VENEERS: YOUR SMILE'S BEST KEPT SECRET.pptx

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

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.

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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