This document discusses porcelain laminate veneers. It begins with definitions of veneers and porcelain laminate veneers. It then discusses the history, indications, contraindications, types based on preparation, material, and fabrication. The document focuses on material selection for porcelain veneers including feldspathic, reinforced leucite, monochromatic, lithium disilicate, and minimally invasive/no-prep veneers. It provides details on different materials and their properties as well as advantages and disadvantages of porcelain veneers.

2. PORCELAIN LAMINATE
Presented by
Dr R Padmini Rani
P.G Trainee
Department of Prosthodontics and Crown
and Bridge

3. CONTENTS
1. INTRODUCTION
2. DEFINITION
3. HISTORY
4. INDICATIONS AND
CONTRAINDICATIONS
5. TYPES OF VENEERS
6. ADVANTAGES AND
DISADVANTAGES
7. PORCELAIN VENEER
• MATERIAL SELECTION
• DESIGN CONSIDERATION
• CEMENTATION PROCEDURE
8. CONCLUSION
FUTURE OF PORCELAIN VENEER
9. REFERENCES

4. INTRODUCTION
• Laminate veneers are a conservative treatment of unaesthetic
anterior teeth.
• The continued development of dental ceramics offers clinicians many
options for creating highly aesthetic and functional porcelain veneers.
• This evolution of materials, ceramics, and adhesive systems permits
improvement of the aesthetic of the smile and the self-esteem of the
patient.
• Clinicians should understand the latest ceramic materials in order to
be able to recommend them and also understand their applications
and techniques,to ensure the success of the clinical case

5. DEFINITIONS
Veneer:
1. A thin sheet of material usually used as a finish.
2. A protective or ornamental facing.
3. Superficial or attractive display in multiple layers, frequently termed
as laminate veneers. (GPT 9)

6. Porcelain laminate veneers:
A thin bonded ceramic restoration that restores the facial surfaces and
part of the proximal surfaces of the teeth requiring esthetic
restorations. (GPT 9)

7. HISTORY
• 1937: Pincus attached thin labial porcelain veneers temporarily with
denture adhesive powder to enhance the appearance of Hollywood stars
for close-up photographs.
• 1955: Buonocore introduced the acid etch technique to increase the
adhesion of acrylic filling material to enamel.
• 1958: Bowen developed silica-resin direct filling material.
• 1975: Rochette mentioned the use of a silane coupling agent with
porcelain laminate veneers for repairing fractured incisors.

8. • 1976: Faunce and Myers used acrylic resins for preformed laminate
veneers.
• 1983: HORN introduced platinum foil technique.
• 1983: Calamia introduced refractory die technique.
• 1983-1984: Calamia demonstrated good bond strengths for
hydrofluoric acid etched porcelain, and that the use of silane coupling
agent could further increase the bond strength of resin composite to
etched porcelain

9. INDICATIONS
1. Discolored teeth - increasing /Improve extreme discolorations such
as tetracycline, staining, flourosis, devitalized teeth, and teeth
darkened from age.
2. Fractured teeth
3. Diastema closure
4. Slight malposition - Improve the appearance of rotated or
misaligned teeth
5. Crown height- Ability to lengthen anterior teeth.

11. CONTRAINDICATIONS
1. Teeth with insufficient or inadequate enamel for sufficient
retention.
2. Severe crowding
3. Parafunctional habits like Bruxism, clenching
4. Large Class-IV defects should not be restored with veneers because
of the large amount of unsupported porcelain and the lack of tooth-
colored backing.

13. Types of Veneers
1. Based on extend of preparation
2. Based on type of material employed
3. Based on mode of fabrication

14. Based on extend of preparation
1. Partial Veneers: restoration of localized defects or areas of intrinsic
discolorations
2. Full Veneers : restoration of generalized defects or areas of intrinsic
staining involving most of the facial surface of the tooth

15. Based on type of material employed
1. Directly applied composite veneer
2. Processed composite veneer
3. Porcelain or pressed ceramic veneer

16. Based on mode of fabrication
1. Direct Veneers
a. Partial veneer
b. Full veneer
2. Indirect veneers
a. No prep Veneer
b. Etched veneer
c. Pressed ceramic veneer

17. ADVANTAGES
• It is very conservative in preparation. Enamel reduction of 0.5 mm or less is
enough
• Excellent esthetics: Porcelain veneers create a life-like tooth appearance
• Excellent Biocompatibility: Tissue tolerance is excellent because of the
highly glazed porcelain surface which provides less plaque accumulation
• Porcelain veneers resist staining
• Though the porcelain veneer is fragile, it is strong when bonded to tooth
• The bond of the etched porcelain veneer to the enamel surface is
considerably stronger than any other veneering system

18. DISADVANTAGES
• The placing of veneers is technique sensitive
• The veneers cannot be repaired once they are luted to the enamel
• It is difficult to modify color once the veneers are luted in position on
the enamel surface
• Fragile veneer can break: Although strong when bonded to tooth,
porcelain veneers are extremely fragile during try-in & cementation
stages
• Inability to trial-cement the restorations: They cannot be temporarily
retained with a provisional cement for evaluation purposes
• Expensive

19. Porcelain Veneer

20. • Success of porcelain veneers depends on both clinical and lab
procedures.
• Case selection and tooth preparation as required by the situation,
shade selection, proper material selection and lab procedures,
etching technique and good bonding materials can make the
porcelain veneer last long with best appearance.

21. Material selection
There are four types of veneering ceramics.
(1) low-fusing ceramics (feldspar-based porcelain and nepheline
syenite-based porcelain)
(2) ultra low-fusing ceramics (porcelains and glasses)
(3) Stains
(4) glazes (self-glaze and add-on glaze).

22. Classification of All Ceramic Systems used as
Veneering Materials
1. Conventional powder slurry ceramic
i) Optec HSP – Leucite reinforced porcelain
ii) DuceramLFC–Hydrothermal lowfusing ceramic
2. Pressable Ceramic
i) IPS Empress
ii) Optec Pressable Ceramic
3. Castable Ceramic
i) Dicor
ii) Cerapearl
iii)

23. 4. Machinable Ceramic
i) Cerec Vitablocs Mark I & II
ii) Celayblocks
iii) Dicro MGC
5. Infiltrated Ceramic
i) In-Ceram

24. Ceramics are classified according to their composition into:
• Glass based ceramics: Feldspathic porcelain, IPS Empress, IPS Empress
II, and e-max Press.
• Alumina based ceramics: In-ceram Alumina, In-ceram Spinell, In-
ceram Zirconia, Procera All Ceram
• Zirconia Based Ceramics.

25. STACKED/FELDSPATHIC TEETH VENEERS:
• These veneers contain many stacks of porcelain giving rise to multiple
layers in the veneer.
• Feldspars are naturally occurring aluminium silicate containing sodium or
potassium.
• The feldspars contain fluoroapatite crystals improving the optical
appearance of the tooth.
• It has a polychromatic appearance and high translucency, hence closely
resembles the natural tooth. Hence it is of great esthetic value.
• It is the highest quality cosmetic veneers.They are not as thick as
monochromatic veneers.
• However the downside of these feldspar veneers is that they are not strong
due to their low mechanical properties as the flexural strength is from 60-
70 MPA

26. TEETH VENEERS WITH REINFORCED LEUCITE:
• They are thinner veneers, having good aesthetics and used when
teeth require minimal preparation.
• These veneers are patented and are available only from a lab in
California and are not widely available.
• Reinforced Leucite has a flexural strength of 120-140 MPa and a
moderate compressive strength.
• NitheshShetty, SavitaDandakeri, ShilpaDandakeri.'Porcelain Veneers, a Smile Make Over': A Short
Review.Journal of Orofacial Research.July-September 2013;3(3):186-190.

27. THICK MONOCHROMATIC TEETH VENEERS :
• These are usually thicker than the normal veneers, hence contributing
to its strength and durability.
• They are present in one colour and can be customised according to
the patients preference.
• They are used when the teeth has to be lengthened due to age or
other factors. How ever these monochromatic veneers require more
preparation to implement.
• NitheshShetty, SavitaDandakeri, ShilpaDandakeri.'Porcelain Veneers, a Smile Make Over': A Short Review.Journal of
Orofacial Research.July-September 2013;3(3):186-190.

28. LITHIUM DISILICATE VENEERS :
• They are the most widely used true glass ceramics. It is versatile and
is stronger than other porcelain veneers .
• It has a high flexural strength and available in a variety of shades. It
has high resistance to thermal shock .
• It is used for teeth which requires minimal reshaping. It can be used
to correct the shape of a malformed tooth.
• They can be conventionally cemented or adhesively bonded.
• IPS Emax (Ivoclair vivadent) is an example of these veneers.
• NitheshShetty, SavitaDandakeri, ShilpaDandakeri.'Porcelain Veneers, a Smile Make Over': A Short Review.Journal of
Orofacial Research.July-September 2013;3(3):186-190.

29. MINIMALLY INVASIVE VENEERS OR NO PREP VENEERS :
• These veneers are ultrathin having a thickness similar to contact
lenses of about 0.3-0.5 mm and hence get are called "contact lenses
of teeth".
• These help in greatly conserving the tooth structure as previously
used porcelain veneers which needed a mandatory 0.5mm to 1 mm
removal of tooth structure
• They consist of lumineers, durathin veneers and vivaneers.
• Strassler HE. Minimally invasive porcelain veneers: indications for a conservative esthetic dentistry
treatment modality. Gen Dent 2007;55(7):686-94; quiz 95-6, 712

30. A) LUMINEERS :
• They are exceptionally thin veneers (0.3mm) made of a special
cerinate porcelain.
• Cerinate is material made of feldspathic porcelain reinforced with
leucite crystals.
• They have low thermal expansion.
• They have high strength and resilience despite being exceptionally
thin. They can be directly placed on the tooth without any anesthesia.
• They can be showed according to the patients wishes and can be
placed with minimal visits to the dentist. They can be placed within
two visits to the dentist.
• How ever the disadvantage of lumineers is that they have an opaque
appearance interfering with the aesthetics of the patient.

31. B) DURATHIN VENEERS:
• These veneers are exceptionally thin and are about 0.2 mm whereas
the traditional veneers are usually about 0.5 mm thick.
• These veneers have gained popularity due to its good esthetic effects
as it gives a natural translucency to the teeth closely resembling
natural teeth.
• This is one of the advantages that durathin veneers have over
lumineers.
• It is of high quality and requires the work of any highly artistic dental
lab ceramist.
• Strassler HE. Minimally invasive porcelain veneers: indications for a conservative esthetic dentistry treatment
modality. Gen Dent 2007;55(7):686-94; quiz 95-6, 712

32. C) VIVANEERS:
• These are extra tough veneers with a thickness of about 0.3 mm and
hence need a minimal thickness of about 0.3 mm
• .They are manufactured in Glidewell laboratories, USA
• Glidewell Laboratories. http://www. glidewelldental. com/lab/products/prismatikthinpress.aspx:
Glidewell Laboratories; 2009.

33. ZIRCONIA VENEERS:
• Zirconia is a polycrystalline ceramic which is acid resistant with no
amorphous silica which does not react to traditional glass etching
treatments.
• Zirconia veneers have excellent aesthetics. It is a versatile material.
They are high strength materials having fluxural strength of 1000
MPa.
• They are resistant to fracture having a fracture toughness of 8-10
MPa.
• They can be used for discoloured tooth as they are opaque and easily
mask the colour of the underlying tooth.
• Denry I, Kelly JR. State of the art of zirconia for dental applications. Dent Mater. 2008 Mar;24(3):299-307.

34. Choice of Ceramic Material to Fabricate Porcelain
Laminate Veneers According to Clinical Situation
Two important factors will affect the choice of ceramic for fabrication
of ceramic laminate veneers:
1. the amount of functional loading to which the ceramic laminate
veneer is subjected, and
2. the needed change in shade by fabrication of ceramic laminate
veneer.

35. • Generally higher tensile and shear stress occur
when there are large areas of unsupported porcelain (as in cases of
diastema closure and teeth with chipping or fracture),
deep overbites,
overlaps of teeth,
when bruxism is present and when the restorations are placed more
distally .
• In these higher risk clinical situations high strength ceramics as
alumina- based ceramics, zirconia based ceramics should be
considered .

36. For correct ceramic choice in relation to color consideration the
patients can be divided into two main types:
1. Type I patients: these are subjects programmed to receive esthetic
changes where teeth present no color alternations. The only
objective in these cases is to apply porcelain laminate veneers for
shape modifications
2. Type II patients: these patients are programmed to receive esthetic
changes and the teeth present color alternations. Therefore in
addition to shape modifications the selected ceramic material must
be able to hide the underlying teeth color.

37. Type 1
• Feldspathic porcelain provides great esthetic value and demonstrates
high translucency, just like natural dentition
• The indications for a non preparation or minimally invasive laminate
veneer including teeth that have: displeasing shapes or contours
and/or lack of size and/or volume, requiring morphologic
modifications; diastema closure, anterior tooth alignment, restoring
localized enamel malformations, flourosis with enamel mottling, and
misshapen teeth
• Pini, N.P., Aguiar, F.H., Lima, D.A., Lovadino, J.R., Terada, R.S. and Pascotto, R.C. (2012) Advances in
Dental Veneers: Materials, Applications, and Techniques. Clinical, Cosmetic and Investigational
Dentistry, 4, 9-16.

38. Type 2
• The opaque nature of zirconia laminate veneers offers an advantage
over traditional feldspathic and glass based ceramics in masking
undesirable tooth colors.
• Another ceramic that is effective in color masking is the alumina base
ceramics. It was demonstrated that alumina based ceramic veneer
within 0.7 mm total thickness will be sufficient to mask underlying
tooth color .
• Heat pressed alumina laminate veneers with 0.25 mm thickness
(Procera AllCeram; Nobel Biocare, Yorba Linda, Calif) are able to mask
discolored teeth

39. Design consideration
• This stage is determined by the evaluation of the condition of the
teeth, the indications of the clinical situation, and the material chosen
(feldspathic or glass ceramic).
• Concepts regarding the preparation of teeth for porcelain veneers
have changed over the past few years.
• Although early concepts suggested minimal or no tooth preparation,
current belief supports removal of varying amounts of tooth
structure.

41. TOOTH PREPARATION
Labial reduction:
• The optimal reduction of gingival 1⁄2 of labial surface is 0.3mm and
for incisal 1⁄2 is 0.5mm
• Using diamond depth cutter, depth orientation grooves of 0.3mm in
gingival 1⁄2 & 0.5mm in incisal 1⁄2 of labial surface are placed
• The tooth structure remaining between the depth orientation is
removed with round-end tapered diamond while the tip of round-end
diamond establishes a slight chamfer finish line at the level of gingiva
• The margin should follow the gingival crest so that all discolored
enamel will be removed.

43. Interproximal extension:
• The laminate preparation must be extended into the embrasure areas
to ensure that the margin between the veneer and the unprepared
tooth structure is hidden.
• This right-angled extension to the labial surface improves the strength
and adhesion of the veneer.
• The proximal reduction should extend into contact area, but it should
stop just short of breaking the contact.

45. Incisal reduction:
At the incisal third, the preparation may
be modified.
• The options include the “window”
preparation, the most conservative and
maintain enamel in incisal third, which
results in a visible line between enamel,
resin, and ceramic.

46. • The other possibility is the “feather”
preparation, which recovers the
incisal of the tooth, maintaining its
format.
• The critical points of this technique
are the difficulty in positioning the
ceramic restoration at the moment
of its cementation and in matching
the optical properties of the
remaining incisal structure.

47. • So, to obtain adequate color properties
at the incisal third of the laminate
veneers, the preparation needs to allow
a thickness of ceramic of 1.5–2.0 mm,
and this is possible with the “overlap”
preparation.
• At the proximal region, the preparation
must follow the papilla and extend until
interproximal contact.

49. Gingival preparation:
• At the cervical third, the gingival margin of the veneer must be
located at the same level as the gingival crest or lightly subgingival for
the anterior teeth.
• In this region, it is difficult to obtain a preparation with suitable depth
while preserving intact enamel; therefore, in this place, the wear
must be approximately 0.3 mm.

50. CEMENTATION PROCEDURE
• Check for fit of veneer: A drop of water or glycerine will help the
veneer stay in place during try-in.
• Check for color / shade: The final appearance of veneer is affected by
shade of cement used. The actual composite resin cement is placed &
trial checked. The un-cured composite cement is removed by
application of acetone or alcohol.
• Ceramic veneers should be etched, silaned and bonded to underlying
enamel with selected shade of dual-cured composite resin cement.
• The ceramic veneers are etched for 1min with 5% hydrofluoric acid
solution.

51. • The etched surface is then treated with silane coupling agent that
chemically bonds the restoration to the resin cement
• The tooth is then etched with 37% phosphoric acid for 15-20 sec,
followed by rinsing with water for 30 sec & drying with air.
• A layer of bonding agent is cured to the etched enamel
• The selected color of luting composite is coated onto the laminate
veneer & seated with finger pressure.
• Excess cement is removed, & curing is done for 1min with curing light.

53. Etching the laminate veneer Etching of tooth
Application of primer on tooth and
veneer

54. CEMENTING
Finishing
and
polishing

55. THE FUTURE OF PORCELAIN LAMINATE VENEERS
• The introduction of new dental technology combined with changing
patients attitude, is slowly altering dentistry’s approach to esthetic
problems.
• The patients acceptance of the porcelain laminate veneer technique
now-a-days seems to be high.
• A study conducted by Goldstein and Lancaster showed that patients
would readily accept shorter restoration life expectancy (five to eight
years) if enamel could be saved by not reducing the tooth for a full
crown.
• The technique is expected in the near future to be drastically
simplified.
• Clinical researches to date has shown excellent retention rates.

56. • The introduction of high strength dentin bonding agents and reliable
resin cements will accelerate the progression towards bonded
porcelain used in clinical practice.
• On the other hand long-term study of porcelain veneers is required in
order to study their marginal integrity, marginal staining and their
effect on gingival tissues.
• Finally, the advantages of this technique as a treatment modality
makes it worthy of serious consideration in view of the distribution
and prevalence of certain dental problems confronting the general
practitioner.

57. REFERENCES
• CONTEMPORARY FIXED PROSTHODONTICS-:STEPHEN F. ROSENSTEIL
• ESTHETICS IN DENTISTRY- RONALD E. GOLDSTEIN VOL 1 PG 433-468
• THE SCIENCE AND ART OF DENTAL CERAMICS:J.W.MCLEAN:
(J.OPERATIVE DENTISTRY:1991:16:149-156)
• KARISHMA RAVINTHAR, JAYALAKSHMI. RECENT ADVANCEMENTS IN
LAMINATES AND VENEERS IN DENTISTRY. RESEARCH J. PHARM. AND
TECH 2018; 11(2):785-787.
• SADAQAH, N.R. (2014) CERAMIC LAMINATE VENEERS: MATERIALS
ADVANCES AND SELECTION. OPEN JOURNAL OF STOMATOLOGY, 4,
268-279