Dental veneer

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Dental VENEERS
Presented by: Dr Abhisek Guria
Dept. of Conservative Dentistry & Endodontics

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CONTENTS
 Introduction
 History
 Definition
 Laminates vs veneer
 Smile design
 Indications
 Contraindications
 Classification (sturdevant)
 Indirect method
 Direct method
 Partial veneer:
 Full veneer with window preparation
 Full veneer with incisal lapping preparation
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VENEERS
 Treatment planning
 Composite resin systems
 Premise indirect
 Sinfony
 Gc gradia
 Tescera atl
 Signum
 Ceramage shofu
 Anterior composite resin laminate veneers
 Prefabricated composite resin laminate veneers
 Componeers
 Edelweiss composite laminate veneers
 Porcelain laminate veneers
 Composition
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VENEERS
 Basic laboratory techniques
1. Platinum foil backing,
2. Refractory casts,
3. Direct castings,
4. Cad-cam machining
 Advantages
 Disadvantages
 Indications
 Contraindications
 Tooth Preparation
 Static Area Of Visibility Versus Dynamic Area Of Visibility
 Tooth Preparation For Porcelain Veneer
 Armamentarium
 Facial Reduction
 Proximal Reduction
 Magne & Douglas Classification
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VENEERS
 Incisal Reduction
 Lingual Reduction
 Gingival Finish Line
 Single-tooth provisionalization
 Multi-tooth provisionalization
 Laboratory communications
 Try in considerations
 Cementation
 Finishing and polishing
 No- prep veneers
 Lumineers
 Failures
 Esthetic failures
 Mechanical problems
 Adhesive problems
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VENEERS
 Failures Due to Internal or External Forces
 Color Change
 Aging
 Micro leakage
 Lack of Marginal Fit
 Incomplete Polymerization
 Biological Failures
 Improper Finishing
 Occlusal Failures
 Conclusion
 References
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Introduction
 A nice smile, that reflects self confidence and self esteem, is
an important part of the face beauty.
 The beauty of the teeth, that show when laughing, through
their
 - shape.
 - color.
 - Position and alignment.
is an essential part of the smile.
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History
 1930s: Charles Pincus- Thin porcelain veneers
 1968 - McCulloch …first described the use of castable glass-
ceramic facing.
 Horn and Calamia… reported first porcelain facing technique.
 2nd evolution- Preformed veneers/crowns
 1970s- introduction of visible light cured composites  direct
composite laminate veneers.
 Faunce described a one piece acrylic resin prefabricated veneer.
 1981- Ronk L. Sterling described a direct laboratory technique
for fabricating dental laminate restorations.
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Definitions
 A layer of tooth colored material that is applied to a
tooth to restore a localized or generalized defect and
intrinsic discoloration (Sturdevant)
 Constructing a veneer and bonding it to tooth
structure is referred to as laminating
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Laminates vs veneer
 Mayekar (2001)
 Laminate maintains colour. Usually requires no Tooth Prep.
 Veneer- change in colour, requires Prep. (endodontically
treated teeth and tetracycline stained teeth)
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Shape or form
 Masculine smile
 More closed and
 prominent incisal angles
 Feminine smile
 Rounded incisal angles,
 Open incisal and facial embrasures and
 softened facial line angles
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Sex, Personality and the Age (SPA)
Factor
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Lip line
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Mid-line
Ideally, the papilla between the maxillary central incisors
coincides with the mid-line of the face.
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Incisal Length
 To correct incisal wear, inadequate tooth display, or a
displeasing tooth or crown proportion.
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Incisal visibility
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Zenith Points
 The most apical points of the clinical crowns; which are the
height of contour.
 They are usually placed distally, when viewed from the
facial aspect.
 in the laterals, they are placed centrally.
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VENEERS
 When closing diastemas,
the zenith points should be
repositioned to avoid a
mesially tilted appearance
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VENEERS
 where the tooth needs to be shown longer or more
tapered at the gingival 1 /3rd, the zenith points can be
moved apically
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Gingival Levels and Harmony
 The tips of the papilla gradually follow a pattern in the
apical direction, when proceeding from the anterior
towards the posterior dentition, thus the volume of the
gingival embrasures is getting smaller.
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Tooth Axis
 In comparison to central incisors, the laterals exhibit a
more distal inclination towards the apex.
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Interdental Contact Areas (ICA)
and Points (ICP)
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Incisal Embrasures
 It is smallest and sharpest in the central incisors.
 posteriorly, the embrasures become larger and wider.
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Golden Proportion
 It is a mathematical theorem concerning the proportions of the
dentition. It is considered as the only mathematical tool for
determining dominance and proportion in the arrangement of
the maxillary teeth from the frontal view
 Lombardi was the first actually to apply this equation to
dentistry
 Levin developed the principles of visual perception and their
application to dental esthetics
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recurring esthetic dental (RED)
proportion
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Tooth Character
Surface Texture and Contour
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Illusions
 Certain conditions may alter the perception of teeth by
creating illusions in the oral environment
 1. Depth can be created with shadows.
 2. Prominence can be increased with light.
 3. Length can be emphasized with vertical lines.
 4. Width can be emphasized with horizontal lines.
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Indications - Marzouk
 Single or multiple discolored
teeth
 Presence of diastema
 Fractures
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VENEERS
 Teeth with abnormal shape and form-
peg laterals
 Lingual positioned teeth
 Enamel defects/ hypocalcification
 Improper surface texture
 multiple carious lesions
 Poor restoration
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VENEERS
 Decalcifications
 Malaligned teeth where orthodontics is
not sought or indicated
 Attrition / abrasion / erosion
 Aging
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Contraindications
 Teeth with defective enamel formation
insufficient crown material (E for bonding)
 Young permanent teeth
 Severe periodontal involvement
 severe crowding
 Poor oral hygiene
 Labial version
 Excessive interdental spacing
 Teeth exhibiting severe occlusal wear
patterns, due to Para-functional habits
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• Partial veneers
• Full veneers
Extent of tooth involved Type of materials used
• Directly applied composite veneers
• Processed composite veneers
• Porcelain or pressed ceramic veneer
MODE OF FABRICATION
Direct veneers
a) Direct partial veneers
b) Direct full veneers
Indirect veneers
a) Processed composites
b) Etched porcelain veneers
c) Pressed ceramic veneers
Classification (Sturdevant)

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I. Based on use of material:
1. Composite veneer
2. Porcelain veneer
II. Based on the fabrication technique:
I. Directly fabricated veneers:
Direct composite veneers
II. Indirectly fabricated veneer
a) Composite.
b) Etched porcelain
According to Marzouk

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Indirect method:
Composites
1) Microhybrid composite
2) Filled resins.
3) Prefabricated resin shells.
Porcelain:
Feldspathic porcelain
Castable glass ceramic
Heat pressed ceramic
CAD/CAM ceramic
Based on coverage of tooth.
1. Partial veneers: - localized defects
2. Full veneers: - generalized defects

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1) Conventional powder-slurry ceramic (feldspathic porcelain).
This type of porcelain is layered on the refractory die in the lab
2) Heat-pressed ceramic.
These products are melted at high temperatures and pressed into a
mould created using the lost-wax technique
(e.g., IPS Empress 1 and 2, OPC).
3) Machineable (CAD/CAM) ceramics
(e.g., CEREC, E4D).

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According to Preparation

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Full veneer with window preparation:
. Ben-Amar suggested a design that extends to
gingival crest and terminates at the facio -
incisal angle.
Recommended for most direct & indirect
method
Indications-
 to preserve functional lingual & incisal
surfaces of anterior teeth
 To prepare maxillary canines in patients
with canine guided occlusion
 In high occlusal stresses

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Advantages –
 Saves the functional lingual &
incisal surfaces of anterior teeth
 It does not extend subgingivally /
involve incisal edge
 ↓ the chances of wear of opposing teeth

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Feathered-edge preparation
 Boksman and colleagues and Garber recommended
 recommended for patients with normal overbite
 Disadvantages
 weak veneer, high risk of experiencing ceramic chipping,
and difficulty with seating of the veneers, marginal
discoloration and poor marginal adaptation
VENEERS

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Overlap incisal preparation
designs
a. Butt joint preparation
 Advantages
 masking of the otherwise noticeable incisal finish line,
 thicker ceramic and reinforcement of incisal edge, and
 positive seating of ceramic veneers,
 allow translucency of incisal edges and a more natural
appearance
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Garber advocated
Design extending subgingivally & includes all of
incisal surface.
Indications-
 When crown length has to be ↑
 When the incisal defect is severe & restoration
is necessary
 Where seating is accurate & more esthetic
demand
Advantages-
 Tooth preparation is within the Enamel , no temp
restoration is necessary
 Improves the esthetics along the incisal edges
b. Palatal chamfer preparation

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Literature
 Schmidt and colleagues reported that palatal chamfer
incisal preparation group had significantly higher failure
load than the butt joint incisal preparation group in both
nonworn and worn tooth samples.
 Jankar and colleagues reported the highest fracture load
with palatal chamfer incisal preparation design, followed
by butt joint and feathered-edge preparation design
VENEERS

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VENEERS
 da Costa and colleagues concluded that a palatal chamfer
incisal preparation design increased the risk of developing
ceramic fractures.
 An in vitro study by Bergoli and colleagues showed that
ceramic veneers with a feathered-edge preparation design
had significantly higher fracture load compared with a
palatal chamfer preparation design.
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VENEERS
 Zarone and colleagues comparing the window and the
palatal chamfer incisal preparation designs showed that
ceramic veneer with palatal chamfer incisal preparation
design had the highest stress tolerance under functional
loading, and the incisal preparation helped distribute the
stress throughout the surface of preparation without
overloading the incisal edge.
 Li and colleagues reported similar results when
comparing ceramic veneers with butt joint and palatal
chamfer incisal preparation designs.
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RESULTS:
Under the limitations of the available literature, the clinician preference is
the decisive factor for choosing the preparation design. Nonetheless, incisal
overlap preparation seems to have the most predictable outcome from all
the preparation designs.
CONCLUSION:
Porcelain veneers show excellent aesthetic results and predictable longevity
of the treatment, while composite veneers can be considered as a good
conservative option, but with less durability.

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Direct veneers area placed on small localized defects / intrinsic
discolorations which are surrounded by sound enamel
Indication - less no of teeth involved
- localized defects
- young permanent teeth
- diastema
Materials used - microfill, nanohybrid composite resins
Direct partial veneers

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Advantages – economic
- single visit
- useful in young pt & localized defects
- repairable
Disadvantages– more chair side time
- more labour
- tech sensitive
- operator skill required

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Finishing kit
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 Assessment of face, lip line, skin color
 Assessment of smile, gingival display
 Impression for study models/bite
registration record
 Diagnostic aids- mock ups, costs, computer
imaging, photographs, radiographs
 Oral prophylaxis, shade selection
 If defect extended to dentin – LA
 Isolation – rubber dam
Treatment planning (Single appointment)

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 Out line form – include solely by defect, &
all discolored areas
 Tooth ppn – 0.5 – 0.75mm - in pulpal
direcction
(coarse, elliptical, round diamond bur
with water coolant )
 Etching the tooth , bonding agent
 Opaque placement to mask dark
discoloration( optional)
 Composite Resin placement( microfilled )
 light curing
 Finishing & polishing

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Indications – diastema
- grossly stained & pitted
- gross enamel hypoplasia of anterior teeth
Advantages – less tech sensitive
- last longer
- effective for multiple veneers
Disadvantages – expensive
- require special tooth ppn
DIRECT COMPOSITE FULL VENEERS

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 Steps _ Reduction of tooth by coarse round end diamond bur-
0.5 – 0.75mm – mid facially, tapering down to a depth of about 0.2
– 0.5 mm along gingival margin
at proximal side the ppn should be facial to the contact point
 heavy chamfer at gingival crest
 In diastema- proximal ppns are extended from the facial onto the
mesial surface , terminating @ the mesio lingual line angle

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 Should it terminate short of free gingival crest ?
 At the level of gingival crest ?
 Apical to gingival crest ?
Depends on individual situation-
If the defect does not extended subgingivaly
- the margin should not extend subgingivaly
In case of if area is carious
defective restoration extend subgingivaly
dark discoloration
Location of gingival margin ?

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 Etching the tooth ,washing & drying followed by
bonding agent
 Resin Opaquing agents applied in thin layer to mask
dark tetracycline discoloration
 Composite Resin placement – starts from gingival 3rd-
incrementally, light curing
 Create proper physiological contour, contact point,
smooth surface
 Finishing & polishing

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COMPOSITE RESIN SYSTEMS
1. Premise Indirect (Kerr Corp.)
 low-wear, high-strength microhybrid
 Trimodal curing (light, heat, and pressure) achieves over 98% material
conversion
 COTE - is similar to natural dentin
 A reinforcing fiber material of woven polyethylene braids coated with a
reactive monomeric solution that allows the product to be bonded to a
resin based crown and FPD substructure by the application of heat.
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2. Sinfony (3M ESPE)
 Ultrafine particle hybrid composite resin
 contains two kinds of filler:
 macrofiller (strontium aluminum
borosilicate glass with a mean particle
diameter of 0.5 to 0.7 mm; 40% by wt.)
 microfiller (pyrogenic silica; 5% by wt.)
 addition of a special glass ionomer (5% by wt.)-
plaque accumulation is minimized.
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3. GC Gradia (GC America Inc.)
 light-cured high strength microhybrid
 couples a microfine ceramic/prepolymer
filler with a UDMA matrix to produce a
superior ceramic composite resin with
exceptionally high strength, wear resistance,
and superior polishability
 Oxygen also plays an important role in the
apparent translucency or opacity of the
polymerized resin restoration
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4. TESCERA ATL (Bisco, Inc.)
 Dual-cured microhybrid composite
 incremental layers are condensed with
pressure and then polymerized to prevent
delamination and keep the restoration
free of voids.
 Final polymerization occurs in an oxygen-
free environment to achieve a high-gloss–
free surface to reduce staining.
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5. Signum
 Glass-ceramic composite resin with microfine filler
particles
 for the requirements of metal-free restorations;
 High intrinsic durability (E-modulus)
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6. Ceramage Shofu
 zirconium silicate integrated indirect
restorative
 A progressive fine structure filling of
more than 73%, plus an organic
polymer matrix delivers superior
flexural strength, elasticity, and
excellent polishability.
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Tooth preparation for Indirect
composite veneers
 Clean the tooth and Select the desired shades of composite
 Prepare teeth by removing small amounts of enamel with a medium
grit flame or chamfer diamond bur.
 remove only 0.25 to 0.50 mm of enamel from the facial area and
none from the incisal area.
 If incisal reduction is necessary, remove 1 to 1.5 mm.
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VENEERS
 Make impression with a vinyl polysiloxane impression material.
Place a provisional restoration
 Pour stone casts
 Laminate veneers can be fabricated on the stone cast by using a
separating medium or on a flexible cast
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VENEERS
 fabricate and Remove the laminate veneers from the flexible cast.
 Contour and polish using 12- and 30-fluted finishing carbide
burs.
 Heat treat the laminate veneers in boiling water or a heat device,
for 10 minutes
 Acid etch with 10% HF gel for 30 seconds or lightly sandblast
with a microetcher or air abrasion unit
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VENEERS
 rinse, and dry
 etch the enamel
 Leave the tooth surface slightly moist for wet bonding.
 apply silane coupling agent to the internal surface
 coat the etched surfaces with a hydrophilic primer
 Paint a thin layer of bonding resin onto the internal surface of the laminate
veneers.
 Apply a luting composite resin to the internal surface of veneers.
 Place on the prepared tooth and remove excess resin with a brush dipped in
bonding agent and do finishing
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PREFABRICATED COMPOSITE
RESIN LAMINATE VENEERS

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Componeers
(Coltene Whaledent)
 polymerized, prefabricated composite resin enamel shells made
of a nanohybrid composite
 0.3 mm in thickness
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Edelweiss Composite Laminate Veneers
(Ultradent Products Inc.)
 Laser sintered- particles are fused together to provide a
high gloss, uniform surface, and a thermally tempered base.
 filler particle is between 0.02 and 0.03 mm
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Introduction
 Use of fused porcelain
 Silicate cements in 1908
 Acrylic resins in 1946
 In the late 1970s, direct and indirect laminate veneers
were introduced.
 In 1983, the porcelain-laminate veneer was introduced
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Indications
 1. Correcting diastemata
 2. Masking discolored or stained teeth
 3. Masking enamel defects
 4. Correcting malaligned or malformed teeth
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Contraindications
1. Patients who exhibit tooth wear as a result of bruxism
2. Short teeth
3. Teeth with insufficient or inadequate enamel for sufficient
retention (e.g., severe abrasion)
4. Existing large restorations or endodontically treated teeth
with little remaining tooth structure
5. Patients with oral habits causing excessive stress on the
restoration (e.g., nail biting, pencil biting)
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ADVANTAGES
 Excellent esthetics
 long-term durability.
 Marginal integrity
 Soft tissue compatibility
 Minimal tooth reduction
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DISADVANTAGES
 Cost.
 Fragility
 Lack of repairability
 Inability to trial cement the restoration.
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Dental ceramic or porcelain
 Porcelain is the most durable esthetic restorative material.
 It is impervious to oral fluids and is biologically compatible,
 Porcelain is a chemical mixture of metallic and non – metallic
elements which allow ionic and covalent bonding to occur.
 Dental Porcelain is based on silica Network (SiO2) and
Potash Feldspar (K2O.Al2O3.6SiO2) Or
Soda Feldspar CaNa2O.Al2O3.6SiO2) or
both
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COMPOSITION
Feldspar 60 – 80%  Basic Glass former
Kaolin 3 – 5%  Hydrated Aluminium Silicate,
Binder
Quartz 15 – 25%  Filler
Alumina 8 – 20%  Glass former and flux
Oxides of 9 – 15%  Flux
Na, K, & Ca pigments and opacifiers are added to control
properties.
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Materials available
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Which material to choose?
(a) Type I patients:
 facets are out of functional stresses and are just esthetic, and are
referred to as simple esthetic facets; use feldspathic ceramics.
(b) Type II patients:
 in these cases the facets are exposed to functional loading, and
are referred to as functional esthetic facets, this cases needs high
flexural strength; use feldspath reinforced with leucite or lithium.
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BASIC LABORATORY TECHNIQUEs
 Porcelain-laminate veneers can be fabricated by the
laboratory in one of four ways:
1. platinum foil backing,
2. refractory casts,
3. direct castings,
4. CAD-CAM machining
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Platinum Foil Backing
To construct the all-porcelain crown.
 layer of platinum foil is placed on the die.
 The porcelain is layered on the foil
 Before try-in, the foil is removed and etched.
Advantages-
 Repeated removal
 easier access to the proximal margins
 foil creates a space for opaquers and tinting agents.
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Refractory Casts
 restoration is fired directly on a refractory die.
 Advantage- tight contact
 Disadvantages- no repetition, less room for coloring agents
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Direct Castings.
 Cast ceramic restorations are fabricated using the “lost
wax” technique.
 eliminates the need for multiple firings
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CAD/CAM Machining
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Shade selection
 Tooth color has intimate relation with the color of the eyes,
skin, and hair. All of these elements have the same
embryonic origin.
Shade selection has three element;
 Hue (color),
 chroma (saturation of color) and
 Value (lightness and darkness).
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How to match a shade
 Pt. should have neutral color clothes and remove the lip
stick.
 Clean the teeth and have Pts mouth at the dentist’s eye level.
 Use the canine as a reference for shade because of the
highest chroma of the dominant hue of the teeth.“
 If unable to precisely match the shade, select a shade of
lower chroma and higher value.
 Obtain value levels by squinting.
 Shade comparisons should be performed at 5 second
intervals
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VENEERS
 The final shade of the veneers
depends on;
 The color,( hue,
chroma, and value.)
 Opacity and thickness
of the porcelain.
 Underlying tooth
shade.
 Color and thickness of
the luting composite.
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TOOTH PREPARATION
 depends largely on the degree of desired color alteration.
 This consideration particularly influences the location of
the interproximal and gingival finish lines.
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Static Area of Visibility Versus
Dynamic Area of Visibility
 Static area of visibility - The entire facial tooth surface,
including the gingival area and the area immediately facial
to the contact area with the adjacent tooth (the facial
embrasure), is visible if the available light and the
perspective of the viewer are optimal.
 The dynamic area of visibility of the facial embrasure is
partially a function of viewing perspective. It is particularly
influenced, however, by shadows cast from surrounding
structures
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 The dynamic area of
visibility (the
triangular area) of the
facial embrasure is
influenced by the
depth of the
embrasure space and
by the shadow cast by
surrounding
structures including
the tooth itself.
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a. Minimal or No Color Change
Proximal Finishing Lines.
 A proximal chamfer finishing line is
preferred except when diastemata
are present.
 Proximal areas adjacent to
diastemata should receive a feather-
edged finishing line
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Proximal Contact Area.
 When the shade difference between the tooth (after
preparation) and the desired definitive restoration is
minimal, proximal chamfer finish lines are placed slightly
facial (approximately 0.2 mm) to the contact areas.
Disadvantage
 eventual staining at the tooth-restoration interface.
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 interproximal tooth structure, which is immediately
gingival to the contact area
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Proximal Subcontact Area.

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Gingival Finishing Lines
 A chamfer is preferred for all gingival finishing lines.
 impressions are easier to make
 likelihood that restoration margins will end on enamel.
 Depends upon clinical crown visibility during smile also
 When entire crown is displayed- 0.1mm below marginal
gingiva
 In recession- extended deeper subgingivally as long as the
biologic width is not violated
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Incisal Preparation.
 should ideally provide for 1 mm of
porcelain thickness.
 A butt joint finishing line provides for
the proper thickness of porcelain at the
margin to prevent restoration fracture.
 The finishing line should slope slightly
gingivally (approximately 750 from the
facial).
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 Facial Depth Reduction.
 A facial reduction of approximately 0.5 to 0.7 mm is
sufficient for most maxillary teeth
 0.3 mm for smaller teeth, such as mandibular incisors
 The entire finishing line should ideally remain in enamel.
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b. Major Color Change
 extension of the interproximal finishing line into the
contact area to a depth of approximately one-half the
labiolingual dimension of the contact area
 finishing line can be extended 1 mm subgingivally
 preparation depth may be increased
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TOOTH PREPARATION FOR
PORCELAIN VENEER
 The preparation is minimal and limited to the enamel only
 Usually an incisal laping design is used
 Steps….
 Facial reduction
 Proximal reduction
 Incisal reduction
 Lingual reduction
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ARMAMENTARIUM
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Veneer preparation kit
Depth cutters
Round end tapered
Torpedo bur

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a. FACIAL REDUCTION
Depth orientation grooves……
 Using depth cutter wheel is penetrated until the shaft flushes with
the tooth structure…which produces the grooves of 0.3mm in the
gingival half.
 Extend these grooves from mesial to distal
Gross facial reduction:
this is done to remove the remaining tooth
structure between the grooves using a round
tapered diamond bur and a chamfer finish line
is established at the level of gingiva.
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 The three depth cuts are equally deep.
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b. PROXIMAL REDUCTION
 It is an extension of facial preparation
 Using a round end tapered diamond bur
 The reduction should extend into the contact area, but it should
stop just short of breaking the contact .
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MAGNE & DOUGLAS CLASSIFICATION
Three type:
a) Short wrapping –
The veneer to extend only to the facial
margin of the tooth.
b) Medium wrapping –
the veneer that extends in to
the bulk of the mesial or distal
marginal ridge by penetrating
50% of the interdental area.
c) long wrapping -
the veneer which covers the
entire interdental area
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c. INCISAL REDUCTION
 The multiple wheel diamond
bur is used to make 0.5m deep
orientation grooves in the
incisal edge.
 The tooth structure between
the grooves is removed with a
round tapered diamond bur.
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d. LINGUAL REDUCTION
 Create the lingual finish line using a round end
tapered diamond bur.
 Chamfer is 0.5mm deep
 It should be 1/4th the way down the lingual surface,
preferably 1.0mm from the centric contact,
connecting two proximal finish lines.
 Placement of the lingual finish line for laminate
veneer will depend on…
 Thickness of tooth
 patient’s occlusion
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Gingival finish line
 The finish line of the preparation could end gingivally
or supragingivally, approximately 0.5 mm incisal to
CEJ
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Finishing the preparation
 The final step in the prepn is the production of a smooth
enamel surface, achieved with fine diamond bur carried
across the enamel with a light sweeping motion,
followed by polishing with small diameter, waterproof,
flexible discs.
 The discs are also used to round off sharp angles left
in the preparation.
 All undercuts and unsupported enamel in relation to
this path must be removed.
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12 fluted tungsten carbide bur 30- micron round end tapered finishing bur
¾-inch fine garnet disc Enhance point used for final finishing

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Final check and adjustments before impressions:
 Margins
 Gingival chamfer
 Occlusion
 Unless there is 0.5 mm or more supra gingival margin, thin braided
retraction cord should be placed beneath the gingival crest.
Dentin considerations:
 If during the course of tooth prepn an “island” of dentin is exposed
but the chamber margin remains in enamel, the exposed dentin
should be sealed with two thin coats of a dentin bonding adhesive
cured independently

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Temporization
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Provisional restorations can
be carefully removed with a
curette or hemostat.

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LABORATORY COMMUNICATIONS
Natural Versus Idealized Artificial Appearance
 Natural teeth are polychromatic and characterized.
 Canines are usually slightly lower in value or higher in
chroma than incisors and premolars
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Shade
 Include in the laboratory prescription both the shade of the
tooth after tooth reduction (“stump” shade) and the
desired definitive restoration shade.
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Texturing
 Texturing scatters reflected light and produces a more
natural appearance
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Try in considerations
 Inspect for cracks and imperfections.
 Place the veneers on the cast and verify appropriate fit
individually and collectively
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VENEERS
 Clean the prepared teeth with flour of pumice on a
prophylaxis cup
 Rinse thoroughly with water and leave wet.
 Moisten the teeth and the internal surfaces of the porcelain
laminate veneers with water.
 Place the veneers on the teeth and evaluate for proper fit
and color
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Shade verification
A. If the shade is correct:
 Verify that untinted luting resin will be acceptable by
placing untinted water-soluble try-in paste or the actual
resin luting cement into the internal surface
B. If the shade must be altered:
 Place the appropriate shade of water-soluble try-in paste
or the actual resin luting cement and place simultaneously
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CEMENTATION
Acid Etching
 HF on its own or together with the sand blasting will
enhance the micro retention
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PLV surface after it has been etched

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 If the etched surface of the PLV is contaminated with saliva,
the surface should be restored with a 15 second
application of 37% phosphoric acid
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Ultrasonic Cleaning
 in 95% alcohol for 4 minutes, or acetone or distilled water
 some have observed no significant differences in surface
morphology and bond strength between the HF etched
feldspathic porcelain and that without ultrasonic cleaning.
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Silane Application
 The silane-coupling agent is the second component of the
classic conditioning methods for ceramic restoration
 high wettability and its chemical contribution to adhesion
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 a chemical link between the bonding composite and the
ceramic,
 The silane group bonds to the hydrolyzed silicone dioxide,
copolymerising with the adhesive resin
 Applied and kept for 1 min
 by blowing the air parallel to and slightly above the veneer
and thus allowing the solvent to evaporate completely
 When the silane-coated porcelain is heated to 100°C it
results in bond strength double that of the porcelain where
no heat was used.
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Adhesive Application
 Tooth surface is etched and rinsed
 Adhesive applied on tooth surface and veneer
 should not be light cured.
 luting agent is placed Inside the veneer
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 Place matrix strips between the first teeth to be restored
and the adjacent teeth
 A light-curing luting composite Is preferred for
cementation of porcelain veneers
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 insert the veneer starting from the incisal edge, and
progressively pushing the veneer towards the gingivoapical
direction
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 Tac cure for 2 sec
 To avoid the development of an oxygen-inhibited layer at
the margins, an oxygen inhibition material, such as deox
(Ultradent) or glycerin, should be applied priorto the final
polymerization
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FINISHING AND POLISHING
 Carefully finish the facial
margins with the finishing
diamond
 Finish the lingual areas
with a fine “football-
shaped” diamond
 Evaluate the occlusion
with articulating paper in
both centric occlusion and
in all eccentric excursion
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 Finish and polish the proximal areas with interproximal
abrasive strips
 Polish with a diamond polishing paste on a prophylaxis cup
using intermittent pressure
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Instructions to patient
Do’s
 Use a soft toothbrush with rounded bristles, and floss as you do with
natural teeth.
 Use a less abrasive toothpaste and one that is not highly fluoridated.
 Use a soft acrylic mouth guard when involved in any form of contact sport.
 Ensure routine cleaning.
Don’ts
 Avoid food or drinks that may contain coloring.
 Do not use alcohol and some medicated mouthwashes because they have
the potential to affect the resin bonding material during the early phase
(the first 48 hours).
 Avoid hard foods, chewing on ice, eating ribs and biting hard
confectionaries and candy.
 Avoid extremes in temperature.
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No- Prep veneers
 Esthetic results are variable.
 To avoid tooth sensitivity and pulpal
death, tooth prepn made in enamel
whenever possible.
 Flattening of prominent cervical
contours must be done to avoid over
contouring of the veneer.
 More optimum esthetic potential when
teeth are prepd with a light chamfer
especially at the gingival margin to
prevent over contouring in that region
BULKY APPEARANCE

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LUMINEERS
 Are thin pieces of porcelain or plastic cemented over the front of
teeth to change the colour or shape.
 Cerinate® Porcelain is the strongest Lucite-reinforced ceramic
 made as thin as a contact lens (0.2 to 0.3mm)
Indicated - to teeth with uneven surfaces
are chipped,
discolored,
oddly shaped,
unevenly spaced or
crooked.

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TYPES OF PLACEMENT LUMINEERS
The LUMINEERS™ No-Prep Technique
• allows LUMINEERS to be placed over the existing teeth without the
removal of any form of tooth structure.
•
• Therefore LA and temporaries are not required.
• The majority of patients fit this technique.
• It is a proven fact that bonding enamel to
porcelain is a solid, secure bond compared
to bonding dentin and porcelain. LUMINEERS™ BY CERINATE®
No sensitive tooth removal
required—only 0.3 mm–0.5 mm
added to the enamel

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Bonding Lumineers to enamel or dentin surface
PROCEDURAL STEPS
Polishing
Porcelain laminate
polishing paste & water

147
Refresh the enamel Interdental metal strips
Paint on Dental dam

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Etching teeth for 20 sec
(Etch N Seal)
BONDING (TENURE A & B)

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TRY IN OF LUMINEERS
Ultra bond try in phase- non setting non
aqueous paste
Hold a mirror approximately 16 inches away from the patient’s
Face and let them examine their smile.

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Prime Bonding on lumineers Ultra Bond Plus on Lumineers

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Insert the lumineer tray
Remove excess Ultra-Bond with a soft brush or with Dab-Eze® sponges.

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Cure lumineers through lumi tray exposing each surface for 5
seconds with a Sapphire Plasma Arc Curing Light fitted with a 9 mm
tip.

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Clean up & Open interdental spaces

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• Check occlusion and polish
• Check the interproximal surfaces with dental floss
for smoothness.
• Polish the new smile with Porcelain Laminate
Polishing Paste.

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Vivaneers
Dura thin veneersGlide well laboratories

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Failures
1. Esthetic Failures
2. Mechanical Problems
3. Adhesive Problems
4. Failures Due to Internal or External Forces
5. Color Change
6. Aging
7. Micro leakage
8. Lack of Marginal Fit
9. Incomplete Polymerization
10. Biological Failures
11. Improper Finishing
12. Occlusal Failures
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Esthetic failure
 Failure in smile design
 Incorrect tooth preparation
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 Wrong case selection
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 Lack of communication with the patient and the lab
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Mechanical Problems
 Fracture of PLV
 Adhesive failure on the tooth-luting
resin interface
 Failure on Porcelain-luting resin
interface
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Failures Due to Internal or
External Forces
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Adhesive or cohesive failure
 Because of under or over preparation
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Too-thick die spacer
 If the thickness of the luting resin is thicker than 1 /3rd
of the PLV thickness, debonding or fractures are bound
to occur
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Color Change
Luting resin
 Stump shade transfer and a brief explanation of the PLV
color, texture and form should be supported with pictures,
Polaroid photographs and slides
 If a colored luting resin Is to be used, then the cervical
margins have to be prepared subgingivally,
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Glazing and Polishing
 Any correction should be done in try in stage
 After glazing if its done it is never like lab glazed
 Aging
 Affect the longer- term color of the PLV.
 Ultra-thin veneers that are bonded with a translucent
luting resin will darken in color ten to 15 years after the
operation
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Discoloration due to aging. Since the PLVs on teeth #12(7) and #21(9) were built
up on an opaque core, they are not affected with this intrinsic color shift,
displaying a shade difference with the adjacent PLVs 10 years postoperatively.
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Microleakage
 Unfortunately, microleakage can only be detected after the
PLV bonding is complete and so the only solution to correct
this problem Is to replace the PLV
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Provisionals
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 Microleakage due to Lack of Marginal Fit
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Incomplete Polymerization
Polymerization of the luting resin is one of the crucial steps of PLV bonding.
In order to eliminate the oxygen-inhibited layer formation on all the margins, oxygen-
inhibiting agents (e.g. Deox, Ultradent) should definitely be applied, and not only limited to
the gingival margin but also to the interproximal, palatinal and incisal margins as well.
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Biologic Failures
 A periodontal and esthetic failure.
 Due to incorrect treatment planning, the gingival asymmetries have
not been taken into consideration, creating an esthetic failure.
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 If the Intercrestal bone is unnecessarily removed, and the
interdental contact areas are kept high towards the apical,
 the gingival architecture will lose its eye-pleasing undulations,
displaying an unacceptable esthetic failure.
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Occlusal Failures
 more common when attempting to lengthen the crown
heights in patients who exhibit bruxing and grinding habits
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Special consideration
Patient education
 It is surprising that the majority of patients have no
understanding of the esthetic asymmetries or conditions that
they have been living with for years.
Bleaching the Teeth
 The reason for the discoloration means that the root canal is
retreated
 Internal or external bleaching is performed
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Earbow Transfer
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Esthetic Orientation
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Reverse Color Gradation
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In presence of restoration or
caries
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Orientation of bur
(a, b) cervical, (c, d) gingivo-proximal,
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reductions are further checked with the help of the silicone
index.
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(a, b) Now it is time to incorporate the existing fillings, cavities or
deficiencies into the preparation,
(c) First, the fillings must be removed,
(d, e) Then the preparation should be extended to the palatinal as
much as necessary, paying close attention not to end up in the
palatinal concavity, especially on centrals and laterals.
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Before and after
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CONCLUSION
 The objective of cosmetic dentistry must be to provide
the maximum improvement in esthetic with the minimum
trauma to the dentition.
 Proper case selection, shade selection, contour must be
taken into consideration

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REFERENCES
1. The art and science of porcelain laminate veneers- Galip Gurel
2. Sturdevants Art and Science of Operative Dentistry Vth edition.
3. Shillingburg HT, Fundamental of Fixed Prosthodontics. III rd
edition.
4. Operative dentisry – MODERN THOERY & PRACTCE –Morzouk
5. Text book of operative dentistry -Vimal sikri

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