TODD C. SNYDER, DDS, FAACD, FIADFE, ASDA, ABAD The Nuts

9/27/2021

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The Nuts & Bolts of Veneers

TODD C. SNYDER, DDS, FAACD, FIADFE, ASDA, ABAD

Accredited Fellow, American Academy of Cosmetic Dentistry

Fellow, International Academy for Dental Facial Esthetics

Member of The American Society For Dental Aesthetics

Diplomat of the American Board of Aesthetic Dentistry

Former Faculty, UCLA Center For Esthetic Dentistry

Speaker, Catapult Education

LEGIONpride.com, Online Training Challenge for Dentists

Entrepreneur, Software Company Owner, Author/Lecturer, Professional Race Car Driver

Todd Snyder, DDS, FAACD, FIADFE, ASDA, ABADLaguna Niguel, CA

Aesthetic Dental Designs®

[email protected]

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Traditional Veneers

The Key to Success:

Traditional Veneers

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Diagnosis & Treatment Planning

The Key to Success:

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You are selling the Emotion…

Do you know “THEIR” desired outcome?

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According to the American Academy ofCosmetic Dentistry 50% of patients areunhappy with their smiles and 3 out of 5people will invest in their smiles.

How Do You Get More Cases?

Business

Deliver

PATIENTS

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Business

Attract

PATIENTS

One of the most powerful & fastest tools you own to create cosmetic opportunities??

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WHITENING

Immediate Call to Action Motivator

Start Here

Over-the-Counter Teeth

Whiteners: $1.4 billion

(MSNBC) ...

(Consumer Reports).

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Over The Counter Whitening

Whitening

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Opalescence GO!• Fast, Easy, Effective, Better

Experience• Convenient & affordable

professional whitening to GO• Pre-loaded, disposable UltraFit™

tray for a custom-like fit• Molar-to-molar coverage• No chair time

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One Shade of Mosaic

One Shade of Mosaic

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Reduce or Eliminate Sensitivity

• Potassium Nitrate & Fluoride

Opalescence Go Sample Tower

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“Total annual revenue in the teeth whitening industry topped $11 billion at the beginning of

2015, with $1.4 billion spent on teeth whitening products. These figures suggest a steady annual increase in the teeth whitening market industry, which is expected to continually climb over the

next 10 years” AACD Research

So why are people willing to pay top dollar for a beautiful smile

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What is the first thing to do for a veneer case?

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Diagnostic Models & Records

Silginat - Kettenbach

Counter FIT- Clinician’s Choice

Status Blue - DMG

Alginate Alternatives

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Silginat - Kettenbach

Counter FIT- Clinician’s Choice

Status Blue - DMG

Alginate Alternatives

3 Sets of Models-One is untouched for legal documentation-Second to practice preparations (It will be waxed up)-Third is a spare to practice on or make bleach trays

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Mounted and Equilibrated

Smile Design/Preparation Design:-What, Where, Why, Apply

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What Records & WhenDiagnostic & Prep Reduction Models

Diagnostic Prep Guides

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Diagnostic Lab Guides

Veneer Preparations

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Tooth Preparation Conservative Preparations

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Veneer Preparations

• Depth Cuts

• Tooth Reduction

• Margins

• Retention Form (Line of Draw)

Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”

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Veneer Preparations

• Depth Cuts

• Tooth Reduction

• Margins



Veneer Preparations

• Depth Cuts

• Tooth Reduction

• Margins



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Veneer Preparations-Feldspathic Porcelain

Depth cuts of 0.2mm-0.8mm*

1.0mm-1.5mm incisal reduction*

Veneer Preparations-Pressed Ceramics

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Minimal or No Prep Veneers• Do a waxup

• Duplicate into a stone model

• Over impression of stone model w/ PVS BEADLINE TECHNIQUE or Siltech Putty

• Intraoral mockup using the over impression filled with temporary acrylic**

• Is thickness and appearance okay?• Depth cuts through over impression if necessary.

• Typically no provisionals are necessary

• No undercuts

• Color change varies based on tooth position/color

Modern Ceramics

• Stand Alone Strength Properties

• Feldspathic (80-120 mpa)

• Lithium disilicates (360-500mpa)

• Lithium silicate (373 mpa)

• Zirconia (Monolithic 640-1200 mpa+)• Layered Zirconia Feldspathic (80-120mpa)

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GC America Initial Lisi Veneering Ceramic for LisiPress (Lithium Disilicate)

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Incisal edge preparations

a) No incisal lengthening

b) Changing color or wear

c) Lengthening tooth

d) Interproximal

a) When to break contact?

e) When to do a crown

Veneer Preparations


labial reduction options Depth Limiting Burs - Brasseler USA

Average enamel thickness

At CEJ .3-.4 mmMiddle third .8-1.0 mmIncisal third 1.1-1.3 mm

Veneer Preparations

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Preparation Reduction• Depth reduction burs

• Safe reduction

• Lasco

Veneer Preparations

Independent Depth Cuts (Lasco Burs)

▪ Depth Cuts▪ Tooth Reduction▪ Interproximal & Margins▪ Retention Form (Line of Draw)

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Preparation

Aesthetics

Function

Bonding to Enamel

Material Options

Minimal Prep Case

Minimal Prep Case:

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Wax-up Case:

Preparation Guides:

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Burs• Organization

• Diamonds

• Carbides

◼ K0096 Finishing Kit $126.47 each

◼ K0095 Preparation Kit

$125.47 each65

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• Bioactive flowable

• Releases Calcium, Fluoride, Phosphate ions

• Highly fracture and wear resistant

• BPA & Bis-GMA free

• Highly radiopaque

• 8 Shades A1-3.5, A4, A6, B1, BW

Cavities, Old Composite Replacements,

Undercut Block Out

Shade Assumptions

BW, B1, B2, A1, A2

Provisional Techniques

-Free hand

-Beadline Provisionals

-Putty over impression of waxup

-Premade temps?

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Review-Chief Complaint

-Occlusion

-Photographs/Imaging?

-Whiten first

-Waxup/BeadLine Provisional

-Material Selection

-Practice Preps

-Photograph Prep Shade

EMOTIONFocus on overall appearance

Stay away from little details

“Going to look & feel great”

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Minimally Invasive Veneers…. Why? Benefits??

Waxup

Mockup

Preparation

Provisional

Bonding to Enamel

Material Options

Minimal Prep Case

Beadline Provisional Mockup

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Mockup

Depth Cuts

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Photos for Laboratory Technician

Photos for Legality

AACD Series + Adjunct Photos

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Provisional Restorations

Final Restorations

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Provisionals Mimic The Final Restorations

LuxaTemp Ultra (DMG)

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-5 Year Long Term Provisional

-Tooth-like translucency and opalescence

-30% stronger than LuxaTemp Ultra

-Natural Fluorescence

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Simplified Provisionals**

Siltech Putty Matrix

Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.

Cosmetic Provisionals (Bead Line Technique)

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Scribe a 0.5mm-1mm groove into tissue & a little on tooth


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Shades:

B1, BL

A1,2,3, 3.5

High impact strength, flexural strength, diametrical tensile strength, and elastic modulus.

Tooth-like translucency and opalescence ensure optimal integration into the existing dentition thanks to the chameleon effect.

Natural Fluorescence

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No Polish Necessary if you use a good model


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AESTHETIC TEMPORARY CEMENT

ClearTemp LC-Ultradent

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▪ 4 upper & lower trays

▪ 60 sec. @ 158°F

▪ Fast, efficient

▪ Virtually custom

▪ 30% less impression

material used

Impression Trays

HeatWave by Clinician’s Choice

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Impression Trays


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Impression Trays


Dry all teeth in arch

Place tip in most difficult area first

Keep tip on margin and immersed in material

Go around entire margin first

Next go to adjacent teeth

Then do coronal aspect of teeth

Double Mix Single Impression is the most accurate

Syringe Placement

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Panasil Initial Contact (VPS)

Kettenbach

TIP

Panasil Initial Contact

▪ Lowest contact angle of any VPS

impression material

▪ Fast set and Regular set

Kettenbach

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Hydrophilicity: angle of contact

Panasil ® = Hydrophilicity

▪ Hydrophobic water droplet ▪ Hydrophilic water droplet

Lowest contact angle of any VPS impression material

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Panasil® Initial Contact (PIC) Hydrophilicity Demo

Hydrophilicity: comparison

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drop age [s]

Aquasil™ Ultra XLV(Dentsply)

Affinis™ light(Colténe)

Impregum™ Garant™L DuoSoft™(3M Espe)

Panasil® initial contact X-light(Kettenbach)

Panasil® initial contact light(Kettenbach)

Comparison of spreading behavior 30 s after mixing starts within the first 3safter applying a water drop: relative humidity 50 % - 80 %

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Hydrophilicity: comparison

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Aquasil™ Ultra XLV(Dentsply)

Affinis™ light(Colténe)

Impregum™ Garant™L DuoSoft™(3M Espe)

Panasil® initial contactX-light(Kettenbach)

Panasil® initial contactlight(Kettenbach)

Contact angle after 30 min at 23°C: relative humidity 50 %

Cracked toothKettenbach

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Panasil Initial ContactKettenbach

▪ Exceptional Flow Properties▪ Exceptional Detail▪ Exceptional Performance even in a moist environment

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Panasil Initial ContactKettenbach

Kettenbach

Identium(Vinylsiloxanether-VSXE)Identium® is developed especially for the single impression technique and

combines the best of the two worlds: all advantages of conventional

polyether materials paired with those of A-silicones.

"Best of Two Worlds"

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Identium®: the Vinylsiloxanether

The best of polyether:

▪ High degree of precision

▪ Dimension stability and

▪ Detail reproduction.

▪ Well-developed flow properties

▪ Low contact wetting angle

▪ Long working time

▪ High final hardness

Identium®: the Vinylsiloxanether

▪ The best of A-Silicone:

▪ Well-developed elastic properties

▪ Resists even high mechanical stresses

▪ Optimal recovery after deformation

▪ Easy removal from mouth and model

▪ Improved patient comfort due to the absence of odor

…and taste,

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Kettenbach

Identium for single teeth

Identium for multiple teeth

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Identium for multiple teeth

Make cases easyIdentium for multiple teeth

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Make cases easy, make your patients happy

Make cases easy, make your patients happy

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Bite Registration Demonstration Video w/ Handout

O-Bite:

PVS bite registrations

When to use,

How to use Correctly.

Strong material

Easy to cut

Good rigidity

Fast

LuxaBite

BisAcryl material

Higher accuracy

More rigid

Use for bigger cases

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TROLLDENTAL-4.5ΜM ARTICULATING PAPER

WWW.TROLLDENTALUSA.COM

DIRECTA DENTAL

Mixed Provisionals

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• 1) Implant screw retained.

• 2) FujiCEM Evolve (RMGI Cement) #6 & #8 or Doxa Ceramir

• 3) Bisco All Bond Universal Adhesive & Choice 2 Veneer Cement

Margin Refinement

K0095 Preparation Kit (Brasseler USA)

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Margin refinement with electric

handpiece @ 5-10,000 rpms

TISSUE MANAGEMENT…

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Types of Moisture

Saliva

Crevicular Fluid

Bleeding

Fluid/Tissue Management

Superoxol

Epinephrine

Ferric Sulfate

ViscoStat 20%

Astringent 15.5%

Aluminum Chloride

Viscostat Clear 25%

Expa-syl

Hemostasyl

Aluminum Sulfate

Tissue Goo 25%

Various Cords

Enhancing Moisture Control


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Lasers (Diodes) Fast

Hemostasis

No crevicular fluid

No cord

Better healing

Enhancing Moisture Control


A soft tissue laser incision at 1000x

magnification

Laser cut

Superficial coagulation

Heat dissipation with little/no edema

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Gemini Dual Wavelength

Aesthetic Contouring

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Aesthetic Contouring

Time??

ROI??

Aesthetic Contouring & Provisional

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•Invisible under restorations, yet detectable for excess removal•Beautiful esthetics, transparency•Easy one-piece removal of excess•Optimal adhesion with easy removability•Eugenol free•Not sticky•Flows and mixes easily

Laser Tissue re-contouring, Provisional & Impression

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Beadline provisionals that are locked on.

Removing provisionals that are locked on.

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Removing provisionals that are locked on.

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Nine Years Later

QUESTIONS?

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REVIEW

• Full arch impression Heat Wave Tray

• Record or Diode laser

• Light & Heavy Body Impression Material

• Bead Line Provisional Technique uses no temp cement or adhesives,

mechanical retention, shrink wrapped

CEMENTATION

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1.

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2.

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-Clean Tooth

-Try-in with water soluble try-in paste, not water.

-Clean & Decontaminate

3.

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4.

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5.

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6.

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7.

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- Light-cured luting cement designed for cementation of porcelain veneers.

- Color stability.

- Corresponding try-in pastes (sold separately)

- Choice 2 is specifically formulated for color stability (Delta E <1.2**) resulting in high esthetics

-Highly filled resin cement enhances the overall strength of the restoration

-Low film thickness ensures veneers are completely seated

-Corresponding try-in pastes confirm shade selection prior to cementation

-Choice 2 cement will not change (shade shift) over time, a problem that can occur with dual-cured systems

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Machined from Aerospace Aluminum

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Comparisons - Lights

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VALO DELIVERS

Access to the curing site = Energy to the resin

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• Design• Power• Durability• Access• Posterior tooth• Broad Light Output Range

– 385-515nm

• Cost• Weight• 5 Year Warranty

8.

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All Steps are the SAME, Except we are using a Dual Cured Resin Cement where there is

decreased exposure from curing light because of ceramic material or thickness.

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1) Implant screw retained #7

2) Bisco All Bond Universal Adhesive & Duo-Link Universal #6, 8 & 10

3) Bisco All Bond Universal Adhesive & Choice 2 Veneer Cement #9 & #11

- Dual Cured

- Quick Clean Up

- High Conversion

- Low Film Thickness

- Radiopaque

- Available in Universal (A2) & Milky White shades

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• What is the working time of DUO-LINK UNIVERSAL?

Minimum 2 min. (includes mixing)

• What adhesive can I use with DUO-LINK UNIVERSAL?

Can be used with any – we recommend All-Bond Universal. Some manufacturer's adhesives are

too acidic to properly bond to self -& dual-cured resins. ALL BISCO manufactured adhesives

are compatible with self- & dual-cured cements. If you are using an adhesive from a different

manufacturer, please refer to their instructions for compatibility.

• Do I need to pre-treat the surfaces of my indirect restorations?

Yes. Silane should be used to prime the surface of glass ceramics. Z-PRIME™ Plus should be

used to prime the surface of metals, composites, and zirconia.

• Can I use this for all indirect restorations?

Yes, however we recommend the use of a light-cured resin cement such as Choice™ 2 for

veneer cementation to ensure shade stability.

FAQs

A Universally Simple, Universally Strong adhesive resin

cement specially formulated for cementation of ALL* indirect

restorations.

• Universal - for all cementation procedures*

• Formulated to allow for quick and easy removal of excess cement

• Easily identified on radiographs for quick and effective diagnosis

• High degree of conversion in both light- and self-cured modes

ensures a strong, long lasting restoration

• Easy to use auto-mix, dual-syringe provides a consistent mix for

immediate delivery

• Ideal for all chairside and lab-fabricated restorations

• Available in Universal (A2) & Milky White shades

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Duo-LinkUniversal Multilink NX3 XTR

Sh

ea

r B

on

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tre

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th (

MP

a)

Light-Cure SE Self-Cure SE

* It is recommended to use BISCO’s CHOICE™ 2 for veneer cementation.

SBS Competitive Comparison

Data on file. BISCO, Inc.

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VISALYS CEMCORE(Dual Cure)

1 Product2 Indications

Review & Questions?

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Alkaline pH 8.5

Moisture Tolerant

Self Sealing

Apatite Formation

Insoluble/No Degredation

Stronger with time

Semi / Translucent

Biocompatibility-Excellent

Bioactivity-Apatite formation

No silane, conditioning, bonding

Calcium Aluminate/Glass Ionomer Hybrid Cement**

Bioactivity

A reactive bioactive system that contributes to hydroxyapatite mineralization of hard tissue through ion release and alkaline

pH.**


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Cementation Technique

Mix for 8-10 seconds

.17ml vs single cap .10ml

3-4 restorations


Lithium Disillicate (eMax)• Cleaning

w/phosphate

scavengers is not

necessary

• Silane is

contraindicated

• Tooth etching or

conditioning is not

necessary

• Bonding agent is not

needed

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Cement Selection

Three year recall data yielded no loss of retention, no

secondary caries, no marginal discoloration, and no

subjective sensitivity. All restorations rated excellent for

marginal integrity.

Cement SelectionJournal of Esthetic & Restorative Dentistry March 2015

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Simplify Cementation

-Silane is contraindicated

-Restoration does not have

to be cleaned after tryin

-Tooth etching or

conditioning is not necessary

-Bonding agent is not

needed

Technique Research/Literature**

Moisture Tolerant

No Sensitivity

Alkaline pH

Apatite Forming

Insoluble

Stronger With Time

Self Sealing

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KEY FEATURES:Tough, resilient, fracture resistant, absorbs shockInsolubleReleases and recharges calcium, phosphate and fluorideChemically bonds – Seals against microleakageNo sensitivityMoisture tolerant – Simplified technique – No etching, no bondingLight cure and self-cureAvailable in A2 and translucent shades

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Legal Documentation

Signed treatment plan

I.C. RBAs

Arbitration agreement

Driver’s License

Headshot in your office

Paid prior to starting appointment

Waxup signed off as approved

Temps signed off as approved

Final appearance at tryin approved giving consent to cement as final.

Document discussion of wearing a clear aligner or night guard and having discussed OSA. OHI. Eating and Habits.

PLAN

Who are you?

Who and What do you want?

How will you achieve it?

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Business

Deliver

PATIENTS

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https://www.legion.dentist/singularity

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Case Acceptance,Communication, Sales TrainingLearn how to help patients say yes to treatment and financing

https://www.legion.dentist/inception

• Reduce Your Stress & Build A Better Life

• Better Business & Communication Skills

• Incredible Marketing & Advertising

• Front Office Simplification

• Insurance Independence

• Office Metrics/KPI

• Responsive Websites, Social Media

• Enhance Diagnostic Skills & Procedures

• Photography

• Elective Dentistry & Sales Skills

• Cosmetic & Restorative Dentistry

• New Materials, Techniques, Technology & more..

Online Training/Mentorship For Dentists.www.Legion.dentist

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https://www.legion.dentist/inception

http://www.instagram.com/LegionPride/

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Digital Lecture Handouts

www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers

Link will be emailed to you, check your spam or junk folder.

I reward you with lots of extra free information so be sure to

get yours.

Digital Handouts

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TODD C. SNYDER, DDS, [email protected] WWW.LEGION.DENTIST

QUESTIONS?YOUR FUTURE BEGINS NOW!

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According to the American Academy of Cosmetic Dentistry 50% of patients are unhappy with their smiles and 3 out of 5 people will invest in their smiles.

How Do You Get More Cases?

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Documents

TODD C. SNYDER, DDS, FAACD, FIADFE, ASDA, ABAD The Nuts