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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)
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DR. DR. ABHISHEK JOHN SAMUELABHISHEK JOHN SAMUEL MDS, Endodontics & Conservative DentistryMDS, Endodontics & Conservative Dentistry
VENEER: layer of tooth colored : layer of tooth colored material that is applied to a material that is applied to a tooth for esthetically restoring tooth for esthetically restoring localized or generalized defects localized or generalized defects or intrinsic discolorationsor intrinsic discolorations
-Sturdevants Art & Science of Dentistry Pg. 322
Made of chairside composite, porcelain or cast ceramic materials
1. Closing spaces. 2. Minor tooth position improvements (correcting rotation or
overlap). 3. Lengthening short or worn teeth. Improving tooth shape. 4. Making aged teeth look youthful. 5. Correcting teeth in lingual version. 6. Post orthodontic treatment. 7. Shade change/Brighten shade/Stain Correction
Discoloration leading to deep dentinal defects
Enamel defects Large DiastamataMalpositioned teethPoor restorations on labial sufacesAging Wear pattern
Available enamelAbility to etch
enamelOral habits
Shape or form Symmetry and proportionality Position and alignment Surface texture Color Translucency
Feminine smile
Rounded incisal angles,open incisal and facial embrasures and softened facial line angles
Masculine smile More closed and
prominent incisal angles
Prominent areas highlighted by light
Depressed areas shadowed
Change in apparent size of a tooth- narrower by positioning mesiofacial and distofacial line angles together
Sense of balance and harmony – subconscious visulisation
Augmentation of proximal surfaces with composite
Restorations at midline- incisal and gingival embrasure form
Tooth position tooth alignment, arch form, configuration of smile
‘Golden proportion’Proportion of smaller tooth to larger tooth 0.618‘Repeated ratio’Golden proportion only in 17% of casts (Preston et al)
The golden ratio (also known as the golden mean, golden section or divine proportion) is a height to width ratio that measures 0.618 and manifests itself in nature, art and architecture
RED- the proportion of the successive widths of the teeth as viewed from the frontal should remain constant as one moves distally.
In other words each tooth becomes smaller by a fixed percentage as you move back in the mouth.
The RED proportion is not limited to one particular proportion but allows the desired allows the desired RED proportion to be selected and consistently applied for each individual RED proportion to be selected and consistently applied for each individual case. case.
Studies have shown that smiles which maintain a constant 78% width/height ratio of the upper central incisors are preferred.
The taller the teeth the smaller the RED Proportion usedThe taller the teeth the smaller the RED Proportion used. The shorter the teeth the larger the RED Proportion used.
YOUNG TEETH AND OLD TEETH
ANATOMICAL FEATURES
Cervical areas darker than incisal areas
Young patients-lighter teeth Older- incisal edge enamel thinned
due to wear and is darker Shade selection Metamerism
Esthetics and function
Anterior guidance and occlusal harmony
Physiologic contours
Emergence Profile
Mayekar (2001) Laminate maintains colour. Usually requires no Tooth Prep. Veneer- change in colour, requires Prep. (endodontically
treated teeth and tetracycline stained teeth)Constructing a veneer and bonding it to tooth structure is
referred to as laminating
1930-40s- Charles Pincus- Thin porcelain veneers
1970-80s- Direct composite resin laminates- No tooth preparation
2nd evolution- Preformed veneers/crowns1980- Etching of glazed porcelain with
hydrofluoric acid and silane coupling agents
Partial Veneers- Localized defects or as areas of discoloration
Full Veneers- More generalized defects/ intrinsic staining
Direct Indirect - less technique sensitive - more esthetic -longer lasing - multiple teeth
For opaque, tinting, bonding or veneering material for maximum esthetics without overcontouring/overprep
Remove acid resistant, fluride rich enamel Rough surface for bonding – diamond abrasives Definite finish line
Preferred in Direct Composite Veneers.
Preserve lingual and incisal surfaces Significant occlusal function Preservation of functional surfaces Reduces wear of opposing tooth
Lengthening of tooth Incisal defectFacilitates seating of veneer Lower anteriors not veneered
Outline extent of defect Coarse elliptical/round diamond 0.5-0.75mm Subgingival extention- if defect is
subgingival Microfilled or more opaque
composite depending on remaining defect
Half the depth of enamel-0.5-0.75mm mid facially and 0.2-0.5mm along gingival margin
Chamfer for definite cavity margin Incisal edge not included. If included for anterior guidance, tooth reduction of at least 1mm. Shade selection- very important (3D Master) No.212 retainer Margin at crest of gingival tissue
1. Processed composite
2. Feldspathic porcelain (+++esthetics)
3. Cast or pressed ceramic (+++ fit and finish)
Superior properties- Light, heat , vacuum, pressure etc.
Superior shading and characterizing Better control of facial contours Easily repaired Children and adolescents as interim
restorations Wear pattern Lower cost
Window-Prep is ideal!
Limited bonding- surface conditioning or sand blasting required
Multiple large existing restorations compromise bonding
Window preparation recommended due to limited bond strength
Incisal lapping if incisal defect
Intraenamel preparation Elastomeric impressions No temporization
First Appointment
1. Evaluate fit of veneer2. Tooth side of veneer (preetched) is primed3. Tooth etched, rinsed and dried. Adhesive is
applied but not cured4. Adhesive cement applied5. Veneer placed and excess cement removed6. Check for fit with no.2 explorer7. Light cured for 40-60sec facial & lingual
Second Appointment
ADVANTAGES Color Bond strength Periodontal health Resistance to abrasion Inherent porcelain strength Resistance to fluid
absorption Esthetics +++
DISADVANTAGES Repair difficult Technique sensitive Color modification not
possible Tooth preparation
required Extremely fragile &
difficult to manipulate Expensive
PORCELAIN VENEERS
0.3-0.6mm/ half enamel thickness of available enamel
Adequate space for porcelain veneer
Remove convexities Space for opaquer Enamel surface conducive to
etching & bonding Definitive seat Margin placement clarified
Labial- LVS no.1 and LVS no.2 Depth guide Interproximal- Margin halfway into proximal
contact area - Wrap around effect - Procelain bulk Sulcular – 0.05-0.1mm into sulcus - retraction cord - chamfer/ bevelled shoulder
Bi-Planar Reduction: 0.5-0.75mm – Facio-Gingival margin 1-1.2mm – Facio-Incisal margin
A) The facial surface should be reduced in two planes; one nearly parallel with the path of insertion, and one parallel with the incisal two-thirds of the facial surface of the tooth
B) One plane reduction parallel with the path of insertion may result in insufficient space for porcelain in the incisal 1/3 of the tooth
C) One plane reduction which creates adequate space for the restoration both in the shoulder and the incisal areas, will endanger the pulp entity and produce overtapered restoration.
Featheredge or knife edge Pointed end tapered fissure bur to provide this type of margin. It’s the most conservative type. But the margin is weak. Impression tearing It form >135 cavo surface line angle.
Therefore a definite finish line (chamfer) is adviced.
Should stop just facial to the proximal contact point – easier placement
Incisal - definite stop - 0.5mm if restoration of
original length Lingual - rounded/heavy
chamfer 1. Prevent shearing of
porcelain 2. Bulk of porcelain of at
least 1mm 3. Increased strength Elastomeric impression
Silane coupling agent – increases wettability
Etching ceramic with Hydoflourous acid 7-10%
Porcelain polishing paste
• NX3 from Kerr, Variolink• Veneer or Variolink II from
Ivoclar• Vivadent or RelyX Veneer
Cement system from 3M ESPE
5-15% opaque porcelain
Deeper tooth preparation
Die spacer (engage the cement’s shade)
IPS empress
Mild to moderate discoloration
Better marginal fit
Little marginal finishing necessary
Thinness and fragility of ceramic veneers
Computer programmed oversized dies
Highly sintered high purity alumina-0.25mm
Simple to use Excellent esthetics
Pre-fabricated nano-hybrid-composite enamel-shells
Attractive teeth and a new smile after only one visit
Very little removal of healthy tooth structure – 0.3mm max
Individual, customized shaping of the front teeth
Shine can be refreshed by polishing at any time
Unlike porcelain veneers, they can be easily repaired
Modeling MB5 Contour Guide
Unesthetic facial portion of metal restoration
No.2 carbide bur
Mechanical retention in no.1/4 bur- 0.25mm
4-META
Always place centrals, then laterals, and so on
Repair with composite resin. Preparing surface to resist functional stresses and thermocyclic loading High-energy ceramic reparative surface (the exposed chipped ceramic) and a
chemical/mechanical link to the restorative composite resin. micro-etcher (20-µm aluminum oxide under 35 psi) etch the ceramic surface with 5% to 9% hydrofluoric acid This is completed by applying a minimal amount of a pre-hydrolyzed silane the ceramic surface should still have a "frosty" appearance as it did after etching. If
the surface is "shiny" then the silane is too thick and should be removed by sandblasting and re-applied in a lesser amount
The last step is to apply a bonding adhesive which should be light-polymerized before application of the restorative composite resin.
Condition Whitening Veneers
Teeth stained by tobacco Y Y
Teeth stained by coffee/tea Y Y
Teeth stained by fluorosis N/Y Y
Age-related staining Y YTeeth that have been dark
since childhoodN Y
Teeth darkened by trauma N Y
Teeth darkened by root
decayN Y
Stained teeth with
extensive gum recessionN Y
Gapped teeth N YCrooked teeth N Y
Same function and benefits. When placing lumineers, the structure of the tooth remains unchanged. Are as thick as a contact lens, but this does not make them less durable. Might feel a little bulkier than the classic porcelain veneers. The tooth is still protected by its natural enamel, even if the lumineers need to be taken
off. In terms of costs, lumineers have similar costs as the porcelain veneers. Not