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VENEERS: YOUR SMILE'S BEST KEPT SECRET.pptx

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SatvikaPrasad

Veneers are a transformative dental solution that offers a seamless blend of aesthetics and functionality, making them a popular choice for enhancing smiles. These thin, custom-fabricated laminates are primarily constructed from either high-grade porcelain or composite resin materials, both selected for their superior aesthetic and functional properties. Veneers are meticulously bonded to the labial surfaces of anterior teeth, providing a definitive solution for a variety of dental conditions, including intrinsic discoloration, enamel defects, minor malalignments, diastemas, and structural deficiencies such as chips or fractures. The preparation for veneer placement typically involves minimal reduction of the tooth structure, preserving the maximum amount of healthy tooth while allowing for optimal adhesive bonding. This conservative approach is pivotal in maintaining tooth vitality and structural integrity. The precise customization and application of veneers require a thorough understanding of dental materials, occlusion, and esthetic principles, underscoring their role as a sophisticated and effective treatment modality in contemporary prosthodontic practice.

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VENEERS : YOUR SMILE’S BEST KEPT SECRET DR. SATVIKA PRASAD MDS DEPT. OF PROSTHODONTICS
CONTENTS • Introduction • Definition • History • Types of veneer system • Indications and contraindications • Shade selection • Tooth preparation • Types of preparation • Armamentarium • Procedure • Impression • Provisional restoration • Laboratory procedures • Try in • Cementation • Maintenance • Failures of laminates veneers • Recent advances • Conclusion
INTRODUCTION • The public is bombarded by media extolling the virtues of “ THE PERFECT SMILE ”. • The dental profession is faced with specific aesthetic 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 have evolved over the last several decades to become one of aesthetic dentistry’s most popular restoration. • The laminate veneers is a conservative alternative to full coverage for improving the appearance of an anterior tooth.
DEFINITIONS VENEER :- • A thin bonded ceramic restoration that restores the facial surface and part of the proximal surfaces of teeth requiring aesthetic restoration -GPT 8 • A superficial or attractive display in multiple layers, frequently termed as laminate veneers - Rosensteil • A conservative esthetic restoration of anterior teeth to mask discoloration, restore malformed teeth, close diastemas & correct minor tooth alignment. - Mosby’s dental dictionary
HISTORY 1970s Laminates were bonded to teeth using composite resin, but due to polymerization shrinkage and high thermal expansion marginal adaptation was compromised 1955 Buonocore discovered that resin filling materials adhere to ‘acid etched enamel’ 1960s Rafael Bowen incorporated Bis-GMA into composite resins 1973 Ceramic etching and bonding by Rochette 1980s Bonding porcelain to etched surfaces • Calamia et al - application of silane coupling agent = improved bond strength • Hsu et al – mechanical retention increased by etch Shear bond strength of etched is 4 times more than that of unetched 1930s Dr. Charles Pincus used thin porcelain veneers to improve esthetic of movie stars with the help of denture adhesive
1. Minimally invasive - conservative 2. Excellent color and light transmission - good aesthetics 3. High color stability 4. Good tissue response 5. Excellent durability – good strength, wear resistance and no fluid absorption 6. Speed and simplicity 1. Tooth preparation, however minimal, is required 2. Cementation is time-consuming and technique sensitive 3. Fragile may fracture if improperly handled during try-in or cementation. 4. Proper selection of underlying cement is critical for success 5. Difficult to repair 6. Cost ADVANTAGES DISADVANTAGES
TYPES OF VENEERS SYSTEM 1. Indirect Resin System 3. Direct Resin System 2. Porcelain Indirect System
Direct composite technique • Only 1 appointment is required • The dentist directly controls form and color. • Cost is reduced • Composite veneers are repairable Indirect porcelain technique • The dentist may use the time saving and artistic skills of ceramist • Multiple units can be placed with less chair time • Porcelain is the optimum material for color stability, esthetics, wear resistance and tissue compatibility Indirect resin system • Resin and composite processed at elevated pressures and/or temperatures (Dentacolor, Isosit, Visio- Gem) • Castable hydroxyapatite • Injectable ceramics (Dicor, Cerestore) It involves laboratory fabrication of the veneers, compensate for the short comings of the direct composite resin technique Processed materials other than porcelain have been suggested for the indirect technique Veneers made of a composite resin material applied directly to your teeth
• The indirect resins have better physical properties than light cure composites, but reduced bond strength. • The cast ceramics have the advantage of wax-up stage, excellent translucency, and reduced plaque adherence, but technique sensitive • 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
Color / contour abnormality • Bleaching • Cosmetic contouring • Esthetic fillings Does the patient have these conditions? • Bruxism / clenching habit ? • Severe discolorations ? • Single unit? • Limited finances TREAT WITH DIRECT COMPOSITE VENEER Are results ok ? YES NO NO TREATMENT SUCCESSFUL TREAT WITH PORCELAIN VENEER NO Select porcelain shade slightly lighter then desired shade Is tooth free from • Faulty restorations ? • Abnormal/ unesthetic contours ? • Caries? YES NO • Cosmetic coronoplasty • Recontour incisal edges • Restore/ replace defects with GIC of suitable shade PREPARE TOOTH FOR PORCELAIN VENEER YES
Can veneers bond to composite or GIC ? • Veneers can be bonded to sound composite or GIC 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 promote fluoride also.
INDICATIONS • Extreme discolorations: Such as tetracycline staining, fluorosis, devitalized teeth and teeth darkened by age which are not conducive for bleaching • Enamel defects: Small cracks in the enamel due to ageing, trauma or hypoplasias • Diastemas: 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 • Repair of functionally sound metal-ceramic or all- ceramic restoration with unsatisfactory color: The labial surface of old porcelain restoration is prepared and a ceramic laminate is bonded correcting the anomaly. • Tooth fracture: Restricted to incisal thirds. • Restoring anterior guidance in worn mandibular incisors. Tetracycline staining Enamel defects Diastemas Peg lateral
CONTRAINDICATIONS • Insufficient coronal tooth structure: Fractured teeth with more than one-third loss of tooth structure, grossly carious or extensively restored teeth Full coverage restorations are preferred • Actively erupting teeth. • Parafunctional habits like bruxism • Severe periodontal involvement and crowding • Endodontically treated teeth: Present a poorly receptive surface for bonding and full coverage restorations are indicated.
SHADE SELECTION • This should be done at the beginning, during the consultation or treatment planning appointment • It has to be done when the teeth have not been dried out for any period of time. • It is done under a color corrected light or outside in daylight
• A shade is selected from a porcelain system that is one half shade lighter than the desired. • This provides the dentist latitude and allows for a slight darkening attributable to increase translucency with polymerization of composite luting cement. • The conventional shade guides such as vita porcelain shade guide, are not ideal for veneers because their porcelain thickness is high • Now-a-days VITA Easyshade V digital spectrophotometer was developed for precise, fast and reliable shade determination of natural teeth and ceramic restorations.
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 • Rationale:- • Enamel preparation is done: 1) To provide adequate space for porcelain opaquing and composite resin luting materials. 2) To remove convexities in the surface and provide a definitive path for insertion. 3) To assist veneer seating during placement and bonding the laminate. 4) To facilitate margin placement 5) To provide adequate contour and color without over contouring
TYPES OF PREPARATION • Type I – contact lens type / window • Type II – feather • Type III – butt joint or bevel • Type IV – wrap around or ¾th type or overlap
Type I – Contact lens type or Window type • Veneer is taken up to the height of the incisal edge but does not cover the incisal edge
Type II – Feather • Feather preparation: in which the incisal edge of the tooth is prepared bucco-palatable, but the incisal length is not reduced
Type III – Butt joint or Bevel • Bevel preparation: in which the incisal edge of the tooth is prepared bucco-palatable, and the length of the incisal edge is reduced slightly (0.5-1 mm)
Type IV – Overlap or Wrap around or 3/4th • Incisal overlap preparation: in which the incisal edge of the tooth is prepared Bucco-palatable, and the length is reduced (about 2 mm), so the veneer is extended to the palatal aspect of the tooth
Armamentarium • A diamond depth cutter with three 2mm diamond wheels mounted on a 1 mm diameter non cutting shaft. The radius of wheels from the non cutting shaft is 0.5mm which produces a depth cut of 0.5mm • A diamond depth cutter with a wheel diameter of 1.6mm. Produces a depth cut of 0.3mm. • Round end tapering diamond (medium and fine grit) • Finishing diamond burs • Airotor handpiece
Procedure • It involves following steps- • Labial reduction • Proximal reduction • Sulcular extension • Incisal reduction • Lingual reduction
Labial reduction • The thickness of the ceramic laminates should be 0.5mm • To achieve this, the labial preparation should achieve a uniform reduction of 0.3- 0.5mm, less gingivally and more incisally • This involves – • Depth cuts • i.) round bur • ii.) depth grooves • Reducing remaining enamel
• For using depth grooves, a 0.5-mm depth cutter is used across the facial surface. • With the help of pencil, the base of the depth cuts are marked • Then, a coarse diamond bur is used to a depth across the whole facial surface up to the depth of the pencil marks A medium grit round ended diamond bur is used to remove a uniform thickness of facial enamel by joining the depth grooves
Triple angulation • To provide a natural healthy look for the incisor that mimics its true convex nature, a uniform removal of the substrate is essential and can be achieved through the use of the bur, keeping it at three different angles. • One of the main characteristics of the veneers is biological preservation. This is possible when the buccal contour is preserved during preparation, by following the three inclinations of the natural tooth; the cervical third, middle third and incisal third. • So, the veneer can be inserted in a rotational movement allowing preservation of the enamel and access to cervical and proximal undercuts areas.
• Otherwise, one plane facial reduction may come too close to the pulp. • Tooth preparation without respecting the facial convexity. Such straight preparation can result in irreversible pulp damage. • If the incisal or the cervical third is not prepared deeply enough, the final restoration may be overcontoured in this area.
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, just continued into the proximal area (halfway). • It is ensured that the diamond is parallel with the long axis of the tooth. • Proximal reduction should stop just short of breaking the contact. • Margin should be hidden within the embrasure area.
• Reasons to prevent contact area:- 1. It is an anatomical feature that is extremely difficult to reproduce. 2. It prevent displacement of the tooth between the preparation and displacement of gingiva if no provisional restoration is planned. 3. Post insertion oral care is easier 4. Simplifies try in – no need to adjust the contact 5. Simplifies the bonding and finishing • To open the contact • Certain clinical circumstances, such as: 1. Closing a diastema or changing the shape or position of a group of teeth, may require some specific preparation of the interproximal areas in order to allow the dentist, greater freedom in alteration of the form or position. 2. The existence of caries, defects or preexisting composite fillings. In such cases, it is important that after a thorough elimination of carious dentin, the weakened residual enamel thickness be evaluated.
Sulcular extension and margins placement • Margins should be place – subgingivally or equigingivally mainly for better esthetics • A rounded 0.3 mm chamfer serves as an ideal finish line for ceramic laminate veneer 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 are easily inserted at try in and final placement
• Supragingival Margin: Placement of the gingival margin supra-gingivally or coronally frees the gingival margin. This has many advantages such as: Eliminating the chances of injury to the gingival tissue Decreasing the risks of undue exposure of the dentin in the cervical region Obtaining crisp clear margins offering easier access to the finishing and polishing stages with easily accessible margins. Impressions are easier to make. During the try-in and bonding stages, proper isolation of the operative field is easier, so moisture control and the chances of contamination during adhesive procedures are reduced.
Postoperatively it eliminates the possibility of impingement on biological widths by an inadvertent overextension of the preparation Making it possible for the patient to perform meticulous hygiene in this critical region. Allowing the dentist to evaluate marginal integrity during the follow-up and maintenance visits. Increasing the likelihood that the restoration will end on enamel and this increased area of enamel is extremely important for stronger adhesion and less microleakage in the future. • Restrictions to enamel is a necessity for marginal tooth preparations and bonded restorations as exposure of the dentin margins may reduce bond strengths and increase the chance of microleakage. • When the preparation margins are completely located in the enamel, microleakage is minimal or none at the tooth-luting agent interface and negligible in the resin/porcelain interface. • It is always better to finish the cervical margin on enamel since more microleakage has been found at the luting composite/tooth interface when the cervical preparation margin was located in the dentin.
• Subgingival Margin: • The reaction of the gingival tissues largely depends on the cervical extension of the restoration in regard to the location of the gingival margin. Generally, the major etiological factor in periodontitis is the subgingival placement of a restoration. • In a majority of the cases, it is best to place the subgingival extension of the intra-suclar margins at about half the width of the crevice depth :- to create a buffer zone between the epithelial attachment and the bur, to prevent encroaching of the epithelial attachment of the biologic width if the preparation was extended deeper than the desired depth. to leave enough space for the gingival cord placement. The deeper the restoration margin resides in the gingival sulcus, the greater the chance of inflammatory response and that such tissues can bleed upon probing. DISADVANTAGE ADVANTAGE The difficulty of visually following the cervical margins so that even the experienced restorative dentist can miss marginal defects. It allows the technician to preserve the existing height of the papilla as well as to make certain that all interproximal spaces and/or diastemas will be closed while permitting control over the emergence profiles.
Incisal preparation • The incisal reduction is done the same way in that a specific sized bur is used to create depth cuts. • The same bur is then used to remove material in between the depth cuts to obtain adequate incisal reduction
ADVANTAGES DISADVANTAGES WINDOW Retain natural enamel over incisal edge Incisal edge is weakened by the preparation. Esthetically not pleasing as the margins may be visible FEATHER Guidance on the natural tooth is maintained Veneer is fragile at the incisal edge and get dislodged during protrusive movements BUTT / BEVEL More control over incisal esthetics More extensive tooth reduction OVERLAP Provides a positive seat for luting the veneer More extensive tooth reduction
Palatal preparation • Any reduction of the incisal edge would necessitate some lingual enamel modification so that there is no butt joint at this incisal/lingual junction but rather a rounded chamfer. This modification will help to prevent the porcelain from shearing away from the incisal edge during function. • The round end tapered diamond is held parallel to the lingual surface with its end forming a slight chamfer 0.5 mm deep. • The lingual extension will also enhance the retention and increase the surface areas for bonding.
IMPRESSION MAKING • A single impression, double mix or a combination, of putty and light body is recommended for laminates. • A double impression technique using spacer is not recommended due to the reduced thickness of laminate as compared to crown, which leads to greater shrinkage of light body. • The impression is made with a standard fixed prosthodontic impression materials such as addition silicones as they have - excellent accuracy, remarkable mechanical properties and good dimensional stability
• The light body is syringed on the prepared teeth and gently spread so that the entire preparation is covered and no air bubbles exist. • A simultaneously mixed putty, or heavy body is loaded on a stock tray and inserted over the light body material and impression is made.
PROVISIONAL RESTORATION • Provisional restorations for laminates may not be essential as - There is no exposure of dentine (so no sensitivity) The proximal contacts are maintained ( so no drifting of the adjacent teeth occurs) • But most often its may be necessary for a patient to maintain social engagements and to prevent breakage of proximal contacts (wrap around technique). 2 methods Direct Method Fabricated intra-orally Indirect Method Fabricated on cast/ model
DIRECT METHOD • The provisional method is fabricated intra-orally. It can be done by using :- 1. Composite 2. Auto-polymerizing acrylic resin 1. COMPOSITE • A few spots on the prepared tooth or a central spot is etched (spot etching) with phosphoric acid and bonded. • Restorative composite is built 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.
1.Initial situation 222. Wax up 223. Putty index 4. Spot etching 5. Bonding by DBA 6. Light curing
7. Self curing composite is used. The mixing tip should be immersed inside the material to prevent internal voids. 8. Wait till the gel stage to remove the excess 9. Remove the silicone index 10. After 5 minutes, wipe with alcohol to remove the oxygen inhibition layer and continue for finishing and polishing 11. Final result
• 2. AUTO-POLYMERIZING RESIN • Tooth colored acrylics can also be used. • A putty index of the tooth made prior to tooth preparation or after wax up is filled with resin following the preparation and inserted in the mouth. • It is removed following initial set, allowed to polymerize, trimmed and can be luted using provisional cements or spot etched and bonded with resin cement
INDIRECT METHOD • A model is fabricated following tooth preparation will allow the acrylic provisional to be made indirectly on a cast.
HOW TO MECHANICALLY CLEAN THE PREPARATIONS ? • First, remove the provisional restorations and any excess cement, and thoroughly clean the area, as anything remaining could interfere with the fit or color. • A pumice slurry is a good option for the mechanical cleaning of the preparation. • The walls and occlusal areas can be cleaned with a small brush, but the sensitive marginal areas close to the gingiva should instead be cleaned with a foam pellet. • Never use sodium bicarbonate-based cleaning agents or powders – they can inhibit bonding. Glycine Prophy Powder can be used.
Laboratory procedures • 4 methods can be used to construct porcelain laminate veneers:- 1. Platinum foil technique 2. Refractory die technique 3. Castable and pressed porcelain veneer systems 4. Milling systems
PLATINUM FOIL TECHNIQUE- • Foil of 0.001 inch thickness is adapted or swaged on to the master cast for porcelain condensation. REFRACTORY DIE TECHNIQUE- • Porcelain powder is applied directly on to the cast made of a refractory investment material, then fired
CASTABLE AND HEAT PRESSED PORCELAIN VENEER SYSTEMS – • Heat and pressure are used to mould the porcelain to the dies. E.g- Dicor Plus, IPS Empress MILLING SYSTEMS – • CAD / CAM (e.g.- CEREC) and copy milling machine (e.g.- Celay) are used to shape the porcelain veneers from dense porcelain blocks
• The platinum foil and refractory die techniques are common choices because there is no need to purchase expensive laboratory equipment. • Among these two, refractory die technique is becoming more popular because, • Platinum foil technique-, • Margins of the dies are easily damaged during adaptation or swaging • Over contouring occurs because the margins on the cast are being masked by the foil. • Though CAD/CAM is the new technology, but the problem with the computer system veneers is the need to alter the color of the originally monochromatic ceramic blocks with shade modifiers placed under the veneers or with surface stains fired over them
Try in Are processed veneers free of cracks, excessive thickness, marginal discrepancies ? Color shade choice. Return to remake Give LA to ensure patient comfort in placing retraction cord to expose gingival margins, to prevent etch contamination, and to facilitate finishing procedures Clean the preparation and interproximate with flour of pumice Try in “fit” : do veneers trial seated with glycerin? NO YES Individually NO Reduce excess proximal contact with fine diamond YES NO Collectively Make new impression
YES Try in “color” : Is veneer trial seated with glycerin, approximate the same shade as the tooth ? Select a trial composite luting agent with some opaque added Select a trial composite luting agent of neutral and universal shade Is the basic shade of the veneers trial seated with composite satisfactorily? Remove unsatisfactorily trial composite with alcohol. Select alternate shade or add no more than 20% tint NO YES YES Is the selected basic shade accurate for the gingiva and for the incisal areas of the tooth Remove trial composite with alcohol. Repeat until shade acceptable YES Shade and fit confirmed. Prepare tooth and veneer for bonding YES NO NO
Cementation • Involves the following steps :- 1. Initial veneer inspection 2. Preparation of site 3. Try in 4. Bonding 5. Finishing
Initial veneer inspection • The veneer is placed on the cast and assessed for the following : • Imperfections • Individual fit • Collective fit (for multiple veneers) • Veneer color Preparation of site • The prepared teeth are isolated, provisional restoration removed and cleaned with pumice
Try in • The veneers are then tried-in the patient’s mouth and are checked for :- 1. Individual fit 2. Collective fit 3. Color • Water soluble glycerin, transparent silicones and color keyed try in pastes can be used to attach the laminate to the tooth during try in. Factors Influencing Color • Since most often laminates are indicated to correct discolorations, it is important to understand the factors influencing the same. • Original tooth color • Porcelain shade and opacifier • Luting resin color and opacity
Tooth not requiring major color changed is influenced by the factors as follows – • 80% ceramic • 10% cement • 10% tooth • Hence, the most influential factor in changing color is the ceramic itself, which can be achieved by using opaque dentines. • Composite opaquers can be also applied on the tooth to mask color. The color or shade of resin cement can only make a minor correction in color. • For minor color corrections, if laminate appears darker, a light color resin is used and vice versa. Tooth requiring major color change – • 70% ceramic • 10% cement • 20% tooth
Bonding • Bonding involves the following procedures- 1. Preparation of veneers 2. Preparation of tooth 3. Luting Preparation of veneer Preparation of tooth Clean Clean Etch Isolate Silane Etch Bond Bond
Preparation of veneer • Following cleaning of veneer with solvent such as acetone • It is etched with 10-15% hydrofluoric acid for 30sec – 1 min (acc. to the manufacturers instructions or ceramic used) • Note- some clinicians tend to get the veneer etched by the laboratory but it is not recommended as the etched surface may get contaminated during handling and try in procedures. • A silane coupling agent is applied , and is allowed to remain for 1 min. It is air dried. The silane creates a chemical bond between composite cement and ceramic • A normal composite bonding agent is finally applied to the fitting surface at the same time when the tooth surface is also bonded. It is NOT light cured 1. 2. 3. 4.
Preparation of tooth • The prepared teeth are pumiced again to remove any try in paste or cement. • They are isolated using soft metal bands or mylar strips or Teflon tape. • The tooth is etched with 35% phosphoric acid for 15 sec. It is thoroughly rinsed and air dried. Surface should appear typically frosty after etching. • Composite bonding agent is applied on the tooth surface and is NOT LIGHT CURED. 1. 3. 2.
Luting • The cement of choice for luting ceramic laminate veneers is RESIN CEMENT • The resin is adhesively cemented or bonded to the tooth and the laminate • The resin cements available are- 1. Chemical 2. Light -----> preferred as it gives adequate working time and open margins allow good light polymerization 3. Dual cure Ideal requirements of luting cements - • Thin film thickness, 10-20 microns • High compressive and tensile strength • Ability to tint, opaque and characterize • Low viscosity • Low polymerization shrinkage • Good color stability
• Several manufacturers produce resin cements in variable shade with flowable viscosity and with opaquers. • The cement is mixed and applied on the fitting surface of veneer and spread uniformly. • Veneer is then placed on the prepared tooth giving finger pressure labially. • When position is verified to be correct, veneer is initially light cure for 5 sec. • The excess material is removed with a probe and then the light curing is continued for 45 – 60 sec.
Finishing • Fine grit diamonds are used to remove any excess cement from margins. • Final finishing is accomplished with discs and diamond polishing pastes • Occlusion is checked only after veneer is bonded to tooth • Proximal areas are finished with finishing strips
Maintenance • For 72-96 hrs following insertion, patients should avoid highly colored foods, tea , coffee hard food and extreme temperatures. • Routine scaling should be done at least every 4 months, ultrasonic scalers may be avoided • Abrasive and highly fluoridated toothpaste 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.
Failures of laminates veneers MECHANICAL BIOLOGICAL AESTHETIC Fracture – poor positioning of incisal margin, less incisal thickness, margin too subgingival Post-operative sensitivity- improper curing of cement, poor marginal adaptation Improper shade selection. Visible margins in case of discolored teeth Debonding – use of expired cement, faulty veneer/tooth preparation during luting Marginal microleakage- poor fit and extension Gingival recession – overcontour and improper subgingival placement
How to remove the veneers? • High speed diamond bur • A high powered, low frequency laser is activated without in a contactless manner. The laser energy penetrates the veneer material and deactivates the bonding interface between the tooth and the veneer. A wave- like motion is done repeatedly until the veneer detaches from the tooth surface
Recent advances Lumineers What is the difference between Lumineers and standard porcelain veneers? • The main difference is that the Lumineers are made from special patented CERINATE porcelain that is very strong but much thinner than traditional laboratory fabricated veneers. Their thickness is comparable to contact lenses • 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 0.3 mm- 0.5 mm enamel is removed, causing no sensitivity for the patient and therefore no need for any anesthesia.
ADVANTAGES DISADVANTAGES Lumineers can be placed on the teeth without removal of the tooth structure. 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. Lumineers are a reversible procedure 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. Patients can receive their veneers quickly, usually within two weeks from the date that the impressions are made 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. Lumineers bond directly to the tooth, making the bond very strong. They are also very long-lasting- up to twenty years or longer.
Conclusion • Perfect smile improves the self confidence, personality, social life and have psychological effect on improving self image with enhanced self esteem of the patient • Ceramic laminate veneers remain as prosthetic restorations that best comply with the principles of present-day aesthetic dentistry. It offers a transformative solution for achieving a dazzling smile with natural appearance, durability and versatility. • Currently, the properties of ceramics indicate that they are materials capable of mimicking human enamel and their mechanical properties are expanding their clinical applications • These are pleasing to the soft tissue and possess excellent aesthetic quality yet a conservative restoration can be called “Bonded Artificial Enamel”
References • Smales RJ, Chu FC. Porcelain laminate veneers for dentists and technicians. Jaypee Brothers.; 1999. • Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of fixed prosthodontics. Chicago, IL, USA: Quintessence Publishing Company; 1997 Jan. • Tylman SD, Malone WF, Koth DL. Tylman's theory and practice of fixed prosthodontics. (No Title). 1978. • Pini NP, Aguiar FH, Lima DA, Lovadino JR, Terada RS, Pascotto RC. Advances in dental veneers: materials, applications, and techniques. Clinical, cosmetic and investigational dentistry. 2012 Feb 10:9-16. • Sisler ZS. Preparation Guides: 10 Steps to Maximize Success for Veneer Preparation. Journal of Cosmetic Dentistry. 2020 Jan 1;35(4):26-33. • Mizrahi BA. Porcelain veneers: Techniques and precautions. Wear. 2007;1(4). • Farias-Neto A, Dantas de Medeiros FC, Vilanova L, Chaves MS, Batista de Araujo JJ. Tooth preparation for ceramic veneers: when less is more. International Journal of Esthetic Dentistry. 2019 Jun 1;14(2).

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VENEERS: YOUR SMILE'S BEST KEPT SECRET.pptx

Editor's Notes

  1. While doing contouring of incisal edges with GIC / composite, will the veneers be retained