
  109. 109. www.indiandentalacademy.com
  110. 110. www.indiandentalacademy.com
  111. 111. The restorations produced by these systems produce considerable wide gap between the restoration and the tooth structure. www.indiandentalacademy.com
  112. 112. Pressable ceramics.  1. IPS EMPRESS(IVOCLAR , N. AMERICA)  2.OPTEC PRESSABLE CERAMIC (JENERIC /PENTRON)  3.CERGO-DENTSPLY  4. VITA PRESS-VIDENT www.indiandentalacademy.com
  113. 113. www.indiandentalacademy.com
  114. 114. www.indiandentalacademy.com
  115. 115. www.indiandentalacademy.com
  116. 116. Veneering porcelain IPS Empress- Empress IPS Empress 2 Empress 2, Eris Optec- optec Cergo- Ducera Gold Vita Press- Vita Omega www.indiandentalacademy.com
  117. 117. These ceramics offer greater flexural strength when the veneer thickness is not less than 0.5mm. www.indiandentalacademy.com
  118. 118. Infiltrated ceramics. Composed of an infiltrated core veneered with feldspathic porcelain. Core is initially extremely porous, and is composed of either Aluminiun oxide or spinel( a composition containing Al2O3 and MgO). This porous sub structure is subsequently infiltrated with molten gas. Veneering porcelain-Vitadur alpha www.indiandentalacademy.com
  119. 119. www.indiandentalacademy.com
  120. 120. Extremely high flexural strength Strongest of all ceramic dental restorations www.indiandentalacademy.com
  121. 121. Disadvantages- core of Al2O3 or spinel is so strong that traditional internal surface etching is not possible because of opaque Alumina core , the translucency of the final restoration may not be as life like as with other systems www.indiandentalacademy.com
  122. 122. Stratification method.4 Stratification is a process of forming in layers. A porcelain veneer that is bonded to the tooth with a resin cement is an example of stratification. www.indiandentalacademy.com
  123. 123. The layers are : The inner layer – the tooth. The middle layer – the resin cement. The outer layer- the porcelain veneer. www.indiandentalacademy.com
  124. 124. www.indiandentalacademy.com
  125. 125. Various principles are involved in enhancing the color of the porcelain veneers. The dynamic application of these principles to complex area of porcelain veneer coloration is called stratification method. www.indiandentalacademy.com
  126. 126. Tooth preparation: Without graded tooth preparation, color control is inconsistent, and over contoured veneers are the rule. www.indiandentalacademy.com
  127. 127. Two levels of graded tooth preparation are necessary to create space. One level -----> moderate color change (universal preparation). Another level -----> profound colorwww.indiandentalacademy.com
  128. 128.  For Moderate color change , two color change or less, a two plane facial reduction of 0.3 mm in the cervical one third and 0.5 mm in the incisal two thirds is indicated. www.indiandentalacademy.com
  129. 129. www.indiandentalacademy.com
  130. 130. www.indiandentalacademy.com
  131. 131. For profound color change, three shades or more, all teeth except mandibular incisors, atleast 0.4mm in the cervical area and 0.6mm in the incisal area is indicated. www.indiandentalacademy.com
  132. 132. www.indiandentalacademy.com
  133. 133. www.indiandentalacademy.com
  134. 134. Resin interface space: The relationship between light reflection and vitality of the porcelain veneer. Veneer formed by opaque porcelain ----- masks tooth color ----- limited vitality -------- due to surface light reflection. www.indiandentalacademy.com
  135. 135. Translucent porcelain ------ light transmission and reflection ------ enhances vitality ------ difficult to mask tooth color. www.indiandentalacademy.com
  136. 136. How can porcelain veneers simulate natural teeth? www.indiandentalacademy.com
  137. 137. Using grade resin interface space , to allow resin to dilute tooth discoloration. www.indiandentalacademy.com
  138. 138. Can de accomplished by the use of die spacer. Two shade change or less www.indiandentalacademy.com
  139. 139. Moderate color change. www.indiandentalacademy.com
  140. 140. THREE SHADE CHANGE OR MORE www.indiandentalacademy.com
  141. 141. Profound color change. www.indiandentalacademy.com
  142. 142. Porcelain veneer formulation. For a given cast the ceramist should formulate a porcelain veneer that will contain graded opacity appropriate to the desired color change. www.indiandentalacademy.com
  143. 143. Moderate color change ------ translucent porcelain. www.indiandentalacademy.com
  144. 144. Moderate color change. www.indiandentalacademy.com
  145. 145. Profound color change ------- more opaque porcelain. For polychromatic color gradation veneers are highly characterized. www.indiandentalacademy.com
  146. 146. Profound color change. www.indiandentalacademy.com
  147. 147. Porcelain laminate veneers. Compiled by Dr. Venkat Yenepoya Dental College(2004-07) www.indiandentalacademy.com
  148. 148. Table of contents. Introduction. Definitions. History. Review of literature. Indications. Contraindications. Case selection for PLV. www.indiandentalacademy.com
  149. 149. All ceramic systems used for laminate veneers. Tooth preparation. Impression making. Shade selection. Provisional restoration. Lab communication. www.indiandentalacademy.com
  150. 150. Lab Fabrication. Try- in considerations. Luting of porcelain laminate veneers. Finishing and polishing Summary. Conclusion References. www.indiandentalacademy.com
  151. 151. Mastique veneer system (L.D Caulk Company) 19 A kit containing several shades of composite resin, laminates. A large assortment of shapes and sizes of the laminates. www.indiandentalacademy.com
  152. 152. The clear , shell like laminates (0.4mm in thickness) are made of synthetic resin by a pressure and heat cured process. www.indiandentalacademy.com
  153. 153. www.indiandentalacademy.com
  154. 154. Veneer primer cleaner www.indiandentalacademy.com
  155. 155. Cerestore system: (Johnson and Johnson dental products)7 Shrink free ceramic crown. www.indiandentalacademy.com
  156. 156. This system uses a transfer molding technique to fabricate ceramic crowns directly on the master die with the excellent marginal fit. www.indiandentalacademy.com
  157. 157. www.indiandentalacademy.com
  158. 158. Ceramic is flowable at 160deg c and then transferred into the plaster mold by pressure. www.indiandentalacademy.com
  159. 159. www.indiandentalacademy.com
  160. 160. Why the ceramic donot shrink? Oxidation of silicone. The silicone resin used as a binder during transfer molding compensates for the shrinkage of the core material by conversion of siO to siO2 during firing from 160 degree C to 800 degree C. www.indiandentalacademy.com
  161. 161. Composition: Al oxide. MgO Glass frit. Kaolin clay. Silicone resin. (thermosetting, thermoplastic) www.indiandentalacademy.com
  162. 162. Difference between Castable and Pressable ceramics.18,4 Castable ceramics (Dicor) contains tetrasilicafluoroamina crystals. www.indiandentalacademy.com
  163. 163. After the glass casting core is recovered , the glass is sandblasted and the sprues are cut away. The glass is covered by a protective embedment material and heat treated to cause microscopic plate like crystals (mica) to grow within the glass matrix. This is known as ceramming.(1350 deg C for 10hrs) www.indiandentalacademy.com
  164. 164. www.indiandentalacademy.com
  165. 165. www.indiandentalacademy.com
  166. 166. www.indiandentalacademy.com
  167. 167. Creamming 1350 deg c for 10hrs. www.indiandentalacademy.com
  168. 168. Ceramming process results in: Increased strenght and toughness Resistance to abrasion and thermal shock. The material is less abrasive. www.indiandentalacademy.com
  169. 169. Whereas Pressable ceramics contain higher concentration of Lucite crystals that increase the resistance to crack propagation. www.indiandentalacademy.com
  170. 170. Castable Pressable Infiltrated. Machinable . Margin quality Good. Good- excellent Fair- good fair appearanc e. translucent Slightly translucent Opaque. Slightly translucent strenght Weak. Moderately strong Moderate- very strong Moderately strong Acid etchable Etchable. Etchable. Not indicated Etchable. www.indiandentalacademy.com
  171. 171. Tooth preparation.1,3,4,5  Objectives of tooth preparation: 1. To provide adequate space for the PLV buildup to prevent over contouring. 2. To allow efficient bonding with less acid- resistant enamel. 3. To create a definite finish line for the technician to fabricate restorations with superior marginal fitting. www.indiandentalacademy.com
  172. 172. 4. To provide adequate thickness for porcelian strenght. 5. To allow operator to adapt the veneers more easily to their correct positions. www.indiandentalacademy.com
  173. 173.  Usually tooth preparation can be divided into four parts: 1. Labial reduction 2. Interproximal extension. 3. Cervical margin placement. 4. Incisal preparation. www.indiandentalacademy.com
  174. 174. Labial reduction. The labial reduction of the maxillary teeth should be in the range of 0.3- 0.7mm. www.indiandentalacademy.com
  175. 175. Crispin & Hewlett www.indiandentalacademy.com
  176. 176. Careful depth control is necessary when an even thickness of the enamel is to be removed. Needed for natural convexities of the labial surfaces. www.indiandentalacademy.com
  177. 177. Nixon porcelain veneer kit II, Brasseler GmbH. www.indiandentalacademy.com
  178. 178. www.indiandentalacademy.com
  179. 179. LVS , Brasseler GmbH www.indiandentalacademy.com
  180. 180. www.indiandentalacademy.com
  181. 181. Lasco, Chatsworth, CA. www.indiandentalacademy.com
  182. 182. www.indiandentalacademy.com
  183. 183. Interproximal extension. To conceal the finish, the preparation should extend laterally to finish facial to the interproximal contact areas. If preparation extends on to the lingual side of the contact areas , then undercut zones are created in the cervical areas. www.indiandentalacademy.com
  184. 184. www.indiandentalacademy.com
  185. 185. www.indiandentalacademy.com
  186. 186. Sorensen etal.,(JPD 1992;67:16-22).  found that the mesial and distal proximal cervical margins of the porcelain veneers have more marginal discrepancies when compared with those of labial surface. www.indiandentalacademy.com
  187. 187. Margin placement. A well defined chamfer is usually recommended. www.indiandentalacademy.com
  188. 188. Subgingival margin. www.indiandentalacademy.com
  189. 189. Incisal reduction. GILMOUR AND J.S. GLYDE (BDJ 1988;9-14) CLASSIFIED THE PREPARATION INTO 4 TYPES www.indiandentalacademy.com
  190. 190. Window or intra enamel preparation with intact incisal enamel. www.indiandentalacademy.com
  191. 191. Feathered incisal preparation labially www.indiandentalacademy.com
  192. 192. Incisal edge preparation to form butt joint lingually. www.indiandentalacademy.com
  193. 193. Incisal edge preparation overlapping lingual surface. www.indiandentalacademy.com
  194. 194. HIGHTON R. etal JPD 1987:58;157-161 Did a photoelastic analysis- showed that incisal overlapping reduce stress in the veneer most effectively. www.indiandentalacademy.com
  195. 195. Graber etal suggested placement of palatal chamfer-results in increased veneer strength www.indiandentalacademy.com
  196. 196. Tooth preparation in special situations 4 Diastema closure. www.indiandentalacademy.com
  197. 197. Correct proximal preparation www.indiandentalacademy.com
  198. 198. Deficient proximal preparation. www.indiandentalacademy.com
  199. 199. Malpositioned teeth. www.indiandentalacademy.com
  200. 200. Facially tipped teeth. Desired contour. Facially tipped. www.indiandentalacademy.com
  201. 201. enameloplasty Desired contour Lingual deficiency www.indiandentalacademy.com
  202. 202. Original contour Space for veneer Lingual finish line www.indiandentalacademy.com
  203. 203. Post-operative view. www.indiandentalacademy.com
  204. 204. Gingival retraction.3 www.indiandentalacademy.com
  205. 205. www.indiandentalacademy.com
  206. 206. Impression making.4,5 Materials  Rubber base impression materials such as addition silicones or polyether. www.indiandentalacademy.com
  207. 207. Trays:  Custom made or stock full arch impression trays are used. www.indiandentalacademy.com
  208. 208. www.indiandentalacademy.com
  209. 209. Embrasure blockout www.indiandentalacademy.com
  210. 210. Inteproximal tear through margin. www.indiandentalacademy.com
  211. 211. Embrasure blockout. www.indiandentalacademy.com
  212. 212. Intact interproximal extension. www.indiandentalacademy.com
  213. 213. Shade selection.4,5,6 Because ceramic veneers are thin, color from the underlying tooth may alter the final veneer shade. Without prescribing the background of the tooth to be veneered it is difficult to select the shade of the veneer. www.indiandentalacademy.com
  214. 214. Shade of the prepared tooth. www.indiandentalacademy.com
  215. 215. Shade of the veneers www.indiandentalacademy.com
  216. 216. www.indiandentalacademy.com
  217. 217. Provisional restorations.3 Usually not necessary. In several clinical situations, provisionalization may be required. www.indiandentalacademy.com
  218. 218. If excessive reduction is done to align the tooth. To prevent supraeruption of the prepared tooth. If isolated teeth are prepared. High esthetic expectations. www.indiandentalacademy.com
  219. 219. Materials that can be used for provisional restorations: Acrylics.(SNAP (PARKEL), TEMPLUS (ELLMAN) ,JET (LANG) , DURCALAY (RELIANCE) Composites.( Revotec, Protemp Grant, Unifast L C) www.indiandentalacademy.com
  220. 220. Techniques : Direct technique.( acrylic, composites) Indirect technique. (acrylic, composites) www.indiandentalacademy.com
  221. 221. Direct technique ( acrylic resin). JPD 1989;2;4;139 www.indiandentalacademy.com
  222. 222. www.indiandentalacademy.com
  223. 223. www.indiandentalacademy.com
  224. 224. www.indiandentalacademy.com
  225. 225. BONDING OF PROVISIONAL RESTORATION Composites. Provisional Non- eugenol cements. www.indiandentalacademy.com
  226. 226. www.indiandentalacademy.com
  227. 227. D.A.ELLEDGE etal (JPD 1989;62;139-142) www.indiandentalacademy.com
  228. 228. Direct method using composites: JADA 1995;126:653-656. www.indiandentalacademy.com
  229. 229. www.indiandentalacademy.com
  230. 230. www.indiandentalacademy.com
  231. 231. Indirect method:(composites) 4 www.indiandentalacademy.com
  232. 232. www.indiandentalacademy.com
  233. 233. www.indiandentalacademy.com
  234. 234. Vacumm Formed provisional coverage4 www.indiandentalacademy.com
  235. 235. Position stabilisation using composite resin.4 www.indiandentalacademy.com
  236. 236. Porcelain laminate veneers. Compiled by Dr. Venkat Yenepoya Dental College(2004-07) www.indiandentalacademy.com
  237. 237. Table of contents. Introduction. Definitions. History. Review of literature. Indications. Contraindications. Case selection for PLV. www.indiandentalacademy.com
  238. 238. All ceramic systems used for laminate veneers. Tooth preparation. Impression making. Shade selection. Provisional restoration. www.indiandentalacademy.com
  239. 239. Lab communication. Lab Fabrication. Try- in considerations. Luting of porcelain laminate veneers. Finishing and polishing Summary. Conclusion References.www.indiandentalacademy.com
  240. 240. THINGS NEEDED FOR GOOD COMMUNICATION ARE.4 Laboratory prescription. Pretreatment models. Photographs of the teeth. Accurate impressions. www.indiandentalacademy.com
  241. 241. Lab prescription. A complete lab prescription consists of the following: 1. shade of the prepared teeth. 2. shade of the veneer: cervical, body, incisal. 3. appropriate interface space in die spacer coats. 4. veneer length, contacts, incisal shape. www.indiandentalacademy.com
  242. 242. Shade of the prepared tooth: www.indiandentalacademy.com
  243. 243. Shade gradation of the veneer: www.indiandentalacademy.com
  244. 244. Die spacer: 0.1 mm die spacer for two- shade shift. 0.2mm for profoundly stained teeth. www.indiandentalacademy.com
  245. 245. Translucency and opacity levels: Use of highly opaque porcelain gives non-vital look. Trend is to use translucent and highly characterized porcelain combined with increased die spacing. www.indiandentalacademy.com
  246. 246. Length, contacts and incisal shape: Veneer length relative to the prepared tooth. Contact zone (long or short) Tooth shape( tapered, square) Incisal shape (round, square, variable). www.indiandentalacademy.com
  247. 247. Communication with desired contour and tooth shape. www.indiandentalacademy.com
  248. 248. Lab fabrication.4,5 Platinum foil technique. Refractory die technique. www.indiandentalacademy.com
  249. 249. Platinum foil technique. Fabricate and use standard stone removable dies. Platinum foil can be quickly adapted to the die and fabrication started. Easy to measure the thickness of the veneer during fabrication. www.indiandentalacademy.com
  250. 250. Veneers can be tried on the prepared tooth prior to final glazing. www.indiandentalacademy.com
  251. 251. Disadvantages. Foil distortion possible. Difficult to assess actual color. Cost of foil. www.indiandentalacademy.com
  252. 252. Stone working model seperating dies www.indiandentalacademy.com
  253. 253. Die spacer www.indiandentalacademy.com
  254. 254. Platinum foil adapted on the die www.indiandentalacademy.com
  255. 255. www.indiandentalacademy.com
  256. 256. APPLY GINGIVAL CERAMICS www.indiandentalacademy.com
  257. 257. Apply dentine porcelain. www.indiandentalacademy.com
  258. 258. Cutting back mesial and distal surfaces for enamel porcelain www.indiandentalacademy.com
  259. 259. Application of enamel porcelain. www.indiandentalacademy.com
  260. 260. Blue stain for mesial and distal borders www.indiandentalacademy.com
  261. 261. Yellow stains on the incisal edges www.indiandentalacademy.com
  262. 262. Completed veneer www.indiandentalacademy.com
  263. 263. The veneers should be colored and glazed prior to foil removal. www.indiandentalacademy.com
  264. 264. Refractory die technique.  Advantages: 1. Overall accuracy and fit is generally better. 2. Easier technique. www.indiandentalacademy.com
  265. 265. Disadvantages: 1.Requires duplication of stone dies. 2.Divestment is required. 3.Fit must be verified on stone dies. 4.More difficult to control veneer thickness. www.indiandentalacademy.com
  266. 266. Refractory cast trimmed with stone base. www.indiandentalacademy.com
  267. 267. Dies are placed in the ceramic oven. www.indiandentalacademy.com
  268. 268. Cooled to room temperature and soaked in distilled water. www.indiandentalacademy.com
  269. 269. Application of the opaque layer. www.indiandentalacademy.com
  270. 270. Full contour ceramic buildup. www.indiandentalacademy.com
  271. 271. Contouring the veneers on the dies. www.indiandentalacademy.com
  272. 272. Disc used to cut the veneer away from the die. www.indiandentalacademy.com
  273. 273. Excess is removed from the stone. www.indiandentalacademy.com
  274. 274. Air abraded. www.indiandentalacademy.com
  275. 275. www.indiandentalacademy.com
  276. 276. Porcelain etching4,5 Hydrofluoric acid is applied to the fitting surface of the veneer. Provides good bonding strength by partly dissolving the glassy matrix of the porcelain. www.indiandentalacademy.com
  277. 277. Apply wax to the areas not etched www.indiandentalacademy.com
  278. 278. Internal bonding surface etched with hydrofluoric acid. www.indiandentalacademy.com
  279. 279. Properly etched- foggy appearance www.indiandentalacademy.com
  280. 280. Under etched- shiny appearance www.indiandentalacademy.com
  281. 281. Over etched www.indiandentalacademy.com
  282. 282. Swift B et al., (BDJ 1995; 179: 203-20) Do not place the etched veneers back on the master cast because it will contaminate their fitting surfaces and adversely affect bonding strength. www.indiandentalacademy.com
  283. 283. Trade names. Porcelain bonding kit (KHS polymer technologies). 6% HF. Porcelain etch (Cosmodent) 9.5% HF. Porcelain etchant (Bisco Inc) 4% HF. www.indiandentalacademy.com
  284. 284. Veneer try-in. 4,5,3 www.indiandentalacademy.com
  285. 285. Initial veneer inspection. www.indiandentalacademy.com
  286. 286. Veneer color. Veneer placed on white towel. www.indiandentalacademy.com
  287. 287. Chair side try- in. Three steps: 1.Dry try-in of individual veneer for marginal fit. 2.Wet try-in of all veneers collectively with a clear liquid medium, for proximal fit. 3.Resin cement try-in. www.indiandentalacademy.com
  288. 288. Dry try-in for marginal fit. Place the gingival retraction cord subgingivally to prevent sulcular moisture or bleeding from contaminating the surface. Try each veneer individually in dry to determine marginal accuracy. www.indiandentalacademy.com
  289. 289. Each veneer is placed dry on the prepared tooth to check marginal fit. www.indiandentalacademy.com
  290. 290. Wet try-in for proximal fit. Fill the internal etched surface with water soluble glycerin to minimize dislodgement if a vertical position is assumed. Try veneers on appropriate teeth in sequential manner. If the veneer resists seating remove the veneer and carefully reduce using microfine diamond bur. www.indiandentalacademy.com
  291. 291. www.indiandentalacademy.com
  292. 292. All veneers are seated to check the marginal fit. www.indiandentalacademy.com
  293. 293. Veneer try-in for color and color modifications. www.indiandentalacademy.com
  296. 296. For color evaluation veneers must be placed with the material that optically connects the veneer to tooth for correct color evaluation. Clear water soluble gel is used. www.indiandentalacademy.com
  297. 297. If the color is acceptable cementation using a clear acrylic is initiated. www.indiandentalacademy.com
  298. 298. If the try-in is lighter than a intended shade. Use resin cement that is darker or approximately same degree. www.indiandentalacademy.com
  299. 299. If it is darker than the intended shade Mix one part of light opaque resin cement with ten parts of light translucent resin cement. www.indiandentalacademy.com
  300. 300. If generalised polychromatic shade modification needed only for a portion of veneer . www.indiandentalacademy.com
  301. 301. High chroma composite tint on inner gingival surface. www.indiandentalacademy.com
  302. 302. Grey tint on the inner incisal third. www.indiandentalacademy.com
  303. 303. Veneer seated with right and left rocking motion to extrude cement laterally www.indiandentalacademy.com
  304. 304. Seating veneer from incisal to gingival forces all tints gingivally www.indiandentalacademy.com
  306. 306. Cementation and finishing. 4,5,3,1 Good moisture control is necessary. www.indiandentalacademy.com
  307. 307. Gingival retraction. 4 Gingival cords: •Retraction cord is of great help to prevent contamination from gingival crevice www.indiandentalacademy.com
  308. 308. Gingval cords come in different sizes: Ultrapak plain and ultrapak E (epinephrine impregnated) Knitted. # 00,#0,#1,#2. www.indiandentalacademy.com
  309. 309. Fischer’s Ultrapack packers - Small - Regular - Large. www.indiandentalacademy.com
  310. 310. GingiBraid: They are available in both plain and impregnated types. They are impregnated with 10% pottasium aluminium sulphate. They are braided. www.indiandentalacademy.com
  311. 311. Available in different sizes: 0(n) 0(a) 1(n) 1(a) www.indiandentalacademy.com
  312. 312. Chemical used: Al chloride, Al sulphate, ferric sulphate, epinephrine. www.indiandentalacademy.com
  313. 313. Gingival retraction instrument is Retracta-Gard. Bin angle, 0.5mm thick, 3mm wide, light and slender polished shank. www.indiandentalacademy.com
  314. 314. Inserting the retraction cord: www.indiandentalacademy.com
  315. 315. Gingigel. www.indiandentalacademy.com
  316. 316. Veneer preparation. Ultrasonically clean the veneer in acetone for 5 mins www.indiandentalacademy.com
  317. 317. Dry thoroughly and apply silane coupling agent www.indiandentalacademy.com
  318. 318. Apply a thin film of light cured dentin – enamel adhesive liner to the etched surface of the veneer. Donot light cure. Place veneers in light protected area. www.indiandentalacademy.com
  319. 319. Tooth preparation. www.indiandentalacademy.com
  320. 320. CLEAN TOOTH WITH PUMICE www.indiandentalacademy.com
  321. 321. Check interproximal contacts of the teeth using metal strips(0.0005’’) www.indiandentalacademy.com
  323. 323. METAL STRIP PLACED www.indiandentalacademy.com
  324. 324. LOADING VENEER WITH RESIN CEMENT www.indiandentalacademy.com
  325. 325. SEATING THE VENEER www.indiandentalacademy.com
  326. 326. VENEER CARRYING STICKS (GRAB IT-CHAMELEON DENTAL PRODUCTS)3 www.indiandentalacademy.com
  327. 327. EXCESS CEMENT www.indiandentalacademy.com
  328. 328. REMOVING EXCESS RESIN www.indiandentalacademy.com
  329. 329. REMOVING EXCESS CEMENT FROM LINGUAL MARGIN www.indiandentalacademy.com
  330. 330. VENEER TACKED BY LIGHT CURING A SMALL SEGMENT www.indiandentalacademy.com
  331. 331. 2-3mm tip www.indiandentalacademy.com
  332. 332. METAL STRIP DRAWN LINGUALLY www.indiandentalacademy.com
  333. 333. REMOVE ANY EXCESS LEFT www.indiandentalacademy.com
  334. 334. www.indiandentalacademy.com
  336. 336. FINISHING STRIPS- REMOVE INTERPROXIMAL EXCESS www.indiandentalacademy.com
  337. 337. ADJUST OCCLUSAL CONTACTS www.indiandentalacademy.com
  338. 338. POLISH USING CERAMIC POLISHING RUBBER CUPS www.indiandentalacademy.com
  339. 339. www.indiandentalacademy.com
  340. 340. Maintenance of porcelain veneers www.indiandentalacademy.com
  341. 341. Maintenance of porcelain veneers consists of periodic reexamination of the veneers as well as contiguous hard and soft tissue. Patient receptivity to oral hygiene instructions and post-treatment monitoring is optimal. www.indiandentalacademy.com
  342. 342. It is beneficial to contact patient within 30 days of initial placement. www.indiandentalacademy.com
  343. 343. The soft tissue should be examined. If the veneer margin has a porcelain ledge, the veneer is over contoured, porcelain surface has been roughened, or extraneous cement flash is still present, a localized gingivitis may persist. www.indiandentalacademy.com
  344. 344. The causative factors for any such gingivitis should be diagnosed and eliminated at this follow- up appointment by recontouring or polishing the porcelain. The patient should continue to be followed up at 2 weeks interval until gingival tissue is healthy. www.indiandentalacademy.com
  345. 345. If the repeated attempts to resolve a localized gingivitis fail , then the veneer should be removed and replaced. www.indiandentalacademy.com
  346. 346. All the veneer margins should be checked with a sharp explorer along the gingival, proximal and incisal margins. If any catch occurs a micro fine diamond bur and a 30 fluted carbide bur , following by porcelain polishing paste is used to eradicate it. www.indiandentalacademy.com
  347. 347. If any marginal void is detected , a small diamond bur should be used to make penetration into the void. The enamel surrounding the void is etched for 30 sec , and a polishable resin which matches the veneer is placed to repair the void. This resin patch should be highly polished. www.indiandentalacademy.com
  348. 348. Any Occlusal prematurities should be detected and adjusted. If any interferences present, they should be removed , and the veneer should be polished. www.indiandentalacademy.com
  349. 349. Dental hygienist should not polish the porcelain veneers with any form of pumice to avoid altering surface glaze and roughening the porcelain. If polishing is required , a silicon polishing wheel followed by a porcelain polishing paste should be used with the surface kept moist. www.indiandentalacademy.com
  350. 350. Scaling around the veneer should be performed as with the natural tooth. www.indiandentalacademy.com
  351. 351. The dental hygienist should not use acidulate fluoride solutions on any porcelain surface. This will effect the glaze and surface is roughened. www.indiandentalacademy.com
  352. 352. Repair of veneers. Porcelain fractures will occur ranging from minor cracks to bulk losses of the material. For minor cracks, the occlusion should be checked, adjustments made as required. www.indiandentalacademy.com
  353. 353. Minor intra porcelain cohesive failures may require recontouring and polishing of the damaged area. www.indiandentalacademy.com
  354. 354. Larger looses of porcelain , together with adhesive failures, will require repair of veneer with fine particle hybrid resin composite restoration, or its replacement. www.indiandentalacademy.com
  355. 355. Summary. www.indiandentalacademy.com
  356. 356. Conclusion. www.indiandentalacademy.com
  364. 364. 18. Science of dental materials- Anusavice. 19. Art and science of dentistry- Sturdvent. www.indiandentalacademy.com
  365. 365. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com