In the last decades the development of the porcelain materials, the reliable bonding strength to enamel and dentin, and the bonding of resin cement to the porcelain through the silane, Porcelain laminates become trusted type of treatment in the daily practice.
It is an aesthetic treatment that concerns mainly the labial face of the anterior teeth, its thickness is about 0.3 mm in the cervical area to 0.4 -7 at the incisal third, in certain cases it can be done without any prep or just little touch of the enamel (lumineer), but in most prep is indicated to improve the adaptation in the cervical area also to remove the aprismatic enamel layer which which has low bonding strength with the resin cement, however prep should be in the enamel limits, 3 different type of prep are practiced, however, they are the same on the labial surface but the but the difference concerns the incisal edge.
In this lecture, indications and contraindications are exposed. All the materials in use and their indications as well as the clinical procedures are detailed.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
By definition, a veneer is a small sheath-like cover that conceals a particular entity. In dentistry, a veneer is a small piece of porcelain or composite material that fits over a tooth’s enamel, covering teeth abnormalities for a beautiful smile.
Here we discuss various types of veneers, their uses , preparation types as well as the recent advances in a phased manner.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
This presentation is all about restoration of endodontically treated teeth, prefabricated post and core, cast post and core, direct and indirect technique.
Dental Ceramics and Porcelain fused to metal isabel
Dental porcelain (also known as dental ceramic) is a dental material used to create biocompatible lifelike dental restorations, such as crowns, bridges, and veneers.
By definition, a veneer is a small sheath-like cover that conceals a particular entity. In dentistry, a veneer is a small piece of porcelain or composite material that fits over a tooth’s enamel, covering teeth abnormalities for a beautiful smile.
Here we discuss various types of veneers, their uses , preparation types as well as the recent advances in a phased manner.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
a detailed account of the principles of tooth preparation with main reference from Shillingburg
The presentation is available on request. Mail me at apurvathampi@gmail.com
This presentation is all about restoration of endodontically treated teeth, prefabricated post and core, cast post and core, direct and indirect technique.
Dental Ceramics and Porcelain fused to metal isabel
Dental porcelain (also known as dental ceramic) is a dental material used to create biocompatible lifelike dental restorations, such as crowns, bridges, and veneers.
history, classification, types of veneers, indications and contraindications, working procedure, preparation, ipmpression taking for veneers, surface treatment and cementation, veneers vs crowns
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
The pediatric dentistry in the restorative to the damaged tooth by the caries and the prevention for the further shedding and erupting of the permanent tooth.
PARTIAL BONDED RESTORATIONS AND IT’S ADHESION.pptxPranitaGandhi2
Indirect restorations in dentistry. seminar using combination of some of the most comprehensive articles giving an insight on preparation and bonding of partially bonded restorations
Dental Esthetics include the use of bonded ceramic veneers and laminates. This presentation helps to understand various concepts relating to the preparation and utility of such restorations. - Dr. Abhishek John Samuel, MDS (Endodontics)
Metal free ceramics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Porcelain fracture in the patient mouth is areal frustration for both the patient and the dentist, a review of the causes of this problem, whether are technical or clinical, is done. However, it is considered as a frequent problem in the dental office, a review of the different option for managing this dilemma is exposed.
The Pt. adaptation on his complete dentures are based on the ability of the dentures to restore the missed functions due to the loss of the teeth. Good impression is the first step in the success of the complete dentures. A trial to review all the basics necessary to have a good impression is exposed in this lecture.
In prosthodontics, replacing the missing, without affecting the other components of the masticatory system has two main reference the maximum intercupation and the centric relation.
In this lecture discussion of centric relation as reference is exposed.
This presentation describe the evaluation of badly damaged teeth for crowning before starting RCT treatment, because the treatment of such teeth is always achieved by crowning otherwise they will end for extraction. All the necessary procedures to save the damaged teeth are discussed in the context of restoring function, aesthetic and mechanical qualities. Evaluation of any case based on scientific data will insure durability and patient satisfaction.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
2. 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.
3. Introduction.
Alteration of these elements, separately or
together, can be done by;
Bleaching.
Orthodontic treatment.
Fillings.
Crowning.
Porcelain facings ( veneers ).
Porcelain veneers, to certain limits, can alter the
color, the shape, and the position of the anterior
teeth by a minimal amount of tooth preparation
in the enamel limits ( 0.3-0.7mm).
4. Introduction.
The following points;
Esthetic and mechanical qualities and biocompatibility of the
porcelain.
Saving of tooth tissues.
Durability and reliability.
improved quality and strength of bonding.
( the needed force to remove a PV is 63 MPa ).
Make the veneers a recommended treatment for the dentist and a
requested treatment for many patients.
Actually they are considered the first alternative to improve the
esthetic of the anterior teeth and by consequent the related
quality of life.
5. Introduction.
Porcelain laminate veneers were introduced into
dentistry as Hollywood veneers by Pincus (1930).
Buonocoreintroduced the concept of acid-
etching enamel as a means of mechanical
retention that composite resin restoratives had
retentiveness.
Simonsen and Calamiadiscovered composite
resin’s ability to bond to porcelain if the ceramic
was treated with hydrofluoric acid. In 1983.
17. Contraindication..
1. Available enamel; at least the periphery of
the laminate veneer should be surrounded by
enamel, lack of enamel support indicates
crowning of the concerned tooth.
2. Ability to etch enamel; the bonding of
laminates is a micro-mechanical process of
etching. Deciduous and highly fluoridated
teeth may not etch effectively.
18. Contraindication..
3. Oral habits; bruxism and nails and foreign
object bite. Porcelain withstands compressive
force than shearing stress.
4. Patients with high caries index.
5. compromised periodontal health.
6.Endodontically treated teeth; a full crown
would hold the integrity of the non vital teeth
than a veneer.
Teeth with gum recession.
19. Contraindications…
7.Tooth with extensive restorations and small
triangular teeth.
8. Unstable occlusion; pronounced overbite,
edge to edge occlusion, pronounced over jet,
severely crowded teeth and cases which have
to undergo another type of treatment ( endo,
resto, perio, and orthodontic).
9. reduced inter occlusal distance and deep
overlap (higher tensile and shear stress).
21. The current used materials.
Based on the lab procedures used to fabricate
these laminate veneers;
1. Sintered feldspathic porcelain. Using
platinum foil.
2. Pressable ceramic by injection (feldespath
+ leucite).
3. CAD/ CAM technique (feldspath reinforced
with leucite or lithium block) .
22. The current used materials.
Based on translucency and opacity ;
1.The amorphous glassy microstructure (non
crystalline) appears translucent (SiO2, quartz
with small amount of alumina, feldspath).This
type has low flexural strength.
2.The crystalline microstructure appears opaque
(ZrO2, Al2O3).This type has high flexural
srength.
The used porcelain for facing is feldspathic and
glass infiltrated (ceramic), both of them have
long term survival rate 96-98% for 5 years.
23. The current materials
In general feldspathic, glassy and translucent
highly imitate the enamel, bonding to
enamel increase its strength, most of the
cases can be treated by glassy porcelain.
Feldspath + leucite or lithium can be pressed
or milled. It has high translucency and high
flexural strength (cerinate).
Incase of deep stain, a sintered zirconia
milled using CAD/CAM of 0.2mm then a
felspatic veneer is baked over it of 0.4mm.
24. 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.
27. 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).
28. Shade selection.
How to match a shade;
1. Pt. should have neutral color clothes and
remove the lip stick.
2. Clean the teeth, and have Pts mouth at the
dentist’s eye level.
3. Use the canine as a reference for shade
because of the highest chroma of the
dominant hue of the teeth."
30. Shade selection.
4. If unable to precisely match the shade,
select a shade of lower chroma and higher
value.
5. Obtain value levels by squinting.
6. Shade comparisons should be performed
at five-second intervals.
31. Shade selection.
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.
It is impossible to mask a strong discoloration by
a thin layer of porcelain (0.3–0.7 mm) without
making the restoration opaque and lifeless.
34. Prepare or not to prepare.
The porcelain facets, laminates, or facings
include the lumineers and the veneers.
Lumineers are as thin as contact lens and
bond to the teeth with very little if any prep.
They are made of cerinate porcelain
(feldspath leucite reinforced).They are strong
(F. strength 216 Mpa).
Its thickness as thin as 0.2 to 0.3 mm.
They are designed using CAD CAM or
pressable ceramic.
36. Prepare or not to ..
The advantages of lumineers are; no need for
injection, no prep or little, its placed completely
on the enamel so no sensitivity at all and it can
be removed without damage to tooth tissues.
But, due to no prep a small bulk and larger teeth
are likely to develop, also, due to its thickness, it
can not cover all the indications of the facets.
They are considered as ideal for minor cosmetic
adjustment.
37. Tooth prep for veneers.
The ultimate key to long-term success with
etched porcelain veneers is to use an intra-
enamel preparation. Research shows that
bonds to enamel are far more predictable and
durable than those to dentin.
Several methods to attain the required
preparation.
1. Free hand.
2. Use depth or cut grooves.
38. Tooth prep..
3. Use of silicone putty index. It derived from
the wax-up model that allows a visualization
0f reduction required of the preplanned
veneers.
Different types of preparation differ only at
the incisal region of the tooth.
42. Tooth prep Incisal edge ..
a. No reduction of the incisal edge, this the
case where there no modification of tooth
length, also it is called window prep.
B. 1.5-2 mm reduction of the incisal edge
(Incisal butt).
C. Incisal reduction that carried the incisal
edge from labial to palatal, which provide a
positive seating during cementation. Also
margin is not subjected to protruded forces
so stresses are reduced on the veneer.
45. Proximal contact..
Do not break the proximal contact (prepare
2/3 of it).When the teeth are not spaced.
In case of spaced teeth, include the proximal
by slice prep.
47. Cervical margin prep..
It will be chamfer design with maximum
depth 0.3-0.4 mm, also it should be supra-
gingival or at the gum level (use the
retraction cord when taking the impression).
This design allows the veneer to integrate in
the tooth anatomy without any discernible
demarcation.
No dentin exposure which give less chance to
micro leakage.
48.
49.
50.
51.
52. Final impression.
Before taking the final impression of the
prepared tooth, fabricate a preliminary
provisional restoration using a bis-acryl
provisional material.This will give the chance
to evaluate the thickness, the shade, and the
alignment which can be modified before the
final impression.
This could be done by a silicone impression
of the waxed-up model, filled by acrylic and
inserted in the mouth till setting.
53. Final impression.
Use metallic tray (rim lock) to avoid any
distortion or separation of the impression
material.
Vinyl polysiloxane is the material of choice.
You can use the wash technique or double
mix technique.
In case where the dentin is exposed mainly in
the cervical, use the dentin adhesive before
the impression.
54. Cementation…
1.Try in ..
Remove provisionals, clean, isolate and dry.
Moisten the veneers, place them on the
teeth, and check up the fit and the shade.
Use try-in paste to adjust the shade (water
soluble).
Use 37% Ph A for 30 sec to clean the veneers
if they are etched in the lab.
Rinse and dry.
55. Cementation..
2. cementation..
Apply silane to the etched teeth for 60 sec and
air dry.
The teeth are well cleaned, dried and isolated.
Etch for 10 to 20 sec, rinse and dry.
Apply enamel/dentin bonding and light cure the
adhesive, or do not cure up to the manufaturer
instruction prior to seat the veneer.
Apply unfilled resin if indicated.
Apply composite resin on the veneer and place it
in an inciso-gingival direction
56. Cementation..
Hold the veneer and check its proper seating,
remove any additional excess using adhesive
coated brush.The adjacent teeth should be
isolated using celluloid strips, cure starting in
the gingival area for 10 sec, some request
curing in the center first then proceed
removing the excess. then continue around,
then the whole face for 60 sec.
If all the anterior teeth are concerned,
cement 2 by 2 starting from the midline.
57. Cementation..
High filled resin cement should be applied in the
cervical when the margins are in the dentin, this
cement has reducedTEC and reduced setting
shrinkage. So that reduced microleakage
consequently sensitivity, discoloration, and
recurrent caries.
58. Cementation..
Tay et al. [109] advised to remove the excess
of non- polymerised composite cement with
a brush moistened with bonding resin.This
will reduce the dragging out tendency of the
resin out of the marginal gap and ensure a
smoother margin that is polishable.
59. Cementation.
Light curing is preferred for porcelain veneers.
It has the following advantages; in addition to its
color stability , it has long working time
compared to dual cure or chemical cure cements
which give enough time to finish.
The porcelain veneer absorb between 40-50% of
the emitted light.Thickness and opacity
determine the light transmittance.
Use dual cure when the thickness exceeds
0.7mm.
60. Cementation..
Finishing..
Remove gross excess using sharp hand
instruments or fine and extra fine diamond
finishing burs.
Finish the proximal using fine strips.
Place the next two.
Use porcelain finishing paste for polishing if
needed.
Check up the occlusion.
61.
62. Related facts.
Enamel reduction is required to improve the
bonding strength. Doing so means removal of
the aprismatic enamel layer which offer less
retention.
Reduction is in the limit of 0.3 to 0.7 mm. free
hand always remove more than 0.5.
If dentin is exposed, use dentin bonding after
prep directly and provisional restoration is
important.
96% of success rate refers with incisal coverage,
86% W/O incisal coverage.
63. Related facts.
Clinical exam and diagnostic impose the amount
of prep as well as the type of restoration.
To successfully bond veneers, 50% of the bonded
substrate must be enamel, 70% or more of the
peripheral must be in the enamel.
higher failure rates in vivo when porcelain
veneers were partly bonded to underlying
composite restorations. It is advised to change
the old fillings to improve the retention.
64. Related facts
Preparation depth in the range of 0.4 to 0.6
mm was largely seen to be intra enamel,
except in the cervical region. (cherokara et
al).
Wax-up, followed by silicone index, is an
important step, in certain cases, to visualize
the predicted results.
Transparent resin cement is suitable for 90%
of the cases.
65. Related facts.
The mean vertical marginal discrepancy (for
all positions combined) for platinum foil
veneers (187 mic) was significantly less than
that for veneers made with the refractory die
technique (242 mic). ( another study 74 versus
132 mic),
Light-cured and dual-cured luting
composites show a similar leakage pattern at
the luting composite/tooth inter- face
according to Zaimoglu et al.
66. Related facts.
The strength of the combined
porcelain/luting composite/enamel bond (63
MPa), composite/etched enamel (31 MPa)
and luting composite/etched-and-silanized
porcelain (33 MPa) bond strengths.
Poor adaptation means large gap, due to the
setting shrinkage (volumetric S. 2.6-5.7) will
create marginal opening and expose the
cement to wear.
67. Related facts.
Ceramic composition and surface
treatment protocols
Ceramic Conditioning Feldspathic 9.5%
hydrofluoric acid for 2 to 2.5 min; 1 min
washing; silane application. Leucite-
reinforced 9.5% hydrofluoric acid for 60 s; 1
min washing; silane application. Lithium
disilicate-reinforced 9.5% hydrofluoric acid
for 20 s; 1 min washing; silane application
68. Related factors.
During cementation, due to setting shrinkage
and bonding retention certain veneers may
crack, leave but follow up.
A ceramic and luting composite thickness
ratio above 3.This ratio also appears to have
a relevant influence on the stress distribution
in porcelain laminates.Too thin veneer ,
combined with poor internal fit , resulted in
higher stresses at both the surface and
interface of the restoration.
69. Related facts
Micro leakage at the luting composite/porcelain
interface was negligible compared to the luting
composite/tooth interface.
Setting shrinkage and difference of TEC between
the resin , tooth tissues and porcelain, will cause
stress at composite/ enamel, and composite/
porcelain.
Due to the aprismatic enamel in the cervical leakage
is more pronounced.
Stresses are more important than in a composite
filling (done by increment).
70. Relate facts.
Vitro studies have demonstrated a
dissolution of the resin matrix of composite
resin in oral fluids, so that decreased filler in
the resin cement means higher dissolution
and more gaps.
As a conclusion, microleakage can be
minimised by locating the preparation
margins of the veneer in enamel and by
selecting a highly filled luting composite.
71. Maintainance.
1. Avoid colored beverage during initial 72-97
hours.
2. Use soft brush with non abrasive tooth-
paste.
3. Do not shear or bite hard objects.
4. Avoid acidulated mouth rinses.