history, classification, types of veneers, indications and contraindications, working procedure, preparation, ipmpression taking for veneers, surface treatment and cementation, veneers vs crowns

1. VENEERS

2. INTRODUCTION
In dentistry, a veneer is a thin layer of material placed over a tooth. It is normally used to improve the smile of
a patient or to protect a tooth’s surface. The two main types are normally used, them being composite and
porcelain veneers.
The latter are a very popular tool amongst clinics in recent years. They can be used to restore a tooth that has
been fractured or discolored. Also, some patients use them in multiple teeth to replicate the smile of famous
people. Others may have malpositioned teeth that appear crooked or have worn away the edges with
constant grinding.
https://www.youtube.com/watch?v=lufZyqPe5sY

3. DEFINITION
• Porcelain veneers are thin-bonded ceramic prosthetics that restore the facial surface and
part of the proximal
surfaces of anterior teeth that require esthetic treatment.
• They typically consist of thin shells of porcelain, the fitted surface of which has been etched
with hydrofluoric acid and coated with a silane coupling agent.
• Using a resinbased cement, the veneer is bonded to enamel that has been prepared with a
phosphoric acid etchant.
• Due to their high esthetic appeal, as well as their proven biocompatibility and long-term
predictability, porcelain veneers have become a reliable restorative procedure for the
treatment of teeth in the front area of the mouth.

4. HISTORY-PORCELAIN VENEERS WERE INTRODUCED
TO THE PROFESSION BY JOHN CALAMIA IN THE
EARLY 1980S.
• Their development was one of several innovations and outcomes that followed the discovery of
acidetching and bonding to enamel that was first reported by Michael Buonocore in the 1950s.
• Resin composite formulations based on bisphenol A-glycidyl methacrylate (BisGMA) were introduced
to the profession by Rafael Bowen in the early 1960s.
• These resulted in composite restorations with superior physical and mechanical properties, leading to
enhanced clinical performance.
• Following the success of these resin-based restorative composites, resin cements based on Bis-GMA
resin were introduced to the profession in the late 1970s.
• This meant that 3 crucial elements for the development of the porcelain veneer technique had been
realized:
1) the ability to acid-etch enamel to produce a microscopically rough surface that is receptive to
bonding;
2) the ability to acid-etch the fitted Surface of a feldspathic porcelain veneer with hydrofluoric acid to
create a microscopically rough surface that is also receptive to bonding to the resin;
3) and the availability of a resin cement that can be used for cementing porcelain veneers to enamel.

5. CLASSIFICATIONLabial Surface Coverage:
a) No incisal involvement
b) Feathered incisal edge
c) Incisal overlap
Interproximal preparations:
a) No contact point involvement
b) Contact point level
c) Passed contact point
Methods of production:
a) Indirect veneers
b) Direct veneers
Materials:
a) Ceramic
b) Lithium disilicate (very thin and relatively very strong porcelain)
c) Da Vinci (Very thin porcelain)
d) Mac (High resistance to stains and relatively strong)
e) Acrylic (No longer in use for quality work)
f) Composite
g) Nano Ceramic

6. TYPES OF VENEERS
Types of veneers depend on the material from which they were made. Currently on the
market we can find acrylic, composite and porcelain veneers.
• Acrylic veneers are made of an artificial material, which is the acrylic polymer. They are not
as durable and should only be used as temporary replacements.
• Composite and porcelain veneers are best to ensure a beautiful smile for a long time.
• Composite veneers are made of a material similar to the one used to fill cavities. They are
not as aesthetically pleasing as porcelain veneers, but they cost less. Composite veneers last
between 2 and 5 years.
• Porcelain veneers provide the best aesthetic effect and the greatest durability. They reflect
light rays just like real teeth, making them virtually unrecognisable as implants. High
resistance to abrasion, discolouration and the sticking of plaque means that after the
treatment we will enjoy a beautiful smile for up to 10 years.

7. VENEERS ARE ROUTINELY USED TO FIX:
Dental malposition, allowing the
patient to give an illusion of
straight teeth when an
orthodontic treatment isn’t
required.
Spaces between front teeth. Malformations in enamel.
Stained teeth
Fractures that can’t be
reconstructed with other methods
but don’t require dental crowns.
Malocclusions.

8. INDICATIONS FOR PORCELAIN
VENEERS
• Porcelain veneers are ideal for the treatment of discolored vital anterior teeth that do
not respond well to bleaching.
• This includes moderate discoloration caused by tetracycline staining, excessive fluoride
uptake, aging, and amelogenesis imperfecta.
• Enamel hypocalcification and fractures can also be corrected with porcelain veneers.
• They are also useful for closing moderate spacing between anterior teeth and to treat
congenital tooth malformation.
• When there is a need to lengthen or reshape maxillary anterior teeth, porcelain
veneers provide a conservative treatment option

9. CONTRAINDICATIONS FOR
PORCELAIN VENEERS
• In contrast, endodontically-treated anterior teeth that are structurally compromised are
not suitable candidates for porcelain veneers, as they need the bracing provided by
full-coverage crowns to maintain their integrity.
• Heavily-restored teeth with inadequate enamel are not good candidates either, as
enamel is the main source of retention for porcelain veneers.
• Other precluding conditions are dentition lacking posterior support, poor oral hygiene
and existing parafunctional activity, such as bruxism. Magne et al. reported that
success rates for porcelain veneers drop to 60% in patients with bruxism activity;
however, this percentage was similar to that obtained for metal-ceramic crowns used
in the same situation.

10. indications Contraindications
Dental malposition, allowing the patient to give
an illusion of straight teeth when an
treatment isn’t required
Insufficient tooth substrate (enamel for
Spaces between front teeth. Labial version
Malformations in enamel. Excessive interdental spacing
Stained teeth Poor oral hygiene or caries
Fractures that can’t be reconstructed with other
methods but don’t require dental crowns.
Parafunctional habits (clenching, bruxism)
Malocclusions. Moderate to severe malposition or crowding

11. WORKING PROCEDURE
• At the first appointment, the dentist will discuss the pros and cons of veneers, answer
all questions and concerns, as well as carry out a dental examination and pre-qualify
the patient for the right treatment. With the help of special diagnostic models(wax-up),
the patient will be able to see approximately what the final result will look like. Before
implanting veneers, it is necessary to treat any cavities, remove plaque and tartar.
• Implanting veneers is a multi-stage process that requires several visits to the dentist. At
the first visit, the doctor takes impressions needed to prepare the implants. The teeth
are then polished with diamond stones to ensure the veneers will stick to the tooth
surface. To avoid unnecessary pain, local anaesthesia is administered. Patients leave
the office with temporary veneers that allow them to comfortably wait several days for
the final product.

12. WORKING PROCEDURE
• The veneers are implanted during the next visit. Temporary veneers are removed, the
contact surface of the implant with the tooth enamel is once again cleaned, and finally,
using special composite cements, the veneer is placed on the tooth.
• Only thing left is to ensure a normal bite and provide recommendations to the
patients. After this procedure, oral hygiene doesn’t differ significantly from caring for
natural teeth. There are no contraindications to brushing, flossing or using mouthwash.
An appointment for a follow-up visit is also set.
• After leaving the dentist chair, patient can enjoy a new, bright white smile.

13. WORKING PROCEDURE- VIDEO
https://www.youtube.com/watch?v=ukvJSiHxwxE

14. PREPARATION
• Porcelain veneer preparation is characterized by minimal removal of the tooth
structure. Ideally, porcelain veneer preparation should be confined to enamel in terms
of the periphery and depth.
• For maxillary anterior teeth, typical preparation involves the whole facial (labial) surface
to a depth of approx. 0.3 mm. In some cases, when there is a need to lengthen the
teeth or close interproximal spaces, an incisal and/or proximal wrap-around is
indicated. However, the key for proper retention of porcelain veneers is to keep the
preparation within the enamel structure. This will ensure superior bonding and will
allow avoiding the potential for postoperative sensitivity, which may happen if the
dentin is involved in the preparation.
• The finish line of the preparation is typically of the feather-edge type, considering the
minimal amount of enamel removed. Gingivally, it terminates at the gingival margin.
An incisal overlap is performed only when needed. It can either be extended as a
palatal chamfer or merely as a horizontal incisal reduction (a butt joint).

15. TYPES OF VENEER PREPARATIONS
There are four basic preparation designs for porcelain laminate veneers:
a) Window
b) Feather
c) Bevel
d) Incisal Overlap

16. IMPRESSION-TAKING FOR PORCELAIN
VENEERS
• A vinyl poly-siloxane-based impression material is typically used in a custom or stock
tray for veneer impression preparation.
• The retraction cord is positioned to expose the finish line.
• For computer-aided-designed and computer-aided-manufactured (CAD-CAM)
veneers, a digital impression is made with an appropriate scanner
https://www.youtube.com/watch?v=N0nirfT8p9I&ab_chan
nel=DrAndreReis
https://www.youtube.com/watch?v=5X_ujslvnRk&ab_chan
nel=DentalMinutewithStevenT.Cutbirth%2CDDS

17. CURRENT VENEER TECHNOLOGIES
Lumineers
Smile
Infinity®

18. TYPES OF PORCELAIN USED FOR
PORCELAIN VENEER FABRICATION
• Traditionally, veneers are fabricated using the manual layering technique from
feldspathic porcelain. This necessitates the use of refractory dyes to support the
condensed layers of the porcelain slurry. This technique permits the use of layers with
multiple levels of opacity, resulting in optimum esthetics. However, the process is
technique-sensitive, and manual mixing and layering of the porcelain may result in the
incorporation of small voids. These voids may cause crack lines or even a fracture to
occur over time.
• Alternatively, pressed porcelain has been used for the fabrication of veneers.The main
advantages of pressed porcelain are that the resulting veneers have a high level of
accuracy and minimal internal structural defects. Recently, CAD-CAM veneers from
glass-ceramic blocks have become available, and their utilization is on the rise. While
such veneers are significantly stronger than feldspathic porcelain ones, the color of
many of the blocks available is of single opacity.

19. SURFACE TREATMENT
AND CEMENTATION
• Acid etching of the fitted surface with hydrofluoric acid has become the standard
procedure to render the fitted surface microscopically rough.
• A silane coupling agent is applied to the etched surface to enhance bonding to the resin
cement.
• For an optimal ceramic–cement bond, sandblasting the ceramic surfaces with aluminium
oxide particles prior to acid-etching with hydrofluoric acid is recommended.
• Silane facilitates the adhesion between the inorganic substrate (porcelain) and the organic
polymers (resin cement) by increasing porcelain wettability and interlocking.
• Moreover, silane is a bifunctional molecule that chemically bonds to the hydrolyzed silicon
dioxide of the ceramic surface on one side and to the methacrylate group of the resin
cement on the other side.

20. SURFACE TREATMENT
AND CEMENTATION
The attachment of porcelain veneers to the teeth depends on bonding to enamel. An
appropriate resin cement is used to achieve this, and to help seal the margins of the
veneers, reinforcing the ceramic structure and providing an opportunity to modify the
color of the restoration if needed.
A light-polymerized resin cement is the only type of resin cement that can be used with
porcelain veneers. This is because self-polymerized and dual-polymerized resin cements
can darken with time, leading undesirable changes in the color of the veneer.

21. TRY IN AND SEATING
• As porcelain veneers are very thin, they must be handled carefully during the try-in and
subsequent cementation.
• Excessive finger pressure may cause the veneer to fracture, particularly when a high-
viscosity resin cement is used.
• Low film thickness is desirable for optimum adaptation to the tooth substrate.
• Seating the restorations with ultrasonic energy has been recommended.
• The vibrations, based on the oscillation principles of the ultrasonic device, are helpful
in altering the viscosity of the cement, which settles the restoration into place,
spreading the luting agent under the restoration and minimizing the potential for
future leakage.

22. GINGIVAL TISSUE RESPONSE
TO PORCELAIN VENEERS
• Porcelain veneers are typically associated with favorable gingival tissue response due
to the location of their gingival margin, which is typically at the gumline or slightly
supragingival to the tissues.
• A proper emergence profile contributes to lowering the incidence of plaque retention,
thus helping in the maintenance of periodontal health.
• The periodontal response to porcelain veneers reported in the literature varies from
clinically acceptable to excellent.

23. VENEERS VS CROWNS
• Both crowns and veneers are forms of dental restoration. They work by adding a covering
to an existing tooth to improve its appearance or function. The main difference between a
veneer and a crown is how much of the original tooth is removed, how thick the material
covering the tooth is, and how much of the tooth is covered. Both crowns and veneers are
effective in improving the aesthetic appearance of teeth.
• A veneer is usually made of wafer-thin porcelain and is bonded to the front of a tooth. The
porcelain is color-matched to your natural teeth. Veneers are strong but brittle, and sharp
or repeated impacts can dislodge or crack them.
• A crown encases the entire tooth. It can be made of metal, porcelain or a combination of
both. It is usually around double the thickness of a veneer, making it more durable and
resistant to cracking than a veneer.

24. VENEERS VS CROWNS- DIFFERENCES
IN TOOTH PREPARATION
• Veneers are considered a more conservative treatment than crowns. Less of the tooth
needs to be removed in order to place a veneer. Your dentist will usually just remove a thin
layer of tooth enamel from the front of the tooth and will not normally need to touch the
core or the back of the tooth.
• Crowns require between 60% and 75% of the existing visible tooth to be trimmed away
before the crown is placed. This typically means two to four times as much tooth reduction
as veneers.
• There is sometimes a grey area in the preparation required for veneers and crowns.
Occasionally, in situations where veneers are being used to correct alignment, teeth being
prepared for veneers may be accompanied with the more aggressive trimming
characteristic of crowns. This can create some confusion between which type of treatment is
being used.

25. COST
The total cost of veneers will vary, depending on:
• possible initial dental treatment;
• number of veneers implanted;
• the city and the dental office;
• the type of veneers used.
As for composite veneers, be prepared to spend several hundred PLN per tooth.
Porcelain veneers are more expensive and prices start at PLN 1,000.

26. REFERENCES:
• http://www.dmp.umed.wroc.pl/pdf/2018/55/2/207.pdf

27. THANK YOU!
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