Laminate Veneers Guide

Laminate Veneers
Guided By:-
Dr. Dilip Dhamankar (Prof. &
HOD)
Dr. Ravi Kumar C.M. (Prof.)
Dr. Meenaksi (Prof.)
Dr. DRV Kumar (Reader)
Dr. Arun Gupta (Reader)
Dr. Manish Chadha (Senior Lect.)
Dr. Devendra Singh (Senior Lect.)
Dr. Mayank Lau(Senior Lect.)
Dr. Soham Prajapati
2nd Year PG,
Dept. of Prosthodontics
& Maxillofacial Prosthetics
Including Oral Implantology
19-1-14 & 20-1-14
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Contents
• Introduction
• Definitions
• History
• Indications
• Contraindications
• Shade Selection
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Contents
• Tooth Preparation
– Principles of tooth preparation
– Rationale
– Types of preparation
– Armamentarium
– Procedure
• Provisional Restoration
– Direct method
– Indirect Method

• Laboratory Procedures
• Cementation
• Maintenance
• Failures
• Advantages & Disadvantages
• Recent advances
• Conclusion
• References
Contents

Introduction
• The public is bombarded by media extolling
the virtues of “The Perfect Smile”.
• The dental profession is faced with specific
esthetic demands and a rapid evolution of
new but unproven techniques.
• Although the direct bonding of porcelain
veneers is relatively new, reports of success
warrant its inclusion as a restorative
treatment.
Laminate Veneers
Tylman’s Theory & Practice of Fixed Prosthodontics 8th edition, 194 (2002 Edition)
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Introduction
• Laminate Veneers have evolved over the last
several decades to become one of aesthetic
dentistry’s most popular restoration.
• The laminate veneer is a conservative
alternative to full coverage for improving the
appearance of an anterior tooth.
Laminate Veneers
V Rangarajan, Textbook Of Prosthodontics, pg 705-719 (2013 Edition)
6/148

Introduction
• A survey in 1986 stated that 50 percent of U.S
dentists provide indirect veneers and 41
percent of this group offer porcelain Veneers.
Laminate Veneers
Dental Products : Report: Trends in Dentistry, December, 1986
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Definitions
• Veneer:-
– A thin sheet of material usually used as a finish.
• GPT, 8th Edition.
– A veneer is a layer of tooth colored material that is
applied to a tooth to restore localized or generalized
defects and intrinsic discolorations.
• Sturdevant
– A protective or ornamental facing. OR. A superficial or
attractive display in Multiple Layers, frequently
termed a Laminate Veneer.
• Rosensteil

Definitions
• Laminate veneer restorations :
A conservative esthetic restoration of
anterior teeth to mask discoloration, restore
malformed teeth, close diastemas & correct
minor tooth alignment.
• Mosby’s dental dictionary

Definitions
• Porcelain Laminate veneer:
A thin bonded ceramic restoration that
restores the facial surface and part of the
proximal surfaces of teeth requiring aesthetic
restoration.
-GPT.

History
Laminate Veneers
We Read/Listen History, so we don’t repeat History.
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History
• With the advent of photography and motion
pictures, a very accurate and lifelike facsimile
of an individual could be reproduced. Any
disfiguring mark was also reproduced with
discomforting accuracy. Unlike paintings, in
which artist could touch up the offending
areas, FILMS ARE CRUELLY TRUTHFUL.
Laminate Veneers
George Freedman,Gerald McLaughlin, Colour Atlas of Porcelain Laminate Veneers,1st
edition, 1-244
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History
• In many still photographs of the 19th century,
the grain of the film covers facial bleminishes
to an extent, but significantly very few of the
subjects were smiling. The dental blemishes
are thus covered with the lips.
• It is probably not an accident that many of the
forbears seems so serious and strict; in many
instances they were just hiding unsightly
teeth.
Laminate Veneers
edition, 1-244
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History
• With the earliest motion pictures were
produced, the films were so jumpy it was
impossible to see the fine facial features, and
close up sequences were rare.
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edition, 1-244
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History
• In the late 1920s, the talkies arrived.
Combined with improved filming and
projecting techniques, which made minor
details more visible, Hollywood's film makers
experienced a dental dilemma.
Laminate Veneers
edition, 1-244
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History
• Thus it became necessary for movie stars to
have glamorous smiles. The audience
expected nothing less than perfection from
their heros and heroines, and the teeth were
part of that package. Needles to say, not all of
those who were or wanted to be, stars had
perfect dentition. Thus Necessity led to
Invention.
Laminate Veneers
edition, 1-244
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History
• Dr. Charles Pincus was a Beverly Hills
Practioner, and a part of his patient’s load
came from the movie industry.
• Among these were makeup personnel from
various studios. When they bought their star’s
problems to Pincus, he became experimenting
with certain techniques to improve their
appearance.
Laminate Veneers
edition, 1-244

History
• Only consideration he had was esthetics and
should not alter speech. No comfort was taken
into consideration.
Laminate Veneers
edition, 1-244
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History
• In 1930’s Dr. Charles Pincus first used thin
resin facings.
• Then he baked a thin layer of porcelain onto
the platinum foil and designed the appliance
so it would not interfere with oral functions.
• Thus, created the ‘Hollywood Smile’ for
American Actors.
• He used denture adhesive to hold the veneer
in place.
• The stars could not eat and wore then for
performing only.
Laminate Veneers
edition, 1-244
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History
• The development of acid-etch technique 30
years ago introduced an aspect of molecular
dentistry known as ‘Bonding’.
• Phosphoric acid applied to tooth enamel
created a surface of microscopic interstices for
mechanical bonding unfilled resin.
Laminate Veneers
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History
• The prototype system using silica resins was
clinically deficient and was replaced with
unfilled methylmethacrylates that were less
toxic, easily polished, and improved
esthetically.
Laminate Veneers
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History
• In 1970’s preformed plastic laminates were
bonded to the teeth using composite resin.
• However, due to polymerization shrinkage and
a coefficient of thermal expansion that is
higher than that of teeth, the marginal
adaptation was compromised.
• The soft methacrylate surfaces were also
subjected to wear and discoloration.
Laminate Veneers
V Rangarajan, Textbook Of Prosthodontics, pg 715-719
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History
• The evolution of the modern ceramic laminate
was assisted by the following discoveries:
– Etching of enamel by Buonocore (1955)
– Bowen’s BISGMA resins (1960s)
– Ceramic Etching and bonding by Rochette (1973)
– Bonding porcelain to etched surfaces (1980s)
– Calamia et al - Application of silane coupling agent (1984)
Improved bond strength
– Hsu et al - Mechanical retention increased by etch.
Shear bond strength of etched 4 > Unetched (1985)
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Comparison Of Veneer System
• Three Veneer Systems are present
– Direct Resin
– Indirect Resin System
– Porcelain Indirect System
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• Advantages of Direct Composite System
– Only One Appointment is required
– The dentist directly controls form and colour.
– Cost of the patient is reduced
– Composite Veneers are repairable.
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• The indirect porcelain technique, which
involves laboratory fabrication of the veneers,
compensate for the short comings of the
direct composite resin technique:
– The dentist may use the time saving and artistic
skills of a ceramist.
– Multiple units can be placed with less chair time.
– Porcelain is the optimum material for colour
stability, esthetics, wear resistance and tissue
compatibility.
Laminate Veneers
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• Processed materials other than porcelain have
been suggested for the indirect technique:
– Resin and composite processed at elevated
pressures and/or temperatures (Dentacolor, Isosit
and Visio-Gem)
– Castable hydroxyapatite
– Injectable ceramics (Dicor, Cerestore).
Laminate Veneers
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Considerations Direct Resin Indirect Resin Porcelain
Strength Moderate Moderate High
Esthetics Good Excellent Good Excellent Excellent
Coverage of dark
color
Excellent
(w/opaque)
Good Good
Longetivity
Potential
Fair-Good Fair-Good Good
Repair Expectation Low-Modearte Low-Moderate Low
Repair Difficulty Easy Easy Difficult
Cost to Patient 1/3 Crown cost 1/3 -2/3 Crown
cost
2/3-1X Crown
Laboratory cost 0 Up to 65$ +/- 65 $
Laminate Veneers
Tylman’s Theory & Practice of Fixed Prosthodontics 8th edition, 194 (2002)
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Laminate Veneers
Resin (Direct) Resin (Indirect) Porcelain (Indirect)
Indications 1. Need to cover
multiple color
stains of dark
striations.
2. Bruxer, Clencher,
abusive occlusal
habits.
3. Pt. with financial
difficulty.
4. Single teeth
1. Typical, routine
veneering for patients
without deeply stained
or striated teeth.
2. Dentist does not like to
develop tooth anatomy.
3. Bruxer, clencher,
abusive occlusal habits
4. Multiple preps
1. Typical, routine
veneering for
patients without
deeply stained or
striated teeth.
2. Dentist does not like
to develop tooth
anatomy.
3. Multiple preps
Contraindicati
ons
1. Dentist does not
like to develop
tooth anatomy
2. Does not have
ability with colour
1. Difficult to cover dark
stains and striations
without placement of
underlying opaquers before
impression for veneers.
1. Bruxer, clencher,
abusive occlusal habits.
2. Difficult to cover
dark stains and
striations without
placement of
underlying opaquers
before impression for
veneers.
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Laminate Veneers
Esthetic
Potential
Good excellent if
dentist has ability
with colour blending.
Artistc dentist can
produce excellent
result.
Good-excellent with high
level laboratory support
and correct patient
selection
1. Excellent with high
level laboratory
support and correct
patient selection.
Expected
Longevity
1. Some brands in
current
generation of
resin now
observed 7-8
years of success
2. Should last at
least 5-10 years
with aesthetic
acceptability if
placed correctly
1.Observed for about 5
years.
2. Should last at least 5-10
years with aesthetic
acceptability if laboratory
constructs correctly and
placed correctly.
1. Observed for only 2
years. Should last +/- 10
years with esthetic
acceptability if
laboratory constructs
correctly and placed
correctly.
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Laminate Veneers
Ease of
placement
Preparation easy.
Placement
moderately difficult
because dentist
must to have
esthetic sense for
color and contour.
Preparation easy.
Placement not difficult
because veneer material
is same as cementing
medium and new polish
can be placed on veneer
if surface disturbed.
Preparation easy.
Placement difficulties
are:
1. Veneer is fragile
and can break.
2. Selection of
cement colour
3. Loss of glaze
through finishing.
Time
required for
6 veneers
after
experience
Prep and place 1 ½
- 3 hours.
Prep ½-1 hour.
Seat 1-2 hours
Prep ½-1 hour.
Seat 1-2 hours
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Frequency &
location of
clinical
problems
1. Incisal Edge
fracture +/- 10%
cases +/- 3 years of
service.
2. Discolouration of
gingival and
proximal Margins at
+/- 3 years if not
placed correctly.
3. Can cause
gingival irritation
1. Infrequent incisal
edge fracture +/- 3
years into service.
gingival and proximal
Margins at +/- 3 years
if not placed correctly.
3. Can cause gingival
irritation
1.Very little repair
needed in 2 years of
observation.
gingival and proximal
Margins at +/- 3 years
if not placed correctly.
3. Can cause gingival
irritation
Time
required for
6 veneers
after
experience
Prep and place 1 ½
- 3 hours.
Prep ½-1 hour.
Seat 1-2 hours
Prep ½-1 hour.
Seat 1-2 hours
Laminate Veneers
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Repair
Difficluty
Simple. Remove
defective portion
down to enamel
surface, etch, bond
and repair with
resin.
Simple. Remove
defective portion down
to enamel surface,
etch, bond and repair
with resin.
Difficult. Must replace
veneer or patch with
resin with esthetic
difference between
resin and porcelain.
Laminate Veneers
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• The indirect resins have better physical
properties than light cure composites, but
reduced bond strength.
• The cast ceramics have the advantage of
waxup stage, excellent translucency, and
reduced plaque adherence. But technique
sensitive.
Laminate Veneers
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• Thus the choice of veneer material and
techniques depends on
– Physical properties of the material.
– Enamel discolorations.
– Experience of the dentist
– Number of unit treated.
Laminate Veneers
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Indication
Laminate Veneers
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Indications
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Indications
• Extreme Discolorations: Such as tetracycline
staining, fluorosis, devitalized teeth and teeth
darkened by age which are not conductive for
bleaching.
• Enamel Defects:- Small cracks in the enamel
due to aging, trauma or hypoplasia.

Indications
• Diastema: Single or multiple spaces between
the teeth.
• Attritions and root exposure: Can be used to
restore localized attrition and root sensitivity
due to cemental exposure.
• Malpositioned teeth and abnormalities of
shape: Peg laterals and rotated teeth.

Indications
• Repair of functionally sound metal ceramic or
all ceramic restoration with unsatisfactory
colour: The labial surface of old porcelain
restoration is prepared and a ceramic laminate
is bonded correcting the anomaly.
• Tooth Fracture: Restricted to incisal third
• Restoring anterior guidance in worn
mandibular incisors.

Contraindications
• Insufficient coronal tooth structure: Fractured
teeth with more than 1/3rd loss of tooth
structure, grossly carious or extensively
restored teeth. Full coverage restorations are
preferred.
• Actively erupting teeth
• Parafunctional Habits like bruxism

Contraindications
• Severe Periodontal involvement and
Crowding.
• Endodontically treated teeth: Present a poor
receptive surface for bonding and full
coverage restorations are indicated.

Veneer indications
1. Restorations
2. Diastema
3. Fracture
4. Attrition
5. Large pulps
6. Discoloration
7. Malformation
8. Root exposure
9. Erosion/abrasion
Veneer Contraindications
1. Poor enamel quality
2. Insufficient sound enamel
3. Severely Rotated or
overlapped teeth.If indication present
NO
1. Fixed / Removable
Prosthetics.
2. Orthodontics
3. Orthognathic
Surgery
YES
Absolute Contraindications
present?
1. <50% enamel for bond
2. Weak coronal tooth
structure
3. Severe malposition
YES
NO
43

• Albers indicated that a tooth to be bonded
should have at least 50 percent of its surface
composed of etchable enamel.
• Preferably, the peripheral margins are of
enamel conform to the “one millimeter
circumferential principle” for long term
marginal integrity of the enamel resin bond.
Laminate Veneers

Does the patient have
these conditions
1. Bruxism / Clenching
Habit?
2. Severe
discoloration?
3. Single unit?
4. Limited finances
Color / Contour
Abnormality Slight?
• Bleaching
• Cosmetic contouring
• Esthetic fillings
Is Results OK?
YES
NO
NO
YES
TREATMENT
SUCCSESFUL
YES
TREAT WITH DIRECT
COMPOSITE VENEER
TREAT WITH PORCELAIN
VENEER
Select Porcelain shade
slightly lighter than
desired shade
45

Is tooth Free of
1. Faulty Restorations
2. Abnormal /Unesthetics
Contours
3. Caries
• Cosmetic Coronoplasty
• Recontour incisal edges
• Restore/ replace defects with glass ionomer
of suitable shade
Prepare Tooth for Porcelain Veneer
46
NO
YES
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• Veneer can be bonded to sound composite or
glass-ionomer restorations.
• Composite repair studies have revealed that a
delayed resin-resin bond is formed, but with
a reduced bond strength.
• Glass-ionomer bases etched with phosphoric
acid provides some micromechanical
retention to composite and and promote
fluoride release.
Laminate Veneers
Monterio et al, evaluation of materials and techniques for restoration of erosion areas,
J Prosthet. Dent. 55:434,1986
47/148

Shade Selection
• Before starting preparations, establish the
desired shade.
• It has to be done when the teeth have not
been dried out for any period of time.
• It is done under colour corrected light or
outside in daylight.
Laminate Veneers
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Shade Selection
• A shade is selected from a porcelain system that
is one half shade lighter than the desired shade.
• This provides the dentist latitude and allows for a
slight darkening attributable to increase
translucency with polymerization of the
composite luting cement.
• The conventional shade guides such as vita
porcelain shade guide, are not ideal for veneers
because their porcelain thickness is high.
Laminate Veneers
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Preliminary Tooth Modification
• Contouring deficiencies greater than 1 mm
resulting from caries , erosion, or attrition are
restored with GIC of a suitable shade.
• When Class III is present, remove sufficient
filling just prior to bonding to expose the
enamel margins that are then etched and
sealed with bonding composites.
Laminate Veneers
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Preliminary Tooth Modification
• The tooth crown should have a uniform thickness
of veneer and luting agent.
• Unless incisal lengthening is desired, laminate
incisal margins terminate at the facioincisal
angles.
• Preliminary cosmetic contouring defines the
esthetic alignment and incisal profile.
• Recontouring of rotated , tipped or malpositioned
tooth surfaces projecting labially from a uniform
facial plane ensures restoration of harmonious
facial contour.
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Classification
1 Partial
2 Full
1 Prefabricated
2 Custom made
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Tooth Preparation
• Principles of tooth Preparation
– Conservation of tooth structure: the preparation
should be conservative which is the main principle
governing the fabrication of the ceramic laminate.
– Retention is solely by adhesion: Adhesive luting
or bonding using resin cements is the main
contributor to retention rather than tooth
preparation.

Tooth Preparation
• Rationale
– Enamel preparation is done:
• To provide adequate space for porcelain opaquing and
composite resin luting materials.
• To remove convexities in the surface and provide a
definitive path for insertion.
• To assist veneer seating during placement and bonding
the laminate.
• To facilitate margin placement
• To provide adequate contour and colour without over
contouring.

Types of Preparation
• Type I – Contact Lens Type
• Type II – Classic or Conventional Type
• Type III – Wrap-around or ¾th type
Laminate Veneers
V Rangarajan, Textbook Of Prosthodontics, pg 715-719
55/148

• Type I – Contact
Lens Type: Does not
cover the incisal
edge.

• Type II – Classic or
Conventional Type: most
commonly used. Covers
the incisal edge and
terminates lingually.
Thickness of tooth, needed
for increasing tooth length
and occlusion determine
whether type I or type II is
used.

• Type III – Wrap-around
or ¾th type: almost
similar to full coverage
preparations. Indicated
for extensive changes
and colour and contour.

Armamentarium
• A diamond depth cutter with three 2mm diamond
wheels mounted on a 1.0 mm diameter non cutting
shaft. The radius of wheels from the non-cutting
shaft is 0.5. Produces a depth cut of 0.5 mm.

Armamentarium
Laminate Veneers
• A diamond depth cutter with a wheel
diameter of 1.6mm, produces a depth cut of
0.3 mm.
• Round Bur (No.1) (0.8 mm diameter)

Armamentarium
• Round end tapering diamond (medium and
fine grit)
• Finishing diamond burs
• Airotor Handpiece.

Procedure
Laminate Veneers
• It involves the following steps:
– Labial Reduction
– Proximal reduction
– Sulcular Extension
– Incisal Reduction
– Lingual Reduction.
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Labial Reduction
• The thickness of the ceramic laminate should
be 0.5 mm.
• To achieve this, the labial preparation should
achieve a uniform reduction of 0.3-0.5 mm,
less gingivally and more incisally.
• This involves:-
– Depth Cuts
– Reducting Remaining Enamel

Labial Reduction
– Depth Cuts
• These can be done using round bur only or a
combination of round bur and the depth cutter.
• Depth Cuts using only round Bur.

Labial Reduction
• Depth Cuts using only round Bur.

Labial Reduction
– Depth Cuts
• Depth Cuts diamond depth cutter.

Labial Reduction
– Reducing Remaining Enamel

Proximal Reduction
– Depth can often be as 0.8- 1 mm, since the
enamel layer is thick towards proximal surface.
– Done with round end tapered diamond is just
continued into the proximal area.
– It is ensured hat the diamond is parallel with the
long axis of the tooth.
– Proximal reduction should stop just short of
breaking the contact.

Proximal Reduction

Proximal Reduction
– Reasons to preserve contact area
• It is an anatomical feature that is extremely difficult to
reproduce.
• It prevent displacement of the tooth between the
preparation and placement appointment if no
provisional restorations are planned.
• Post insertion oral care is easier.
• Simplifies try-in- no need to adjust the contact.
• Simplifies the bonding and finishing.

Sulcular extension
– Routinely the margins are placed supragingivally.
– When discoloration is excessive, the margins are
extended supragingivally.
– A rounded 0.3mm chamfer serves as an ideal
margin for ceramic laminate veneer.

Sulcular extension
– Advantages of Supragingival Margin
• Increased areas of enamel in the preparation
• Simplifies moisture control
• Visual confirmation of marginal fit
• Margins are accessible for finishing and polishing
• Access to margins for routine maintenance and dental
hygiene procedure.

Sulcular extension
– Advantages of Supragingival Margin

Sulcular extension
– Advantages of Chamfer finish line
• Conservative , Distinct.
• Provides increased bulk of porcelain giving adequate
strength, avoids over contouring.
• Good marginal seal.
• Accuracy of fit – veneers is easily inserted at try-in and
final placement.

For type I, the tooth preparation ends
here. For type II preparations incisal
and lingual reductions are necessary.

Incisal Reduction
– As porcelain is stronger in compression than in
tension, wrapping the porcelain over the incisal
edge and terminating it on the lingual surface
places the veneer in compression during function.
– It also provides a vertical stop that aids in proper
seating of the veneer and improves translucency.
– Reduction
• 1 mm in thickness.

Incisal Reduction

Incisal Reduction
– Key Point :-
• Never end incisal edge where excursive movements of
the mandible will cause shearing stresses across the
junction of porcelain laminates and tooth.

Incisal Reduction
– Indications for incisal coverage
• The incisal thickness is too thin to support the veneer.
• A lengthening of the incisal edge 1.0-2.0 mm is desired.
• Facioincisal margin is visible and unaesthetic.
• Incisal enamel is structurally compromised.
• The incisal edge is subjected to functional stress.

Incisal Reduction

Lingual Reduction
– The round end tapered diamond is held parallel to
the lingual surface with its end forming a slight
chamfer 0.5 mm deep.
– Besides placing the porcelain under compression
lingual extension will also enhance the retention
and increase the surface areas for bonding.

Lingual Reduction

Laminate Veneers
Ramya Raghu, Clinical Operative Dentistry Principles and Practice, 3rd edition, 404
Advantages Disadvantages
Retain Natural enamel over
incisal edge
Incisal edge is weakened by
the preparation. Esthetically
not pleasing as the margin
may be visible.
Guidance on the natural
tooth is maintained
Veneer is fragile at the incisal
edge and get dislodged
during protrusive
movements.
More control over incisal
esthetics.
More extensive tooth
reduction
Provides a positive seat for
luting the veneer
More extensive tooth
reduction
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Prepare Tooth for Porcelain Veneer
Determine depth of enamel
reduction
None – Minimum
• Root Surface
Minimum Requires  0.3 to 0.5 mm
• Tooth Color
• Linguoversion
• Near CEJ
• Mandibular incisor gingival half
Required Heavy 0.5 to 0.7 mm
• Tooth Color shade mismatch
• Labioversion
• Mandibular incisor gingival half
Heavy 1.0 mm
• Functional clearance
8686/148

Prepare Labial depth guide cuts for
controlled reduction
Place gingival chamfer
margin
Is there severe
Discoloration?
Place chamfer at free
gingival margin
Place chamfer of 0.5-1.0
mm below the gingival
margin
Continue Margin interproximally to below contact area
Is existing M-D width
suitable and proximal
contacts present?
Place chamfer lingual
to contact area.
Avoid undercut to
facioincisal path of
draw
Place chamfer just labial to
proximal contact
NO
NOYES
YES
Extend chamfer to incisal. Complete uniform gross facial enamel reduction to peripheral
margins and depth guided
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88
Gross Facial Reduction Complete
Facial Free of localized spots of
severe color/stain?
Reduce Discolored enamel to
accommodate thin, etch retained,
shaded opaque.
NO
YES
Is the existing Inciso gingival tooth
length acceptable? NO
Reduce length
• Esthetics
• Overbite
• Thin incisal
• Functional clearance
Reduce incial 1 mm short of
desired length. Place linguo
incisal chamfer.
Round Incisal angles.
Add length
• Esthetics
• Overbite
• Attrition
• Fracture
Veneer may add 2 mm length.
Place lingual chamfer 1-2 mm
from incisal edge. Round incisal
angles.
YES
Is Facio Lngual dimension at incisal
edge sufficient for veneer support? NO
YES
YES
88/148

89
Refine Preparation with fine diamond or 12 Bladed carbide to extend margins,
round angles, and remove striations and roughness.
Polish Facial enamel to high gloss with super fine diamonds and finishing discs to
provide a normal enamel surface needing to temporization
Does the patient have problem or concern
for
• Exposed dentin
• Sensitivity
• Opened contacts
• Abnormal Contours
• Discoloured teeth
• Place 2 layers of dentin
enamel bonding agent.
• Temporary composite or
resin laminate spot etched
to labial surface
Make an impression of
veneer preparation using
addition silicone or polyether
elastomers. Block out open
gingival embrasures. Place
retraction cord if required.
YES
NO
Prepare Laboratory pescription for a shade slightly than
desired. Specify color, character and contour
modifications. Indicate whetever heavy, moderate, or
slight or no opaque to mask partially discolored tooth.
Color slides and study models may be helpful.
89/148

Provisional Restoration
– Provisional restoration for laminates may not be
essential as there is no exposure of dentine (no
sensitivity) and the proximal contacts are
maintained (no drifting of adjacent teeth).
– But most often it may be necessary for a patient
to maintain their social engagements and if
proximal contact is broken (wrap-around
technique).

– Two Methods:-
• Direct Method
• Indirect Method

• Direct Method
– The provisional is fabricated intraorally. It can be done using:-
» Composite Resin
• A few spots on the prepared tooth or a central spot is
etched (spot etching) with phosphoric acid and
bonded.
• Restorative composite is buit up on prepared tooth
and light cured.
• This acts as a provisional restoration as it can be
easily removed prior to try in, as the entire surface
was not etched.

• Direct Method
» Composite Resin

• Direct Method
» Autopolymerizing Acrylic Resin
» Tooth coloured acrylics can also be used simiar to routine
fixed prosthodontics.
94/148

• Direct Method
» Autopolymerizing Acrylic Resin

• Indirect Method
– A model fabricated following tooth prepartion will allow the
acrylic provisional to be made indirectly on a cast.

Laboratory Procedures
• Leucite and lithium-disilicate reinforced ceramics are
preferred due to their excellent transulency and
aesthetics.

Laboratory Procedures
• Three methods
1. Investment Model Technique(McLaughlin)
2. Platinum foil technique (Greggs)
3. Milling systems : CAD/CAM
Laminate Veneers
edition, 1-244
99/148

Investment Model Technique

Platinum foil technique (Greggs)

102
Are processed Veneers free of cracks,
excessive thickness, and marginal
discrepancies?
NO
Color shade choice. Return for
remake.
YES
Give LA to ensure patient comfort in placing retraction cord to expose gingival margins, to
prevent etch contamination, ad to facilitate finishing procedures
Clean preparation and interproximate with flour of pumice.
Try in fit: Do veneers, trial seated with
glycerin, fit preparations?
Individually Collectively NONO
MAKE NEW
IMPReSSION
Reduce excess
proximal contact
with fine
diamond
YES
102/148

103
Try in color:
Is Veneer, Trial seated with
glycerin approximately the
same shade as the tooth?
NOYES
Select a trial
composite
luting agent of
neutral or
universal shade
Select a trial
composite luting
agent with some
opaque added.
Is the basic shade of the veneer
trial seated with composite
satisfactorily?
NO
Remove trial composite with alcohol.
Repeat until shade acceptable.
YES
Is the selected basic shade accurate for the
gingival and for the incisal areas of the
tooth?
NO
Remove unsatisfactory trial composite with
alcohol. Select alternate shade or add no
more than 20% tint
YES
Shade and fit confirmed. Prepare tooth and veneer for bonding.
YES
YES
103/148

Cementation
Laminate Veneers
– Preparation of veneer
• Following cleaning of the veneer with a solvent such as
acetone, it is etched with 10-15% hydrofluoric acid for
30 seconds to 1 minute according to the
manufacturer’s instructions and the ceramic used.
• A silane coupling agent is now applied to the fitting
surface of the veneer and is allowed to remain for one
minute.
• It is then air-dried. The silane creats a chemical bond
between composite cement and ceramic.
104/148

Cementation
Laminate Veneers
– Preparation of veneer
105/148

• Chemical coupling : Silanization
o Silica content - chemical bond
o -methacryloxypropyl trimethoxy
silane
o Inorganic substrates and organic
polymer.
o Improved wettability
106/148

• Apply Porcelain Primer or Silane Coupling
Agent.
• Use a prehydrolized silane which means you
do not have to mix two components (usually
contained in cementation kit (Nexus, Kerr).
• It is applied with a brush. The coupling agent
acts to wet the surface of the porcelain. The
silane coupling agent is allowed to set on the
surface (usually for at least 60 sec but some
are shorter periods).
• It can be dried with a gentle stream of air. Do
Not Rinse. Set prepared veneer in a lightproof
box until ready for cementation
107/148

Cementation
Laminate Veneers
Preparation of
Veneer
Preparation of
Tooth
Clean Clean
Etch Isolate
Silane Etch
Bond Bond
109/148

Cementation

Cementation
Laminate Veneers
– Luting
• The choice of cement is resin cement.
• Ideal requirements of the luting cement
– Thin film thickness, 10-20 microns
– High compressive and tensile srength
– Ability to tint, opaque and characterize
– Low viscosity
– Low polymerization shrinkage
– Good colour stability
111/148

Cementation
Laminate Veneers
–Uniformly load the veneers with composites
and cover to protect them from light
polymerization.
–Low viscosity composites facilitate fast, low
stress placement.
–Incisally wrapped veneers require first
facial, then gingivally directed pressure for
complete seating.
112/148

– While maintaining a steady pressure on the
veneer, slightly pull the interproximal matrix
lingually to clear proximal margins of excess
composite.
– With the finger applying pressure and blocking
light to the gingival half of the laminate,
“tack”the veneer in place with a 20 second light
exposure with a wide curing light tip.
Cementation

Laminate Veneers
–Repeat the removal of the composite excess
at the margins and cure the entire laminate
for a total of 1.5 to 2 minutes, depending on
thickness, color, and opacity of laminate.
Cementation
114/148

Cementation

Cementation
Laminate Veneers
– The excess material is removed with a probe and
then light curing is continued for 45-60 seconds.
116/148

Cementation

Finishing
Laminate Veneers
–Fine grit are used to remove any excess
cement from the margins.
–Final finishing is accomplished with discs
and diamond polishing pastes.
–Proximal areas are finished with finishing
strips.
119/148

Maintenance
Laminate Veneers
–For 72-96 hours following insertion,
patients should avoid highly coloured foods,
tea or coffee, hard food and extreme
temperatures.
–Routine scaling should be done and
ultrasonic scalers should be avoided.
120/148

Maintenance
Laminate Veneers
–Abrasive and highly fluoridated tooth pastes
should be avoided.
–Excessive biting forces and nail biting and
pencil chewing habits should be avoided.
–Soft acrylic mouth guard can be used during
contact sports.
121/148

Failures
Biological
• Three Types:
– Mechanical
– Biological
– Aesthetic

Failures
• Mechanical
– Fracture- poor positioning of incisal margin, less
incisal thickness, margin too subgingival.
– Debonding use of expired cement, faulty
veneer/tooth preparation during luting

Failures
• Biological
– Postoperative sensitivity – improper curing of
cement, poor marginal adaptation.
– Marginal Microleakage – poor fit and extension

Failures
• Aesthetic
– Improper shade selection
– Gingival recession – overcontour and improper
subgingval placement

Advantages and Disadvantages
1 Minimally Invasive
– Conservative
Tooth preparation,
however, minimal is
required.
2 Excellent colour
and light
transmission –
good aesthetics
Cementation is time
consuming and
technique sensitive
3. Good Tissue
response
Difficult to repair

4 High Colour Stability Fragile – may
fracture if
improperly
handled during
try-in or
cementation
5 Good Tissue response Difficult to repair

6 Excellent durability –
good response, wear
resistance and no
fluid absorption.
Proper selection of
underlying cement
is critical for success
7 Speed and Simplicity Cost
8 Does not compress
interdental gingiva
9 Maintains natural
contacts and incisal
guidance

Recent Advances
• Lumineers:

Recent Advances
• Lumineers
– What is the difference between Lumineers and
standard porcelain veneers?
• The main difference is that Lumineers are made from a
special patented CERINATE porcelain that is very strong
but much thinner than traditional laboratory-fabricated
veneers. Their thickness is comparable to contact
lenses.

Recent Advances
Advantages
• Lumineers can be placed on the teeth without
removal of the tooth structure.
• Lumineers are a reversible procedure
• Patients can receive their veneers quickly, usually
within two weeks from the date that the
impressions are made.
• Lumineers bond directly to the tooth, making the
bond very strong. They are also very long-lasting-
up to twenty years or longer.

Recent Advances
Although Lumineers are the most advantageous
option, there are certain limitations to be
considered:
• Lumineers can only be placed on teeth that are in
good structural condition. The teeth must be free of
decay. Any existing fillings must also be in good
condition, along with the surrounding gum in the
area where the Lumineers will be placed.

Recent Advances
• The patient must have good oral hygiene, with no
receding gums or signs of gum disease. Bleeding of
the gums will interfere with the bonding process.
• Because there is very little or no tooth
preparation, a small bump is likely to develop
between the veneers and the gum.. The bump may
create an irritation to the gum, and may increase
the chances for staining and tooth decay.

Recent Advances
The LUMINEERS
No-Prep Technique allows LUMINEERS to be placed
over the existing teeth without the removal of any
form of tooth structure. Therefore, anesthesia and
temporaries are also not required.
The LUMINEERS Minimal Contouring Technique
requires slight modification of the enamel but never
touches dentin during LUMINEERS placement. Only
.3 mm-.5 mm enamel is removed, causing no
sensitivity for the patient and therefore no need for
any anesthesia.

Recent Advances
PREPARATION OF LUMINEERS
1. Polishing Clean the teeth with Porcelain
Laminate Polishing Paste and rinse.
2. Refresh the Enamel Perform minimal
enamelplasty with a prep diamond bur,
using light pressure. –Use the whole length
of the bur, keeping contact with the teeth.

Recent Advances
1. Interdental Strips Isolate the teeth receiving
LUMINEERS from the teeth not receiving
LUMINEERS by applying Paint-On Dental Dam
or placing metal interdental strips in order to
prevent etchant from contacting adjacent
teeth.
2. Etching
1. Etch the teeth with Etch ‘N’ Seal® for 20 seconds.
2. Rinse thoroughly with water, then dry.

Recent Advances
Bonding Application
1. Add 5 coats of Tenure®
A+B. 2. Add 1 coat of
Tenure S to the teeth.
Note: Tooth surfaces
must be shiny.

Recent Advances
Prime-Bonding on LUMINEE RS
1. Add 1 coat of Tenure A+B on the inner side of the
LUMINEERS.
2. Add 1 coat of Tenure S on the inner side of the
LUMINEERS.
3. Ultra-Bond® Plus on LUMINEE RS Add an even
layer of Ultra-Bond® Plus resin cement to the
inner side of the LUMINEERS. Work upwards from
incisal edge of the LUMINEERS to gingival edge
and keep light contact with the LUMINEERS

Recent Advances
Insert the LUMITray
1. Remove the Paint-On Dental Dam or interdental
strips.
2. Center the LUMITray (midline).
3. Insert the tray in one smooth movement. Apply
light and continuous buccal pressure. Take your
time for the placement.
4. Remove excess Ultra-Bond Plus resin cement
from the gingiva with a microbrush.

Recent Advances
Cure LUMINEE RS Through LUMITray
1. Tack-cure each tooth using a sweeping
movement. Set Light for 3 seconds.
2. Remove more excess cement with a probe.
3. Light-cure each tooth for 3 seconds through
the tray.

Recent Advances
Light-Cure the LUMINEE RS
Light-cure each
LUMINEERS individually for
a second time, on both the
lingual and buccal sides, for
5 seconds with curing Light

Recent Advances
• Lumineers
– Lumineers vs veneers are thinner; roughly the
thickness of a contact-lens.

Acid Etching

Conclusion
Laminate Veneers
• Ceramic Laminate Veneers remain as
prosthetic restorations that best comply with
the principles of present day aesthetic
dentistry. These are pleasing to the soft tissue
and possess excellent aesthetic quality yet a
conservative restoration can be called ‘bonded
artificial enamel’.
145/148
Goldstein, Esthetics In Dentistry, Vol. 1, 2nd edition

References
Laminate Veneers
1. Fundamentals of Fixed Prosthodontics Herbert T Shillingburg
3rd edition.
2. Tylman’s Theory & Practice of Fixed Prosthodontics 8th
edition.
3. Contemporary Fixed Prosthodontics Stephen F Rosenstiel 3rd
edition.
4. Sturdevant’s Art and Science of operative dentistry – Fifth
edition.
5. Porcelain Laminate Veneers for Dentists & Technicians Roger
J smales
146/148

References
Laminate Veneers
6. Esthetic dentistry – second edition, Aschheim, Dale.
7. V Rangarajan, Textbook Of Prosthodontics, pg 707-719
8. George Freedman,Gerald McLaughlin, Colour Atlas of
Porcelain Laminate Veneers,1st edition
9. Ramya Raghu, Clinical Operative Dentistry Principles and
Practice, 3rd edition, 404
10. Monterio et al, evaluation of materials and techniques for
restoration of erosion areas, J Prosthet. Dent. 55:434,1986
11. Goldstein, Esthetics In Dentistry, Vol. 1, 2nd edition
147/148

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