Veneers provide a minimally invasive treatment option to change tooth shape, position, color and surface appearance. They can withstand occlusal forces extremely well when made of materials like Dicor or Empress. However, careful case selection and proper preparation, fabrication, cementation and follow up are required to achieve optimal esthetic results and avoid disadvantages like fractures or poor marginal integrity. Newer ceramic materials and techniques have improved the longevity and outcomes of veneer treatments.

4. •Veneer
• Porcelain Laminate
veneer

5. Benefits :
• Minimally invasive t/t method.
• Shape, position and surface appearance :
Change of canine into lateral incisor.
Tooth length, Alignment, Eliminating any displasia / distrophy
• Colour – Bleaching ineffective.
• Durability – Stand up extremely well, Dicor and Empress.
• Light transmission – Characteristics of natural
enamel, bonding material  colour of dentin
and not seen as maskin agent, Transmit light
progressively.
• Tissue response
• Speed and simplicity

6. Disadvantages :
• Preparation – no rectification, special instrumentation
• Esthetic results – heavy discolouration, monochromatic colour.
• Bonding procedures – Error  failure, crucial and demanding
• Fractures – Prior to bonding, No pressure at Try-in
• 90% of fracture – occlusal edge or angle.
• Inadequate depth
• Cohesive nature
• Restrict the flexural stresses
• Fracture rate – no incisal coverage

7. Problems in laboratory :
Handling layering or segmental build up – 0.7 to 0.3 mm.
Post-firing modification :
Feldspathic  can not be re-fired
IPS empress / Duceram-LFC
Temporization
Difficult to adjust at margins.
Poor marginal integrity
Unrealistic long-term expectation
Lacks – tensofrictional grip.

8. New classification of indications for porcelain veneers
Type I : Teeth resistant to bleaching
Type IA : Tetracycline discoloration of degrees III and IV
Type IB : No response to external or internal bleaching
Type II : Major morphologic modifications
Type II A : Conoid teeth
Type II B : Diastemata and interdental triangles to be closed
Type II C : Augmentation of incisal length and prominence
Type III : Extensive restoration (adults)
Type III A : Extensive coronal fracture
Type III B : Extensive loss of enamel by erosion and wear
Type III C : Generalized congenital and acquired malformations.

9. Contraindications
• Insufficient surface enamel
• Pulpless teeth
• Unsuitable occlusion
• Parafunction
• Unsuitable anatomical presentation
• Single laminate veneers
• Caries and fillings
• Poor dental care and hygiene

10. Case selection :
Static and dynamic occlusal relationship
•Mode of failure is fractures
•Occlusion will dictate
•Contacts
•Occlusal interferences and parafunction habits.
Periodontal and oral health status.
•Forms a strong foundation
•Mouth breathers
Condition of tooth
Degree of discolouration
• Bleach
• Tetracyclin staining
• Veneers appear opaque
• Opaque porcelain preferred over GIC

11. Extent of caries
•Little or no enamel
•Surface area of enamel if decreased by 50%
Extent of restoration
•Small enough
•Cavity design
Quality of tooth :
•Amount of enamel
•Amelogensis imperfecata and dentinogenesis imperfecta.
Patients motivation
• Home care and regular recalls
Patient’s expectations
•Realistic
•Diagnostic wax up
Oral habits
•Nail or pencil biting

12. Advantages :
•Less sensitive
•Multiple teeth
•Longivity
•Non invasive
Types of veneers
Partial veneers Full veneers
Indirect Direct
Preferred to be non invasive
Advantages :
•Failure – no damage
•Problems – overcontoured, more chances for dislodgement
•Intraenamel preparation
•Exception – severe abrasion or erosion.

13. Why we need preparation ?
•Provide space
•Flouride rich layer
•Rough surface
•Definite finish line
Location of finish line ?
Subgingivally
•Area is carious or defective
•Significantly dark discolouration

14. Instrumentation :
TPS (Touati) Braeseler Kit in 1985
Advantages : Simple, coded, limited
Instrument Preparation
Garber (1991)
Lusting (1976)

15. Goldstein (1984)
Lusco’s Enamel depth cutter
Labial preparation :
•Uniform reduction - 0.5mm
•Extreme discoloration 0.7 to 0.8 mm
•0.3mm is not recommended
•50% enamel
•Begin with tracing of horizontal grooves
•Cervical and middle striations – incisal / occlusal striation
•Remaining areas of enamel will be removed - TFC 3 and TFC 4
– double convergence

16. Finish line :
•Chamfer 0.3mm-0.5mm
Supragingival
•Increased area of enamel
•Moisture controle
•Visual confirmation
•Accessibility
•Maintenance of hygiene.
Proximal surface :
•Preservation contact area
•Beyond the visible area.
•TFC3 and TFC4 points
•0.8 – 1mm
•Miniature rounded channel
•Interlock improve the stability
and mechanical properties.

17. Location of margins
•Guided by esthetic
Contact area
•Platinum foil technique – open the contact areas
•Refractory cast
Why to preserve the contact area ?
•Extremely difficult to reproduce.
•Simplifies try-in
•Saves clinical time
•Simplifies bonding and finishing
•Better access
Exceptions
•Small proximal caries lesion
•Old composite restorations
•Angle fractures
•Closing a diastema
•Changing shape / position

18. Lingual surface :
•Incisal edges ?
•1980s tissue conservation
•Higher no. of fractures
•Complete coverage of incisal edge is most preferred.
Advantages :
•Angle fracture
•Esthetic
•Altering tooth shape
•Tooth position
•Occlusion to be adjusted
•Easy handling and positioning
•Margin to be placed outside the area occlusal impact.

19. •Reduction – 1mm
•Spherical diamond
•Fine grit diamond
•20,000-60,000 rpm under air/water spray.
•Prepared wet and examined dry.

20. PREPARATION FOR DIRECT LAMINATE VENEERS
Direct partial veneers
•Outline form – extent of preparation include all defective areas.
•Coarse , elliptical or round diamond
•Depth of 0.5-0.75 mm
•It is mandetory to extend periphery to include defect till round
tooth structure.
Direct full veneers
• Window preparation
•Half the thickness of enamel – 0.5 to 0.75 mm midfacially,
•0.3 to 0.5mm long gingival margin.

21. Gingival displacement :
•No special preparation of soft tissue
•In case of subgingival finish line
•Non medicated retraction cords
Frederick M. McInlyre (1993)
•Locate CEJ
•Evaluate emergence profile
•Visualize the thicness
•Protects gingival tissues
•At the time of luting
•Prevents contamination of cervical margin
facilitates the finish acting as a dam.
•Disinfectant surface tension reducer.
Preparation sites dried.
•Impressions are made

23. ONE STEP SINGLE MIX

24. LABORATORY PROCEDURES
Choice of restorative material and technique.
• Number of systems, composite technologies
• Ceramic - most biomimetic - ability to simulate and to restore
crown rigidity.
• High thermal expansion and elasticity, unfavourable esthetics,
unstable marginal integrity and decreased survival rate.
• Ceramics able to compensate for structural tooth weaknesses.
Ceramic : which one ?
Cracking- feldspathic porcelian
In-Ceram spinell, procera, empress
Crack Propensity.
1) No Sharp angles 2) Sufficient thickness
2) Adequate wrapping design 3) Thorough cleaning of surface.

25. Choice of fabrication technique :
•Ceramic fired on refractory die
Advantages :
•No special equipment
•Effects of colour and translucency.
•Traditional feldspathic porcelain
Platinum foil technique
•Data from 90s - superior marginal
fidelity
•Improved refractory material.
•Marginal closure upto 20-40 m.
•No need of ditching.
Other systems are :
Cast glass – ceramics (Dicor)
Pressed ceramic (Empress)
Slip casting (In Ceram spinell)
Machined ceramics (Cerec)

26. Master cast in the refractory Die technique :
Method :
First pour – individual dies
Most accurate production
To verify the final fit of the restoration.
Refractory dies :
Control dies duplicated
Two sets of replicas

27. Preparatory steps
• Mark the margins
• Dehydration firing 11000C for 5 min.
• Connecting porcelain
- Sealer for the refractory surface
- Adhesive towards which the firing shrinkage should occur.
• Smaller the dies better the marginal fit.
Second Pour : Solid cast
Used for final intra and interarch contact points.

28. Third pour : Soft tissue cast
Advantages :
Dies inserted interchanged
Cermic layering process

29. Ceramic layering and finishing :
2-3 consecutive firings followed by glazing.
1) Opaque dentin firing :
Situations: stained teeth and # incisal edges.
 light absorption at level of missing natural dentin.
Dentin buildup :
Higher croma in cervical
region and higher
value in incisal region.
Cutback :

30. Enamel Incisal wall :
•Horizontal pure enamel
•Life like appearance alternating
translucencies and chroma.
•Buildup oversized
Dentin Characterization :
•Internal effects – fluorescent and non-
fluorescent stains.
•High value – ideal for highlighting
mamelons reduce value.

31. Enamel covering :
-Entire facial surface
-Thirds of facial surfaces covered separately.
-Cervical transperant enamel.
-Combination of shaded enamel – applied
alternately.
-Blue translucent enamel
-Fired work – high value, middle third, average
value cervical third and low value incisal third
60-70% of natural teeth.

32. Contouring :
•Without alteratering essential characteristics.
•Accentuation of crest and transition line angles.
Glazing and surface finishing :
•Well condensed porcelain, adequate, firing - porosity.
•Glazing and polishing esthetics and surface characteristics.
•Diamond-silicone wheels – overglazing or autoglazing –
pumice and calcium carbonate.
•Attached to refractory dies.
•Correction firings must be carried out only with low-fusing
ceramics.

33. Tray-In
•Cleaning the preparation
•Removed the adhesive resin from spot etched area of tooth.
Sequence :
•Individually placed & adaptation is checked.
Note : Excess provisional luting
•All restorations - verify proximal relationship
•Approval
•Not to close the bite.
•Acetone, ethanol, methanol, methylene chloride.
•Can potentially reduce bond strength
•Conditioned after try-in and not before.

34. BONDING PROCEDURE
Conditioning of ceramic surface
•Combination of micromechanical interlocking and chemical
coupling
•Eg. Accu placer, Hu-friedy
A large amalgam condenser
Micromechanical interlocking
Hydrofluoric etching
•Strict protective measures

35. • Feldspathic porcelain – dissolution of glassy matrix - retentive
holes and tunnels.
• Ultrasonic cleaning
• Reaction products of Na, K, Al, and Ca.
• Ceramics with poor glossy content
Eg. In-Ceram or procera core material or pure non-crystalline
ceramics eg. Ducera LFC hydrothermal glass.
• Sintering of Si particles.
• Lithium-base hot pressed ceramics
• Lucite based hot pressed ceramics – chemical coupling

36. Chemical coupling : Silanization
•Silica content or chemical bond
•-methacryloxypropyl trimethoxy silane
•Inorganic substrates and organic polymer.
•Improved wettability MA MA
•4 weeks followign activation
•2-3 coats
•Allowed to evaporate
•Heat treatment
•Dry furnace at 1000C for 5 min.
Ex. In-ceram and procera – Tribochemical silica coating

37. •Neutral composite
•Viscosity 
1
Temperature
Definitive insertion
Advantages :
• Protects from etchent
•Correct seating
•Accumulation of excess
Avoid air bubbles

38. CONDITIONING OF THE TOOTH SURFACE
Enamel :
30 sec etching with 37% phosphoric acid – preparation in enamel.
Significant Dentin exposure :
•Anticipated and solved tooth preparation
•Dentin adhesive prior to making the impression.
•Enhances bonding protection of pulp. Prevents tooth
sensitivity
•Final bonding, cleaned with pumice
•Enamel conditioning.

39. Placement of ceramic restoration :
•Intense light
•Avoid removal of composite at interface.
•Extrusion of composite at margins.
•Flassing avoided crack, displacement or detach.
•Chipped off by scalpel
Light curing – intermittent

40. • Opaldam
• Polymerization at the marginal area - glycerin gel
• Oxygen inhibition
• Rapid degradation
• Multiple restorations - parallel bonding procedures
simulatneously on several teeth - not recommended .
• If any problem in seating arises
• Dipped in acetone and cleaned
• Alcohol pallet – to remove resin residues.
• Reconditioning of enamel
• Ceramic reapplication of the silane

41. FINALADJUSTMENT AND OCLUSAL CONTROL
•Immediately adjusted (maximum intercuspation)
•Maintenance or re-establishment of an adequate and functional
anterior guidance.

42. SPECIAL CONSIDERATIONS
Interdental adjustments during luting procedures
•Passive fit
•Care extensive wrapping and long interdental contacts
•Articulating paper and abrasive

43. Shrinkage of luting composite
Compressive forces Vs thermal expansion
• Shrinkage compressive forces
• Shrinkage forces – counteract expanding forces
Water sorption
• Water uptake complete relief of shrinkage stresses.
• Ideal nonshrinkaging composite. Thermal expansion lowered,
stress distribution within the ceramic will still be impaired.
• Static stress shrinkage alone does not seem to cause crack /
flaws, repeated thermal loads key role.

44. Prebonding cracks
•Cracked procelain
•Vertical eracks internal surface enlarged and adequately
conditioned efficient sealing of the flare by adhesive resin will
occur.
•Initiating outer surface are irreparable.

45. Fluoridation :
Sodium fluoride (2%) is preferred to acidulated phosphate
fluoride (1.23%) gels
Etching effect and damage to ceramic surface.
Chipping :
•Cohesive fracture
•Polished fine grain diamonds and silicon points and left as
it is.
•Severe cases – by sandblasting and silanization and repair it
with composites.

46. Fracture :
Debonding at porcelain composite
interface
•Improper bonding
•Contamination of etched surface
•Improper use of silane coupling
agents.
•Insufficient drying
Debonding at tooth-composite
interface.
•Tooth substrate is dentin.
•Omission of immediate dentin
boding.
Postbonding cracks :
•No procedure
•Not a risk for the remaining underlying tooth
•Can occur quite early – no progression over the years.
•Replaced on patients request

47. Composite resin : Indirect technique restorations
Basic concept :
• Cured – polymerization shrinkage
• Direct technique marginal gap weakest bond strength.
• Cured in laboratory – shrinkage occurs before luting
composite subject to shrinkage. Less marginal gap.
Advantages :
• Accelerated wear of opposing natural tooth
• Composites can be adjusted and repolished easily.
• Can be repaired

48. Composite resin systems :
• Microfilled resins
• Small particle composite resins
• Hybrid resins
• Acid etched or silanated
• New category of processed composite has introduced.
• Polymer-glass, polymer-cermaic, ceromer (ceramic-optimized
polymer)

49. Apply layers of dentin, enamel, and incisal shades and cure
each layer for 40 seconds
• Remove the veneers from the flexible model.
• Contour and polish the veneers 12 and 30 fluted finishing
carbide burs in a high-speed hand piece or porcelain contouring
and polishing wheels on a lathe.
• Place the veneers on the original stone model to check the fit
and margins.
• Curing as per the manufacturers instruction
• These praessed composites canbe conditioned and bonded in a
similar manner as the porcelain laminates.

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