The porcelain laminate veneer (PLV) has gained significant notoriety throughout

popular culture. The use of this treatment modality has elicited a discussion of its
appropriateness and ethical usage. [1] Currently, there are no universally accepted
guidelines as to the suitability of this treatment modality.
PLVs are routinely used in the correction of malposition and minor dental diastemas
(see images below). In addition, malformations, minor chips, and discolorations not
responsive to chemical bleaching are being remedied via the application of PLVs.

Preoperative view of a
diastema.
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Postoperative view of a
diastema closure.
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Successful implementation of PLVs requires meticulous planning, as well as a clear
understanding of the patients expectations. With routine care and good oral hygiene,
PLVs can be a conservative and ideal treatment option.

Two methods are currently being used to manufacture dental veneersdirect and
indirect techniques. The direct method involves the direct application of composite
resin on the tooth surface without laboratory fabrication. In most cases, the direct
technique does not require the temporization of the dentition and may be completed
in a single dental visit. The indirect method utilizes a dental laboratory for the
manufacturing of the veneers. The indirect technique requires that an impression be
recorded, which is an additional step. With the advent of computer-aided design and
computer-aided manufacturing (CAD-CAM) technology, it is now possible to
complete an indirect restorative procedure in a single dental visit.

Treatment via the direct or indirect protocol may or may not require the reduction of
natural tooth structures.

Preoperative protocol for dental veneer treatment requires that all sound dental and
medical principles be followed. In doing so, the following should have been
addressed and resolved preoperatively:
Active periodontal disease
Occlusal imbalances
Other active pathologies
For the vast majority of cases, the placement of a porcelain laminate veneer (PLV) is
elective. The patients objectives and expectations should be thoroughly studied. The
limitations and risks should be explained to the patient and fully understood.
Alternatives such as traditional orthodontics, bleaching, and crown treatment must
be explored prior to intervention. It is not uncommon for several treatment modalities
to be combined in achieving the patients objectives.

A study of the current masticatory system requires the recording of impressions for
the fabrication of study models (see image below).

Preoperative study models.

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To simulate the postoperative esthetics and functional prognosis, an esthetic wax-up
may be constructed upon articulated models (see image below). This aids in
evaluating treatment objectives and potential for additional needs in varying the
periodontal architecture. Gingival architecture plays a crucial role in the smile design
process. [2]
 Wax teeth planning (wax
up) for planned veneers.
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Besides an articulated model, a survey of the patients extra-oral anatomy is ideal.

The smile line, midline, interpupillary distance, and other pertinent anatomical
landmarks are registered and considered. [3] The recording and analysis of such data
is best conducted through the use of digital photography (see image below).

Preoperative view.
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The preparation design for a porcelain laminate veneer (PLV) varies, and several
preparation techniques exist. Overall, the tooth preparation should be optimized for
the removal of the least amount of tooth stricture.

The following necessitates the removal of tooth structure during the preparation
phase:
Providing sufficient thickness for the structural integrity of the PLV
Providing optimal clearance in relation to the opposing dentition
Accommodating space for the new morphology
Accommodating for a shift in the midline
Accommodating for change in tooth inclination
 Removal of decay

It cannot be overemphasized that the mechanical properties and constraints of the

materials used for the fabrication process be respected during preparation. With the
variety of substrates available on the market, the minimum preparation depth for
mechanical integrity varies. In general, when overlaying a veneer, it is important that
a minimum of 1-2 mm of tooth structure be reduced. These guidelines exist for the
consideration of occlusal and shear forces.

A study by Otani et al assessed an automated robotic tooth preparation system for

porcelain laminate veneers for accuracy and precision compared with conventional
freehand tooth preparation. The study concluded that the automated robotic
procedure was able to prepare the tooth model as accurately as the conventional
freehand procedure and the conventional procedure was able to prepare the tooth
model with better precision. [4]

Other guiding principles in veneer preparations include the following:

Maintaining enamel for bond strength
Terminating the veneer preparation at or above the gingiva for moisture control
during cementation
Ensuring that occlusal contact points do not rest upon margins
Avoiding all sharp angles within the preparation as to mitigate force aggregation
Considering preparation characterizations that aid visualization for the laboratory
technicians
Accommodating appropriate lines of draw

Veneer preperation.
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The lack of temporization has become unacceptable to patients for reasons of

esthetics and sensitivity. Besides patient needs, temporization serves as a
diagnostic tool. The transitional restoration allows patients to visualize the final
prosthesis. For the clinician, the temporaries permit an in vivo examination of
functional esthetics. Concepts of guidance and occlusal stability derived in the study
model phase may be reconfirmed. It is not uncommon for the patient to use
temporaries for several weeks so both the doctor and patient can evaluate suitability.
A common technique used in the fabrication of temporary veneers utilizes a matrix,
which is synthesized from a copy of the diagnostic wax-up. Numerous brands of
acrylic resins may be introduced into the matrix and onto the prepared teeth for the
fabrication of an accurate and acceptable transitional restoration. The temporaries
are retained on the prepared teeth through mechanical and/or other bonding
techniques. It is prudent that this restoration permits an efficient and effective oral
hygiene regiment. Violation of this provision could result in gingival irritation, making
the cementation phase of the final prosthesis nearly impossible.

After the trial phase of the transitional veneers, an impression is taken of the
temporaries, along with the prepared teeth. This vital information will guide the
laboratory technician in fabricating veneers that conform to form and function.

Temporary veneers.
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Porcelain laminate veneer (PLV) cementation requires a high degree of technical

skill.
All prepared teeth should be isolated with reliable moisture-control protocol.
Contamination from blood, saliva, or any other fluid will compromise maximum bond
strength and long-term stability.

The retention and removal of the temporary depends on the technique implemented
by the clinician. After removal, the prepared teeth must be thoroughly cleansed of all
residual cements and debris. Failure to do so will impede the precise seating of the
veneers. Pumice may be used as an effective debridement material.
The use of a light-cured or dual-cured resin for the cementation of the final product is
indicated.
 Cemented veneers.
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