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All Part of the Dental Family

What’s a Lab to Do?

Veneers The Latest Trends

June 2008

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©2008 Ivoclar Vivadent, Inc.
is the official journal of the
In this issue…
Dental Laboratory Association
of the State of New York

Executive Board and Staff

Gary Spadaro, Jr.
President’s Message 4
Liberty Dental Laboratory

Vice President, Education

What’s a Lab to Do? 6
Technician Relations George Obst
Raymond Rayeski, CDT
Highland Acres Dental
Labs Inc.

Mark Viscusi
Veneers The Latest Trends 14
Viscusi Dental Lab August Brugera, MDT

Treasurer/Budget &
Smiles Technical Market 22
Norm Friedman, CDT
Crown Dental Laborator

Bill Baum, MDT, CDT How to contact us
Bill Baum Dental Studio

Membership Smiles US Office: Canadian Office:

Gary Spadaro Sr. 1436 Altamont Ave Suite 199 Palmeri Publishing
Liberty Dental Laboratory Schenectady, NY 12303 35-145 Royal Crest Court,
Tel: 518-355-3183 & 1-877-DLANY65 Markham, ON L3R 9Z4
Fax: 1-877-352-6965 Tel. 905-489-1970 Fax 905-489-1971
Professional Relations E-mail:
Gail Broderick, MDT E-Mail:
Jason Kim Dental Web site: Design & Layout: Samira Sedigh
Congress Information:
Constitution and Bylaws
Robert Iuliano
Adirondack Dental SMILES is published four times a year by Palmeri Publishing Inc. Known office of
Ceramics Publication, 2424 Niagara Falls Blvd. Niagara Falls, NY, 14304. Application to mail at
Periodicals Postage Rates is pending at Niagara Falls, N.Y. 14304 U.S. Postmaster send
Head of Legislative address correction to Palmeri Publishing, Box 1068 Niagara Falls, N.Y. 14304.
Kevin Crane, CDT
Crane Dental Lab
Contributions from clinicians, lab owners, suppliers, readers, etc., are solely the opinion of the writers and
Membership & Congress do not constitute the endorsement of this publication or its staff.
Coordinator SMILES makes every effort to report clinical information and manufacturer’s product news accurately but
Michelle Milazzo cannot assume responsibility for the validity of product claims or for typographical errors. The publishers
also do not assume responsibility for product names, claims, or statements made by advertisers.

DLANY Smiles 3
President’s Message

Gary J. Spadaro Jr.

All Part of the

Dental Family

he Dental Laboratory Association of the State of New York is proud and
thrilled to announce that our current legislative efforts are finally producing

In recent meetings with Assembly Members from around New York State, we have
laid the foundation for a legislative bill officially creating the title of Denturologist in
New York State, which will include provisions for licensure. The legal language in the
original draft of the statue has been refined to address issues raised by legislators,
gaining bipartisan support in both houses of the New York State Legislature, and is now
being officially sponsored by Assemblyman Steven Englebright.

The next step in the legislative process is the

assignment of a bill number. We continue being in
constant communication with Assemblyman This is to be considered a
Englebright and his colleagues, and have requested historic accomplishment;
specific and detailed information with regard to the significance and
when this might occur. As the Assembly is near the future ramifications
end of its current legislative session, we hope to see of these developments
our bill voted upon when they reconvene in the fall cannot be overstated.
of this year.

This is to be considered to be a historic accomplishment; the significance and future

ramifications of these developments cannot be overstated. As Denturologists all know,
regulatory efforts to standardize the dental lab industry are long overdue. Upon
enactment of this statute, licensure of the Denturologist will demand that requirements
designed to protect the dental prosthetics consumer are met and maintained.

DLANY Committee members recommend and encourage all of the members of our
profession to support this historic endeavour, as it will finally afford us meaningful status
in a unique industry with growing demands for our products and services.

4 DLANY Smiles
IECDT fuses the traditions and beauty of Hawaii to reflect old technology and
new modern technical applications within the dental technical profession.

62nd Annual
Congress of
Dental Technology
The IECDT evolution continues in 2008
Tailored education to help achieve all your dental lab and technician goals

Friday and Saturday, September 19 – 20, 2008

NEW location: Hyatt Regency, 1800 East Putnam Ave, Old Greenwich, CT

“Ancient Wisdom,
2008 Program to include:
• George Obst
Over 110 commercial exhibits
• Dan Nathanson, DMD
Over 1000 dental technicians in attendance
• Lee Culp, CDT
Over 40 educational sessions
• Romeo Pascetta, MDT ( Italy)
Free Floor Passes
• Francesco Ferretti, MDT (Italy)
• Trevor Laingchild, RDT
• Horst Koining, MDT (Austria)
5 star resort hotel
Minutes from Manhattan
• and many more…
Bring your family; bring your lab for a
Check the web for session updates
getaway weekend of learning

Parking and meals included

Hawaiian Luau Cocktail Reception,
Family Welcome.

For more information call 518-355-3183 or visit:

Become a part of something beautiful.

What’s a Lab to Do?
hanges in dental laboratories are coming so swiftly and move your organization forward. What are
are so significant that it is difficult for dental laboratory the goals that best balance what your
owners, managers, technicians, customer service and laboratory can become and what it can George Obst
sales staff to keep up to date. Most importantly, it’s most realistically achieve? Selecting the right set
challenging to figure out what actions should be taken and of goals and making them achievable is quite a challenge.
when they should be made. Before goals are set a thorough analysis must be done to
You are undoubtedly aware of the biggest factors impacting examine internal strengths and weaknesses. This should be
dental laboratories today: coupled along with the external changes that are impacting
• Automation the business. During periods of rapid change as we are
• Worldwide competition experiencing today, the very nature and magnitude of your
• Double digit growth in implants goals may need to be very different from traditional goal
• A surge in demand for cosmetic dentistry setting activities. To set and accomplish worthwhile goals,
• New product introductions significant dialogue needs to take place between management
• Increased awareness and potential involvement and the staff, before goals are set and subsequent to goal
by the FDA setting. When goals are stated clearly and communicated
• Expanded use of high level magnification and effectively they have a powerful effect on people’s behavior
illumination and results.
Although change is always with us, its current magnitude, A fourth skill is setting laser sharp priorities. Priorities
speed, and depth are unlike what most of us have experienced are the specific pathway for accomplishing the goals. They
in our lifetime. are the road map that organizes and directs the laboratory
To deal effectively with these changes and keep our toward its goals. The right priorities, combined with
competitive edge we need to develop new skill-sets that will relentless follow-up, keep the truly important things from
help us decide what actions to take. Some of these skills are being driven off the radar screen in the day-to-day work
described in a book entitled, Know-how: The Eight Skills That activity world where everything seems urgent and important.
Separate People Who Perform From Those Who Don’t, Priorities are the specific and most important actions that
by Ram Charan a gifted author and management consultant. need to be taken to accomplish the goal.
This article highlights four skill-sets: If the laboratory has a goal of growing 10% during the
• Pinpoint external changes next year, management needs to articulate the “right” four or
• Position your laboratory five priorities or action steps that must be taken to achieve
• Set goals the goal.
• Set laser sharp priorities Applying these skill-sets result in ownership and
One of the most important exercises for every dental management taking new, different, intensive and specific
laboratory is to pinpoint the external changes that affect actions to solve problems as opposed to continuing to talk
the business. This involves keeping up on changes through about problems.
reading dental publications and most importantly by talking More on these skill-sets in the next issue of Smiles.
to customers and finding out what’s on their minds. Yes, it’s
also important to try and speak with customers you may have
lost over the past 12 months. Detecting patterns of change George Obst will be a Key note speaker at the International
early in the cycle of change will help put your laboratory or Education Congress of Dental Technology with a
department on the offensive. presentation titled, "Shaping Pathways to the Future", to
Another skill that needs to be mastered is the idea of be held on September 19-20 2008. Take control of your
positioning or repositioning your laboratory or future.....ponder the following questions and plan to
department. Once you have identified external changes you attend if you are interested in your career success.
need to find and develop the ideas that will best meet
• In one sentence describe the biggest problem you face
customer demands. You have to decide how you will respond
in your lab, department, and or Job.
to each change. For example, with automation will you invest
in equipment for your laboratory or out-source products to • In one sentence describe and important change you
another laboratory where they can be made more efficiently made in the past year.
with quality and service? With substantial growth in implants
and cosmetic dentistry how will you position your laboratory? • In one sentence describe a change you are considering
Will you develop and improve your expertise in these making in the next 6 months.
specialties? Thus, with each external change the objective is
to evaluate what internal actions should be considered. See you at the Congress.
A third skill-set, setting goals, needs to be mastered to

6 DLANY Smiles
The Latest Trends
August Brugera, MDT

hen discussing veneers, everyone understands that Advantages:
they are highly esthetic restorations. Ceramic
veneers have become hugely popular in recent • Develops a highly esthetic and very thin restoration.
years and this is due, undoubtedly, to their excellent • Uses adhesive bonding technique.
biochemical behavior and esthetics after bonding. With these • Controls shade and opacity of the teeth depending on the
traits and the minimal tooth preparation needed for success, it is needs of each case.
no surprise that they are so popular. • Causes little trauma to the natural tooth.
This article reviews the evolution of veneers and shows some • Controls final shade of the restoration well.
first experiences with Empress Esthetic and e.max, new • Bonds with excellent biochemical properties.
materials from Ivoclar. • Highly translucent

Conventional Veneers Figure 1 shows how light transmits through a bonded metal
free restoration. This feature is very important for successful
For many years, teeth have been restored using the integration. When restoring one translucent material with
conventional refractory model technique. Without a doubt this another, the final shade will be the sum of the shade of the
technique has given, and does give great results. Yet, it still has natural tooth plus the shade of the veneer. This feature makes
its pros and cons: the laboratory technician’s work much easier. This would not be
the case with a porcelain metal crown (Fig. 2). The metal core
Disadvantages: eliminates light transmission and requires a cumbersome
layering technique to hide the substructure. To say that
• Length of time needed to prepare models. porcelain veneers are esthetically superior to metal-ceramic
• Slight loss of precision from duplicating methods. crowns is questionable, since comparable esthetics can be
• Precision loss from using removable models. developed with both types of restorations. The main difference

8 DLANY Smiles
Fig.3: After the veneer on #7 is bonded, the crowns on #8, 9, 10 can be
Fig.1: A translucent core always transmits light allowing better matched to it.

Fig.4: Bonded veneers and crowns. The diverse types of restorations are
not an impediment to anterior integration and harmony.

Fig.2: A metal core eliminates light making integration more difficult.

Fig. 5a: The patient presented with moderate to heavy tetracycline


between the two is the difficulty in obtaining a good

esthetic result.
In Figure 3, the patient had three old metal ceramic crowns
removed from teeth # 8 and #9, and #10, and an old labial
composite was removed from #7. Treatment consisted of a
ceramic veneer on #7, two Empress II crowns, taking advantage
of the excellent tooth color on #8 and #9, and a metal-ceramic
crown on #10 to cover a pre-existing cast post and core.
Figure 4 illustrates the fine esthetic result independent of the
type of restoration used. Making the veneer was extremely Fig. 5b: The veneer preparations show severe internal discoloration that
simple compared to the effort involved in making the metal- will have to be eliminated.
ceramic crown. One of the advantages of veneers is the high
translucency but this is a disadvantage when the teeth are When dealing with slight discoloration, a small amount of
severely discolored. opaque dentin added to the initial dentin layer would usually be
Figure 5a depicts a woman who presented with tetracycline sufficient. In this case, however, due to the intensity of the
discoloring plus areas of severe color saturation that emerged discoloration, a more opaque wash mixture of 75% dentin and
during tooth preparation (Fig.5b). 25% IO opaque (d. sign, Ivocalr Vivadent, Amherst, N.Y.) was
At first, it would seem too difficult to restore this case with needed (Figs. 6 and 7).
veneers because they are so translucent. However, it can be This first layer completely neutralizes the discoloration of
accomplished successfully by increasing the opacity of the the preparation, and then the remaining contours are finished
layering materials, thus neutralizing the internal discoloration. with a traditional layering of dentin and enamels (Fig. 8).

DLANY Smiles 9
Fig.6: Applying a mixture of 25% IO and 75% dentin will eliminate the Fig.7: This mixture is applied as a wash without going
discoloration. all the way down to the end of the preparation.

Fig.8: Appearance with the bonded veneers.

Fig. 9: A natural appearance was obtained. Fig. 10: The case before restoration.

By neutralizing the discoloration found during preparation it the finished veneers before bonding. A second look at the
is possible to obtain a result that is esthetic and well balanced patient from a distance shows how, with a very simple
with the patient’s appearance (Fig.9). treatment, the shade defect on tooth #9 is corrected and how
One of the problems with traditional veneers on a refractory his overall appearance was improved (Figs. 12a-12d).
model is that it is impossible to perform a bisque bake try-in.
This test can be essential when trying to restore anteriors where Veneers without Tooth Preparation
precise shade is extremely important. Figure 10 shows a patient
who was not satisfied with the esthetics of tooth #9. The Often, during a diagnostic wax-up, it becomes clear that the
diagnosis and subsequent treatment plan called for this tooth to patient only needs some added structure in areas that does not
be veneered. require preparation of the natural tooth (Figs. 13a &b). Often
Upon observation of the patient from a distance, however these cases can be treated with direct composite
(Fig. 12a), it was apparent that both #8 and #9 lacked the reconstructions. However, another excellent choice is to bond
prominence that the patient’s expression required. The labial indirect porcelain veneers onto the unprepared teeth. Figures
volume and incisal length of both teeth needed to be increased 14a-g show a typical anterior tooth fracture.
to obtain greater morphological contrast. Therefore, it was However, this fracture was repaired without preparing the
decided to place veneers on teeth #8 and #9. Figure 11 shows entire tooth. Instead, the clinician prepared a slight bevel on

10 DLANY Smiles
Fig. 11:
The veneers with
Ivoclar Try-in.

Fig. 12a: The two centrals lack harmony with the Fig. 12b: Now the centrals are more prominent and
patient’s expression. follow the lower lip line.

Fig. 12c: Unbalanced Fig. 12d: Balanced

the border of the fracture to obtain a better esthetic transition The patient’s natural tooth shade must be acceptable when
and greater support. making a veneer without tooth preparation, because the veneer
To mimic the natural enamel, this zone must be constructed material will be too thin to make any major chromatic changes.
with pure transparent opalescence (E1,d.sign). The shade is The transparency of the veneer allows the natural tooth to
then obtained from the natural tooth to avoid undesirable provide the desired hue, chroma and value of the final
chromatic contrasts. restoration (Figs. 16-19). If needed, the value and translucency
In this case, a mini veneer with little preparation was a good of the tooth could be manipulated slightly, however, the ability
esthetic solution and less traumatic. to manipulate shade in very thin veneers is certainly limited.
Figures 15a-c illustrates a patient with composite The restorations are layered with an enamel shade that is
restorations on the facial of the two central incisors. closest to that of the patient’s (in this case TS1, d.sign, Ivoclar
Perhaps the specialist who performed the restorations tried Vivadent). The final veneers are extremely thin (Fig. 20).
to give greater labial contour and incisal length to the central Figures 21 and 22 show how these restorations integrate
incisors. However, after a few years the patient no longer liked before bonding and after bonding and final polish (Fig. 23).
the shade. The long-term prognosis for the treatment is good because
In this case, two veneers were constructed without tooth porcelain restorations do not change shade or morphology
preparation. To do this, the clinician removed the composites, over time.
polished the enamel surface, and took an impression. The supragingival preparation on these restorations ensures

12 DLANY Smiles
Fig 13a: Before the diagnostic wax-up is finished, it is Fig. 13b: The diagnostic wax-up shows what to restore and
impossible to know the treatment plan. what type of restoration is most indicated.

Fig. 14a: Patient presents with a typical impact fracture. Fig. 14b: During preparation, the tooth is slightly beveled,
giving more support to the veneer and favoring integration.

Fig. 14c: The position of the veneer… Fig. 14d: …Increases the illusion.

Fig. 14e: With the veneer almost in place, integration Fig. 14f: Shade try-in
already becomes evident.

Fig. 14g: The bonded and

polished veneer in place.
(Clinical case Dr. Erika
Tellez, Barcelona).

DLANY Smiles 13
that the patient will enjoy impeccable hygiene and otherwise This system employs the lost wax technique without
good periodontal health. duplicate models or refractory material.
The patient in Figure 24 had a fracture of the incisal edge
Empress Esthetic and the clinician made a direct provisional with composite on
tooth #9.
One of the most difficult applications of the veneer technique An Empress Esthetic veneer was chosen to restore this tooth.
occurs when only one central incisor is restored. As mentioned The first thing that we must determine is the appropriate shade
above, it is not possible to perform a bisque-bake try-in with the of the pressing ingot. The ingot must be very similar in shade
refractory model technique and this makes it very difficult to to the adjacent tooth. Using the shade guide, look for the
achieve error free tooth integration on the first attempt. For shaded ingot that appears closest in hue, chroma, value and very
this type of restoration, the new Empress Esthetic system importantly translucence. Once we know the shade of the
(Ivoclar Vivadent, Amherst, N.Y.) is very helpful. pressed ingot, the porcelain layering can be mapped out.

Fig. 15a-c: Typical case where the labial of the central incisors lack sufficient contour.

Fig.16: When restoring a tooth without preparation… Fig. 17: … there must be an adequate basic shade...

Fig. 19: A veneer without preparation on a lateral during a

shade try-in (clinical case Dr. Erika Tellez, Barcelona).

Fig. 18: … because the natural tooth provides the shade.

14 DLANY Smiles
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DLANY Smiles 15
Fig. 20:
Veneers without preparation
can be very thin,
from 0.1-0.2mm

Figs. 21 and 22. Veneers from the case in Fig. 15 at the shade try-in.

Fig. 23. Bonded veneers (Clinical case Dr. Erika Tellez, Barcelona)

First, a full contour wax-up of the crown is achieved; this is very similar to Empress II. However with the Empress Esthetic
similar to the technique required with Empress II (Figs. 25-28). system a wide range of shaded ingots are available.
The wax-up is then reduced in the incisal areas to allow for The porcelain layering begins by reproducing some of the
future enamel layering (Figs. 29a and 30). The resulting dentin shade characteristics with internal stains. (Figs. 32-33).
core is then pressed using the previously selected shaded ingot. The second phase involves the conventional layering of
Observation of the Empress Esthetic core under transmitted enamels and translucencies to finalize the incisal characteristics
light ( Fig. 31) illustrates that the translucency of the material is and overall tooth form.

16 DLANY Smiles
Fig. 24: Direct composite provisional Fig. 25: View of the preparation on the working model.

Fig.26: Occlusal view Fig. 27: Full wax-up of the veneer.

Fig. 28: Occlusal view

of the full wax-up

After-firing, a bisque try-in is made with Variolink II Try-in Figures 40 and 41 show another example of a veneer on a
paste (Ivoclar Vivadent) in order to examine the future shade central incisor restored with Ivoclar's Empress Esthetic system.
after bonding (Fig. 34). The ability to perform a bisque try-in of the veneer is very
Try-in is an ideal bonding simulator to test the effect on the helpful, since it allows for direct evaluation in the patient's
final shade (Figs. 35-38). If everything is correct, mechanical mouth and subsequent firings if necessary, something that is
surface finishing can proceed to see the result of the finished impossible with conventional veneer systems. Empress Esthetic
veneer (Fig. 39). is also a good material for anterior restorations where crowns

DLANY Smiles 17
Fig. 29: Reduction of the incisal area. Fig. 30: Occlusal view of the reduction.

Fig. 31: The Esthetic is very

translucent which favors veneer

"The porcelain
layering begins by
reproducing some of
the shade
characteristics with
internal stains."

Fig. 32: The Esthetic core has been checked and is ready for stain Fig. 33: The stains will be applied internally to reproduce shade
application. characteristics.

Fig. 34: Empress Esthetic allows a

bisque-bake try-in and subsequent
corrections without undergoing
any distortion from the process.

18 DLANY Smiles
Fig. 35: Ivoclar Try-in allows testing before
bonding to see what shade
is the most appropriate.

Fig. 36: The shade of the preparation before try-in. Fig. 37: The veneers positioned without try-in. (Clinical Case Dr.
Sydney Kina, Maringa- Brasil)

Fig. 38: Try-in allows us to individually select the appropriate Fig. 39: The veneer from Fig. 34 already bonded and finished.
bonding material for each veneer.

DLANY Smiles 19
Fig. 40: Another case with a typical impact fracture. Fig. 41: No. 8 is restored with an Empress Esthetic veneer. (Clinical
Case Dr. Erica Tellez Barcelona, Spain)

Fig. 42: This patient will be rehabilitated with.... Fig. 43: .... Empress Esthetic veneers on 5, 6 & 7.

Fig. 44: Empress Esthetic veneer on 10. Ceramo-metal crown on implant Fig. 45: The two centrals are restored with e.max press crowns from
on 11, metal-ceramic on 12. Ivoclar Vivadent.

and veneers must be combined. Since it is possible to perform 43 and 44 show the bonded Empress Esthetic veneers and the
an esthetic evaluation, Empress Esthetic simplifies shade implant supported crown on #11.
matching, from one tooth to another. In this last case, teeth #5 The two e.max crowns are not bonded yet. If the bisque
through #12 were restored. Empress Esthetic veneers were try-in is done with the two e.max crowns next to the previously
chosen for # 5,6,7,and 10. The central incisors were restored bonded veneers, it is much simpler to integrate them, since the
using Ivoclar Vivadent's pressed ceramic material e.max. veneers already exhibit their final shade. Figure 45 shows the
Metal-ceramic crowns were fabricated for #12 and the implant two finished crowns in the shade try-in. The finished
abutment at #11. Figure 42 shows the initial situation. Figure restoration is seen in Fig. 46.

20 DLANY Smiles
Fig. 46:
The integration of the
diverse materials utilized
is very acceptable.
(Clinical case
Dr. Monica Vicario,
Dr. Oriol Llena and
Dr.Jaime Llena, Stoma
Clinic, Barcelona.)

Conclusion • Prof. Urs Belser. Quintessence book 2003.

• Shadows, a World of Shades, August Bruguera, Teamwork
Treatment with bonded veneers has been hotly debated 2003.
in recent history, but today the biomechanical and esthetic • Clinical and Laboratory Aspects in Preparing Porcelain
excellence has been clearly demonstrated and justified. Veneers: science and practice.Inaki Gamborena- Maxilares
For the laboratory, this type of treatment is really 2002.
simple and predictable. • Ultra– conservatively Esthetic Veneers, Alejandro James,
Working with the lost wax technique considerably Eladio Gonzales, Inaki Gamborena, Dental Dialogue Spain 4,
reduces the preparation time in the laboratory, while it 2004.
allows as many bisque firing tests as necessary before • Esthetics of Anterior Fixed Prosthodontics, G. Chiche,
finishing the veneers. Without a doubt Empress Esthetic A Pinault, Quintessence 1994.
was the right choice.

Smiles Product List
I would like to thank Dr. Erika Tellez ( Barcelona, Spain),
Dr. Monica Vicario ( Barcelona Spain), Dr. Sydney Kina
( Maringa Brazxil), Dr. Oriol Llena and Dr. Jamie Llena (Stoma Indication Name Manufacturer/
Befestigungskomposite Variolink II Distributor
Clinic Barcelona, Spain) for their invaluable collaboration on the Farbsimulation Variolink II Try-In Ivoclar Vivadent
clinical cases. Verblendkeramik IPS d.SIGN Ivoclar Vivadent
Vollkeramiksystem IPS Empress Ivoclar Vivadent
Esthetic Ivoclar Vivadent
IPS Empress 2
Bibliography IPS e.max PRESS
IPS e.max Ceram
• Bonded porcelain restorations in the anterior definition,
Pascal Magne.

About the author

August Brugera, is author of several articles published in national and international magazines. Author of the book
"Shadows a World of Shades" Lectures at courses and conferences in national and international conventions.
Consulting member of the US magazine Signature International; Former professor of the Dr. Thomas Escuin
Postgraduate School of the University of Barcelona, Golden Scapel award 2003. Contact: August Bruguera, Disseny
Dental ben. e-mail:

DLANY Smiles 21
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22 DLANY Smiles

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