CONTENTS

 INTRODUCTION

 TYPES OF VENEERS

 INDICATIONS

 CONTRAINDICATIONS

 ADVANTAGES

 DISADVANTAGES

 PREPERATION DESIGN FOR FULL VENEER

 DIRECT VENEERS

 INDIRECT VENEERS

- PROCESSED COMPOSITE VENEERS

- PORCELAIN LAMINATE VENEERS

- CAST CERAMIC LAMINATE SYSTEMS

- REPAIR OF VENEERS

 CONCLUSION

 REFERENCES

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VENEER
 A thin sheet of material usually used as a finish
 A protective or ornamental facing
 A superficial or attractive display in multiple layers, frequently termed a
laminate veneer
 A veneer is a tooth colored material that is applied to a tooth for esthetically
restoring localized or generalized defects or intrinsic discolorations.

Porcelain laminate veneers

It is an out growth of the process described by CHARLES PINICUS in
1930.
At one time it was only for the temporary esthetic modification and for the
improvement of smile of Hollywood film actress.
The concept of laminate veneers although existing long back got its
surface in 1975 by ROCHETTE who introduced the use of silane coupling agents
with porcelain laminate veneers of repairing fractured incisors.
Then the popularity of porcelain laminate skyrocketed in 1980’s partly
because of its conservative nature and dental researches in the acid etching
technique and new bonding methods.

PREPERATION DESIGN FOR FULL VENEER

Two basic pattern designs exist:
1) A window preparation
2) An incisal lapping preparation

According to the technique applied, it can be classified into

1) Direct Veneers.
2) Indirect Veneers.

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TYPES OF VENEERS
 Directly fabricated veneers
- Composite Veneers

Indirectly fabricated veneers

 Preformed laminates
 Laboratory fabricated veneers
- Acrylic resin veneers
- Microfill resin veneers
- Porcelain veneers

INDICATIONS
 Discoloration: Teeth discolored by tetracycline
staining, devitalization, and flourosis and even teeth
darkened with age can benefit by the process.
 Patients can be given younger, brighter-looking
smiles.

 Enamel defects: Different types of enamel hypoplasia and malformations can

be masked.

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Diastema:
 Gaps and other multiple unsighty spaces can be closed.

Malpositioned teeth: Developing the esthetic

illusion of straight teeth where teeth are actually
rotated or malpositioned can be accomplished for
patients who have relatively sound teeth

Poor restorations:
Teeth with numerous shallow, unaesthetic, restorations on labial surfaces
can be dramatically restored.

Aging:
The ongoing process of aging can result in color changes an wear in
teeth.. These teeth may be ideal candidates for improvement by bleaching or in
certain situations, bleaching with subsequent veneering.

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Wear patterns:
 Porcelain laminates are also useful in those cases
that exhibit slowly progressive wear pattern.
 If sufficient enamel remains and the desired
increase in length is not excessive, porcelain
veneers can be bonded to the remaining tooth
structure to change shape, color, or function

Agenesis of the lateral incisor:

In the problem of the canine erupting adjacent of the central incisor (in
those situations where there is a missing lateral incisor) the veneer can be used
to develop better coronal form in the canine, thus stimulating a lateral incisor.

Malocclusion
 The configuration of the lingual surface of the incisors can be changed to
develop increased guidance or centric holding areas in malocclusions or
peridontally compromised teeth

CONTRAINDICATIONS
 No specific contraindications
 But some considerations to be taken into account:
- Available Enamel
- Ability to etch Enamel
- Oral Habits
Available enamel:
o There should be enamel around the whole periphery of the laminate, not only
for adhesion but, more importantly, to seal the veneer to the tooth surface.
o In addition there should be sufficient enamel available for bonding

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o If the tooth or teeth are composed predominantly of dentin and cementum,
crowning may well be the treatment of choice.

Ability to etch enamel:

Deciduous teeth and teeth that have been excessively fluoridated may not
etch effectively. They may require special measures to be successful with
porcelain laminates.

Oral Habits:
Patients with certain tooth to tooth habit patterns, such as bruxism, or
tooth-to-foreign-objects habit may not be ideal candidates for veneers..

Direct veneer techniques:

a) Direct Partial Veneers
b) Direct full Veneers

Indirect Veneer techniques:

a) Processed composite Veneers
b) Porcelain laminate Veneers
c) Acrylic resin veneers

A WINDOW PREPARATION
 A Window preparation is recommended for
most of the direct and indirect composite
veneers.
 This intraenamel preparation design
preserves the functional lingual and incisal
surfaces of the maxillary anterior teeth,
protecting the veneers from significant
occlusal surfaces.

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AN INCISAL LAPPING PREPARATION:
 An incisal lapping preparation is indicated when the
tooth being veneered needs lengthening or when an
incisal defect warrants restoration. Additionally, the
incisal lapping design is frequently used with porcelain
veneers, because it not only facilitates accurate seating
of the veneer upon cementation, but also allows for
improved esthetics along the incisal edge.

Direct Veneer Techniques:

Direct partial Veneers: Small localized intrinsic discolorations or defects that
are surrounded by healthy enamel are ideally treated with direct partial veneers.
Partial veneers can be restored in one appointment with either a self cured
or light composite.
Preliminary steps include cleaning, shade selection, and isolation with
cotton rolls or rubber dam.

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 A coarse elliptical or round diamond instrument with air water coolant to
prepare the cavity generally to a depth of about 0.5 to 0.75mm.
If the entire defect or stain is removed, then a microfill composite is
recommended for restoring the cavity.
If however a residual lightly stained area or white spot remains in enamel,
an intrinsically less translucent composite can be used rather than extending the
preparation into dentin to eliminate the defect.

DIRECT FULL VENEERS:

The “window” preparation is typically made to a
depth roughly equivalent to half the thickness of the
facial enamel ranging from approximately 0.5 to
0.75mm midfacially and tapering down to a depth of
about 0.2 to 0.5mm along the gingival margin,
depending on the thickness of enamel.
The teeth should be restored one at a time.

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 After etching, and drying procedures resin bonding agent is applied and
polymerized.
The composite is placed on the tooth in increments, especially along the
gingival margin, to reduce the effects of polymerization shrinkage.
The composite is placed in slight excess to allow some freedom in
contouring.
It is helpful to inspect the facial surface from an incisal view with a mirror
to evaluate the contour before polymerization.

Tetracycline-stained teeth:
Tetracycline-stained teeth are much more difficult to veneers, especially if
dark banding occurs in the gingival third of the tooth.
Veneer margins are placed subgingivially because of the dark
discoloration in this area.

A light cured composite is strongly recommended for veneers when the

direct technique is used. Shade selection is more difficult.
To obtain a natural appearance, it is helpful to make the cervical third of
the teeth one shade darker than middle or incisal areas.
Because the cervical areas are badly discolored and the gingival tissue
covers much of the clinical crown, isolation and tissue retraction is accomplished
with a heavy rubber dam and no.212 cervical retainer.

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 The outline form includes all of the facial surface, extending approximately
0.5 to 1mm cervical to the mark indicating the gingival tissue level, and into the
facial embrasures but not including the contact areas.

 The tooth is prepared with a coarse, rounded-end diamond instrument by

removing approximately half of the enamel thickness (0.3mm in the gingival
region to 0.75mm in the mid facial and incisal regions).
 After etching, rinsing and drying,
 A thin layer of light cured resin bonding agent is applied to the etched enamel
surface and lightly blowed with air to leave a thin layer and to remove the
excess; then light cure (polymerize).

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 To mask the discolored area, a layer of opaquing agent
is applied.
 Resin opaquing agents should be applied in thin layers
(usually two), each layer being separately cured
because of the difficult in light penetration through the
opaque material.

Now gingival shade of composite is applied with a hand instrument,

starting with enough material to cover the gingival third of the tooth. An explorer
tine is used to adapt the composite to the margin. Excess composite should not
be allowed to remain beyond the margin.
The gingival shade of the composite is feathered out at the middle third,
smoothed and cured.

Now incisal shade is blended over the middle third and onto the incisal
area to obtain proper contour.
The facial contour is evaluated by inspecting from an incisal view with a
mirror before the composite is polymerized

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12
Indirect Veneer techniques:
Many dentists find that preparation insertion, and finishing of several direct
veneers at one time is too difficult, fatiguing, and time consuming. Some patients
become uncomfortable and restless during long appointment’s.
Also, veneer shades and contours can be better controlled when made
outside the mouth on a cast. For these reasons, indirect veneer techniques are
usually preferable. Indirect veneers include those made of
(1) Processed composite
(2) Feldspathic porcelain, and
(3) Cast ceramic.

Although two appointments are required for indirect veneers:

1) chair time is saved because much of the work is done in the laboratory.
2) Excellent results can be obtained when proper clinical evaluation and careful
operating procedures are followed.
Indirect veneers are attached to the enamel by acid etching and bonding
with either a self cured, light cured, or dual cured resin bonding material.

Processed composite veneers:

Composite veneers can be processed in a laboratory to achieve superior
properties. Using intense light, heat, vacuum, pressure, or a combination of these
cured composites can be produced which posses improved physical and
mechanical properties compared to traditional chair side composites.
Additionally, indirectly fabricated composite veneers offer superior shading and
characterizing potential as well a better control of facial contours.
 Microfill composites
 Hybrid Composites can be used
1) Processed composite veneers are easily placed, finished, and polished. They
also can be replaced or repaired easily with chair side composite.
2) Indirect processed composite veneers are often recommended for placement
in children and adolescents as interim restorations.

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3) Indirect processed composite veneers also are indicated for placement in
patients who exhibit significant wear of their anterior teeth due to occlusal
stress.
• Following shade selection, the teeth are isolated with bilaterally placed cotton
rolls and gingival retraction cord. Preparation should be restricted entirely to
enamel if at all possible.
• A “window” preparation design is recommended for most indirect processed
composite veneers due to the limited bond strength of the composite veneers.
• If the teeth require lengthening or if defects exists warranting involvement of
the incisal edge, the “etched composite” veneer should be used with an
“incisal lapping design.

The window preparation is made with a rounded end diamond instrument

to a depth of approximately 0.5 to 0.75 mm midfacially diminishing to a depth of
0.2 to 0.5mm along the gingival margin, depending on enamel thickness.
Generally, no temporary restoration are placed because the preparations
are restricted to enamel.

An elastomeric impression is made of the preparations with the gingival

margins well isolated and space from the retraction cord.
A stone working cast is generated from the impression with individually
removable dies to facilitate access to interproximal areas.

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 At the second appointment the teeth be veneered are cleaned with
pumice slurry, the shade confirmed and the operating site isolated.

 The fit of each veneer is evaluated on the individual tooth and adjusted if
necessary. All of the veneers should fit closely to the tooth at the gingival
area.
A light cured resin bonding medium is recommended for bonding the
veneer to the tooth.
 Polyester strips are placed in the proximal areas of the first tooth to be
restored.
 Wooden wedges can be used to secure the position of the strips, but care
must be taken not to irritate the gingival papilla for risk of inducing
hemorrhage.
The acid etchant is artfully applied with a small brush, sponge or etchant
applicator.
A thin layer of resin bonding agent is applied to the etched enamel, lightly
blown with air, but not cured until placement of the veneer.
The selected shade of light cured resin bonding medium is added to the
tooth side of the veneer.

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• The veneer is carefully placed on the appropriate tooth and lightly jiggled in
place with a blunt instrument or light finger pressure.
• Proper seating of the veneer should be evaluated with a No.2 explorer.
• With the veneer properly positioned and excess bonding medium removed,
• A Visible light curing unit is used to polymerize the material with a minimum
exposure time of 40 to 60 seconds each from the facial and lingual directions
for a total exposure of 80 to 120 seconds.

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Porcelain Laminate Veneers:
Glazed porcelain has a long history of use in dentistry as one of the most
esthetic and biocompatible material available, surpassed only by enamel itself.
Porcelain’s abrasion and stain resistance are excellent and it is well
tolerated by gingival tissues.
The advent of porcelain labial veneers as a permanent esthetic restoration
marked the progression of more than 30 years of dental research in acid etch,
bonding and esthetic restorative techniques.

Advantages of Porcelain Laminates:

Color; This is a dual fold advantage in that the porcelain offers better inherent
color control and a natural look as well as the ongoing stability of these colors.

Bond strength: The bond of the etched porcelain veneer to the enamel surface
is considerably stronger than any other veneering system.

Periodontal Health: This highly glazed porcelain surface provides less of a

depository area for plaque accumulation as to any other veneer system

Resistance to abrasion: The veneer itself is rather fragile, but once it is luted to
enamel ,the restoration develops both high tensile and shear strengths. This is
clinical evident by the fact that veneers cannot be “popped” off teeth but actually
have to be ground away using rotary diamonds through to the original tooth
surface.

Resistance of fluid absorption: Porcelain absorbs fluids to a lesser degree

than any other veneering material.

Esthetics: The esthetics are considerably better than any other veneering
material because of the ability to control color and surface texture with ceramics.

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 Porcelain can be stained both internally and superficially and has a natural
fluorescence, lending a certain vitality.
Texture is readily developed on the veneer surface to stimulate that of
adjacent teeth and can be maintained indefinitely.

Disadvantage of Porcelain Laminates:

Time: The placing of veneers is technique sensitive and therefore time
consuming.

Repair: The veneers cannot be easily repaired once they are luted to the
enamel.

Technique-sensitive: The process of making veneers is an indirect one,

requiring two patient visits.

Color: It is difficult to modify color once the veneers are luted in position on the
enamel surface.

Fragility: The veneers are extremely fragile and difficult to manipulate.

Cost: The dental fee for a porcelain laminate can generally range from three
quarters of the fee or even more than the normal fee for an anterior full crown.
This should depend on the difficulty of the patient’s problem, the time,
level of skill artistic requirements, planning and laboratory costs involved.

PROCEDURE:
The amount of enamel reduction necessary, based on the technician’s
needs is in the realm of 0.3 to 0.6 mm or about half the thickness of the available
enamel.
Enamel reduction should be considered from five distinct aspects:

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 1. Labial reduction
2. Interproximal extension
3. Sulcular extension
4. Incisal or occlusal modification
5. Lingual reduction

Enamel reduction procedure:

Labial reduction:
The labial preparation should encompass the
amount of reduction necessary to facilitate the
placement of an esthetic restoration. Ideally, one would
like to replace the same amount of enamel that is
removed by the preparation.
However, in certain situations, such as rotated
teeth or teeth in labial version, it may be advantageous
to first bring the offending teeth into alignment with the rest of the arch by
reducing their labial contour.

DEPTH GUIDE
LVS No. 1 – 0.5 mm reduction
LVS No. 2 – 0.3 mm reduction

Depth guide:
The depth cutting diamond comes in two sizes (laminate Veneer System
(LVS) No.1 and LVS No.2) one of which would be appropriate for the tooth to be
prepared.

19
 These dimensions are 0.5 mm reduction for most situations and 0.3mm for
small teeth such as mandibular incisors where the thickness of enamel is
considerably less.

Decision is made of the required amount of reduction, then appropriate

diamond depth cutter is selected.

Reduction of the remaining enamel:

The labial reduction should encompass two aspects
1) The bulk of the reduction should be done with a
coarse diamond in order to facilitate added retention
and better refraction of the light transmitted back out
through the laminate and
2) At the marginal area, it is desirable to use a fine grit
diamond that will create a definitive, smooth finish
line to enhance the seal at the periphery.

Interproximal extension
Margin should be hidden within the embrasure area.
Extend about half way into the interproximal area.
Ensures a wrap around with etched resin bonds at right angles to the
labial surface for increased bond strength.
Move the margin just lingual to the buccal surface of the interproximal
papillae so that it will not be visible from lateral oblique view or directly from the
front.

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Sulcular Extension and Marginal Placement:
Sulcular extension and marginal placement are carried out with the LVS
two grit diamond. A narrow gingival displacement cord is placed in the sulcus for
about eight to ten minutes to slightly displace the tissue. This system of first
developing a preparation line confluent with the gingival marginal and then
placing a retraction cord prior to refining and extending it into the sulcus ensures.
 Access for the diamond.
 Less gingival trauma and
 Direct vision of the margin during all procedures.

Finish Line Configuration:

A feather or knife edge finish line is the most conservative preparation but
is inordinately complex because of:
The difficult in fabricated porcelain to the required degree of thinness
accurately and there is invariably a poor marginal fit or seal.
The invariable increased thickness subgingivially and resultant potential
for gingival problems.
Laboratory problems in delineating the exact end of preparation line.
It would appear that the most desired form of finish line is a modified
chamfer created by the LVS two grit diamond or one of similar shape. This
modified chamfer preparation is of nominal depth (± 0.25mm) near the
cementoenamel junction.
The preparation of a chamfer in this cervical area aids in sealing the
restoration by removing the acid resistant surface enamel and exposing
subsurface enamel which is more readily etched.
The modified chamfer as developed by the two grit diamond seems to be the
preparation of choice.

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Benefits of Modified Chamfer Finish Line:
1) An increased bulk of porcelain at the margin and hence increased strength
without over contour.
2) Correct enamel preparation exposing correctly aligned enamel rods for
increased bond strength at the cervical margin.
3) Increased accuracy of fit.
4) Greater ease for the dentist to obtain a correct gingival finish line after
insertion.
5) 5. A definitive stop to aid in seating the laminate in the correct position
on the tooth.
6) 6. An accurately fitting restoration with sound marginal seal

Incisal or Occlusal reduction:

• The fabrication of a porcelain veneer lapping the incisal edge makes
placement of the restoration much easier by virtue of having a definitive stop
during seating.
• The incisal edge gives the clinician a specific relationship from which to
evaluate whether the restoration is correctly positioned.
• The sharp line angles created on the buccal and lingual surfaces must be
rounded.
The incisal preparation design is somewhat controversial. Gilmour and
Stone and Glyde and Gilmour have classified the preparation of this site into four
type. They are:
1) Window or intraenamel preparation labially with intact incisal enamel (results
in an inferior appearance).
2) Feathered incisal preparation labially (porcelain is prone to fracture).
3) Incisal edge preparation of 0.5 to 1.0mm tooth reduction incisally (if no tooth
lengthening needed) to form a butt joint lingually, and.
4) Incisal edge preparation as in 3, but overlapped onto the lingual surface by
using a heavy schamfer preparation, the most versatile.

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Lingual Reduction:
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. It also ensures;
1. Increased thickness of porcelain in this critical lingual area that is being used
for incising and guidance.
2. Enamel bonds at right angles to those on the incisal edge, and Increases
strength.

Impression Technique:
Tissue Management:
The tissue is displaced so that the final finish line
can be seen in the sulcus..
This procedure will displace tissue laterally and
provide access to the sulcus.
The cord needs to remain in place for some five
minutes.

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Impression:
The impression material used should be of two
viscosities; light and heavy.
The light material should be be syringed into the
sulcus

Temporization:
Temporization for laminates is usually unnecessary because, in most
situations, only half of the enamel surface is removed and the dentinal tubules
are not exposed; therefore there should be little or no sensitivity and only minimal
esthetic compromise.
However, in certain situations, temporization may become necessary
• Mandibular teeth with incisial reduction should be
prevented from erupting by some form of temporary
veneers.
• Those situations where the reduced teeth are just too
unesthetic for the patient to function adequate also
require temporization.

There are four basic techniques for developing the temporary veneers.
• Direct composite resin veneer.
• Direct composite Resin Veneer Utilizing Vacuform Matrix.
• Direct Acrylic Veneers.
• Indirect Composite Resin/ Acrylic Resin Veneer

Direct composite resin temporarization

24
 Direct composite resin veneer
utilising vacuform matrix

Indirect composite resin/acrylic resin veneer

25
 Diverse laboratory techniques for fabrication of porcelain veneers have
gained wide acceptance.
• The refractory investment technique.
• The plantium foil technique.
• The IPS Empress system
• CAD-CAM system

The refractory investment technique:

Fabrication of a Master Cast:
A hard die stone, of crown and bridge standards,
should be chosen for pouring the master cast. Before the
stone model is poured, treat the impression with a liquid to
reduce surface tension between the impression and the die
stone. This will decrease the occurrence of air bubbles

Application of Die spacer:

Carefully a thin layer of die spacer is applied to the labial surfaces of the
prepared teeth on the master cast. This will allow space for the film thickness of
the luting resin when the veneer is bonded to the tooth. the die space should be
kept clear of the margins.

Fabrication of Refractory Model:

A refractory investment material should be chosen with a coefficient of
thermal expansion similar to that of the ceramic being used for the porcelain
veneer.
If the difference in coefficient of thermal expansion is too great between
the refractory die material and the ceramic, there is a risk of disproportionate
expansion during processing of the porcelain.

26
 Before the refractory impression is made, the master cast is coated with a
silicone based lubricant.
This will facilitate easy remove of the tray
impression material. An elastomeric impression
material is placed onto the custom cut plastic tray, then
an impression of the labial incisal areas to be veneered
is made.

De-Gassing the Refractory Investment:

To avoid contamination of the ceramic, ammoniated gasses inherent in
the refractory material must be removed.
The basic procedure is as follows:
The refractory model is introduced to the preheated furnace at low
temperature ranging from 1.0000F (5400C) to 1,2000F (6500C) and soaked in
heat for 15 to 30 minutes.
Then the model is placed under vacuum and the temperature is set
between 1,9000F (1,0400C) to 19500F (1,0660C) with a heat rate increase of
750F (250C) per minute.
The temperature is held at 1,9000F(1,0400C) to 1,9500F (1,0660C) for
two to six minutes.
The vacuum is released with a slow decline in temperature to
approximately 1,0000F (5400C).
The refractory model (or dies) is removed from the furnace and is bench
cooled.

Sealant application:
To prevent the refractory investment in absorbing moisture from the
porcelain mix, a specific refractory sealant may be placed over all porcelain
bearing surfaces and marginal areas.

27
 The sealant must be applied beyond the labial margins to achieve a good
peripheral seal. Now the painted refractory model, or dies, is fired according to
the firing cycle of the porcelain being used.
The porcelain is built up to full contour and veneers are finished and
contoured prior to stain application and glazing.

Removal of veneers from refractory material:

After the veneer are glazed and bench cooled, the refractory investment
material is trimmed carefully with an appropriate bur.
Now carefully the veneer is removed and cleaned in an ultrasonic detergent bath
for three minutes.
A rubber wheel is used to lightly remove all porcelain flash and over
extension from the edges before returning the veneers to the master cast for
adjustment.

Platinum Foil Technique:

Choosing a Foil:
Platinum foil commonly used for veneering is 0.001 to 0.00085 inch in
thickness, and is usually sold in widths of 1 1/6 to 1 3/8 inch.
The platinum foil not only acts as a surface substrate for veneer buildup
but also serves to radiate heat during firing, bringing the entire porcelain to
uniform maturity.

28
 When foil is peeled away from the interface of the finished veneer, the
interface will have a smooth, glaze like surface before it is etched and air
abraded.

Model and Die preparation:

All teeth to be veneered including the adjacent teeth are pinned. The
individual dies are sectioned and cut from the master cast.

Foil matrix:
With a triangular template specifically designed for veneering, the foil is
cut into the designated shape.
It is Placed over the labial surface of the die with the apex pointing
downward, thus forming a tab portion which extends below the gingival margin.
Systematically the foil is wrapped over the incisal edge and into the
undercuts of the gingival/proximal margins.
Methodically using an orange wood stick, the foil is adapted and burnished
into an intimately fitting form.

29
 To remove the foil matrix from the die, carefully, the tab extension is lifted
from the gingival surface towards the incisal surface in a hinge like fashion.
This foil matrix is held over a Bunsen burner flame until it glows bright
orange, to decontaminate and to anneal it.
The decontaminated foil is then readapted on the
die.
The preselected porcelain shades is mixed and
applied to the platinum foil following the buildup technique.
The porcelain is Fired according to manufacturer’s
instructions.
The finishing and glazing is Completed.
Removal of Foil:
By grasping the edge of the foil with the fine serrated tip
tweezers, gently pull the foil away from the veneer.
Submerging the veneer in water will reduce surface
tension for easier removal of foil. Lastly, the interface of the
veneer is ready to be etched.

Porcelain Application:
Because the porcelain buildup for a veneer average 0.5 to 0.8mm, the mix
will dry very rapidly while working. Therefore, water and a liquid additive, or a
special liquid medium, should be used to prevent this loss of moisture from the
porcelain mix while build up of the veneer is in progress. Porcelain should be
condensed after the veneer is built to its final stages.
The esthetic results of the finished veneer are enhanced if the porcelain
mix is applied in four stages.
• The gingival third
• Body
• Incisal and
• Enamel shading (buildup)

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Glazing:
A thin layer of porcelain fusing glaze (1.7000F/9270C) is painted on the
porcelain surface to seal any micro porosities and achieve a more natural luster.
To add chroma to the veneers, stains are applied-usually to the incisal or gingival
third in areas requiring characteristics color.
A slurry mix of glaze is painted over the labial surface, Stains are applied
and allowed to dry. The veneer is then fired to the desired surface glaze.

Etching:
The labial surface of the veneer is placed on a clay strip, allowing the
concave inner aspect of the veneer to act as receptacle. Then interface of the
veneer is filled with the etching gel (eg. 7.5% hydrofluoric acid) and allowed it to
stand for seven to ten minutes.
The gel must occasionally be brushed up to the margins to ensure etching
in this critical area. Different porcelain systems require different etching times
with various etching mediums. Individual manufacturer’s instructions must be
followed for optimum results.

31
 Prior to the final luting of the porcelain veneers, it is important to go
through a try-in stage, which is three phase process.
• The intimate adaptation of each individual porcelain laminate to the prepared
tooth surface must be checked.
• The collective fit and relationship of one laminate to another and the contact
points need to be evaluated.
• The color needs to be assessed and, if necessary modified.

Cast ceramic Laminate systems:

There are two distinct system of casts ceramic laminates:
• Castable ceramic (Dicor, Dentsply/York Div., York Pa).
• Castable apatite (Cera Pearl), Kyocera International Japan).
The two systems are remarkably similar despite the fact that the
procedures and material are very different. In both, a wax pattern is produced on
a conventional in the harmonious esthetic tooth form desired. These patterns are
finished in their entirely removed, sprued and invested in their respective types of
crucibles, depending on the type of system being.
Each system has its own particular armamentarium, and once the
investment is set, the mold is placed in a burn out furnace and gently heated to
volatilize the wax pattern. The crucibles are then correctly heated to the
appropriate temperature and placed in their respective casting machines.
For the Dicor system, the cast glass laminate is removed from the
investment and placed in the ceramming oven; this process changes the external
surface of the glass and crystalline structure.
For the Cera pearl system, the entire mold is transferred to the
crystallization oven and heated at 8700C for one hour.
Crystallization takes place producing a casting of hydroxyapatite crystals.
The casting is then separated from the investment and cleaned, using the
conventional sand blasting technique with alumina oxide powder.

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 The cast ceramic laminates can then be smoothed, polished and tried into
the patient’s mouth.

ADVANTAGES:
The Dicor and Cera Pearl veneers provide particularly intimate fit if the
laboratory procedure are correctly performed and they are most effective in
situation where underlying color of the tooth does not need to be changed too
dramatically. They may also work in closing small interproximal space or small
diastema.
The predominant advantage to these two ceramic laminate systems
appears to be the materials themselves; they are less abrasive than conventional
ceramics. Cerapearl is infact hydroxyapatite, which is a similar substance to
enamel composition.

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DISADVANTAGES:
The Dicor material is also abrasive and closer in properties to the natural
tooth enamel. It is however, covered by a layer of shading porcelain that alter the
abrasive nature of the surface.
The Dicor laminate also poses a problem if any, cosmetic contouring or
other adjustment be needed, because the underlying white cerammed glass
would be exposed.

IPS Empress Processing principle – easy and efficient

An anatomical wax-up of the restoration is fabricated, sprued, and
invested.
After preheating the investment ring, the ceramic material is pressed into
the investment ring.
After divesting the pressed objects, complete the restorations according to
the esthetic requirements using the IPS Empress staining technique and the IPS
Empress Esthetic Veneer materials.

MATERIAL
Leucite-reinforced glass-ceramic
The IPS Empress glass-ceramic material is made of a glass phase and a
leucite crystal phase.
The semi-finished product is in powder form, is then pressed to ingots
and fired.

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 The new, phosphate bonded IPS Empress
Esthetic Speed
 Investment is used .
 The system consists of a powder and a liquid

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Sprueing the wax pattern
 Depending on the size of the waxed-up pattern, directly attach a wax sprue
(diameter 2.5–3 mm / 8 gauge) to the object.
 The length of the sprues depends on the size of the objects.
 The sprues should measure 3 mm to max 8 mm in length.
 large (long) wax pattern = shorter sprue
 small (short) wax pattern = longer sprue

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 The sprue and wax pattern should not be longer
than 15–16 mm. Observe a 45-60° angle.

Observe a distance of at least 3 mm between the

individual wax pattern.
Observe a distance of at least 10 mm between the
paper ring/ring gauge and the wax patterns to be pressed.
Consider the direction of flow of the ceramic
material when positioning the sprues.

Investing
 Investment is carried out with the IPS Empress Esthetic Speed.
 Determine the accurate wax weight:
- Weigh the ring base (seal the opening of the ring base with wax).
- Position the wax patterns to be pressed on the ring base and attach them
with wax. Weigh again.
- The difference between the two values is the weight of the wax used.
 Large investment ring
- Up to max. 1.4 g wax weight and two ingots
 Small investment ring
- Up to max. 0.6 g wax weight and one small ingot

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 Set the paper ring on the base of the
investment ring and check for correct fit. Use
the ring stabilizer to stabilize the paper ring.

Mix IPS Empress Esthetic Speed Investment material under vacuum. Pour
the investment material slowly. Avoid the formation of air bubbles

Preheating

Always preheat IPS Empress Esthetic ingots

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 Always place the investment rings in the rear part of the firing chamber.
This allows homogeneous preheating.
The investment rings must be placed in the hot preheating furnace as
quickly as possible. Make sure that the furnace temperature does not drop
significantly.
Always place in the investment rings in the preheating furnace with the
opening pointing downwards.
The investment rings must not touch each other. This would negatively
influence the heat absorption and stability.

Pressing:
Placing the ingots
 Remove the investment ring from the preheating furnace.
 Place the corresponding preheated ingot that matches the desired tooth
shade.
Large investment ring
- Max. 2 ingots per pressing cycle
Small investment ring
- Max. 1 ingot per pressing cycle

Remove the investment ring from the Next, position the AlOx plunger
preheating furnace. Place the preheated
IPS Empress Esthetic ingot in the
investment ring. Place the rings in the
preheating furnace as quickly as possible.

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Divesting
After approx. 60 minutes
After cooling, the investment ring may show cracks. These cracks develop
(immediately around the AlOx plunger) during cooling as a result of the different
CTEs of the various materials (AlOx plunger, investment material, and pressed
materials).
They do not compromise the result of the pressing cycle.

Mark the length of the AlOx Separate the investment ring

plunger on the cooled investment using a separating disk. This
ring. predetermined breaking point
enables reliable separation of the
AlOx plunger and the ceramic
material.

Break the investment ring at the

predetermined breaking point
using a plaster knife

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Rough divestment is carried out with Polishing Jet Medium at 4 bar
(60 psi) pressure. For fine divestment, only 2 bar (30 psi) pressure is
applied.

When divesting the object, blast from the direction indicated in the
schematic at the top

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Luting agents
 Desirable features for luting agents
- Thin film thickness: 10 to 20um.
- High compressive strength
- High tensile strength
- Relative low viscosity
- Ability to opaque, tint and characterize
- Low polymerization shrinkage

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 - Color stability.
 Light cured composite resin system preferred.
 In case of thick or very opaque veneers, dual cured system are preferred.
 “Submicrofill Hybrid” type preferred

1. Enamel Activation

Preoperative view of an Porcelain laminate returned from

esthetically dark canine the laboratory

Clean the canine with a slurry of

pumice and water

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ENAMEL ETCHING

Isolate the tooth with two soft matrix bands

placed mesially and distally and etch enamel
for 15 to 20 seconds.

Wash the tooth with copious amount Dry the teeth with an oil free syringe
of water for 30 seconds and /or utilize a jet of warm air

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APPLICATION OF BONDING AGENT

Isolate the tooth once again and coat the Disperse the bonding agent into a fine
etched enamel surface with DBA and/or thin layer using a stream of dry air and
unfilled resin light cure and seal the surface of the
tooth.

Clean the inner aspect of the veneer with Over the dry silane layer, place a
orthophosphoric acid or citric acid. Wash layer of unfilled resin. Disperse into a
and dry. Drying is further facilitated by fine layer with a stream of air.
coating with a drying agent. Then coat
this surface with a layer of silane which is
allowed to evaporate dry.

Fill the laminate with the selected composite resin luting agent
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 VENEER PLACEMENT
Place the laminate in position on the tooth
rotating it about the incisal edge and toward
the gingiva. Ensure that excess luting
material extrudes from all peripheral
aspects.
Remove excess with a explorer or
sharp scaler.
46
Hold the laminate firmly in place to prevent
suck back an light cure for five seconds to
tack the laminate in place.
Cure the laminate for at least two
minutes on each aspect of the buccal
surface and similarly on the lingual
surface. Two lights used simultaneously
are preferred.
FINISHING

Use carbide finishing bur to remove Use the LVS no. 8 bur to remove
excess cement. composite resin along the incisal
margin.

If there is excessive amount of Clear the contacts with a extra fine

porcelain beyond the enamel, refine metal strip to ensure they are free
this with a LVS no. 6 bur to develop
emergence profile.

Polish contact area with composite Polish the tooth/composite resin

resin finishing strip luting agent/porcelain interface with
diamond polishing paste. Wash and
dry.
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 Check interproximal areas for Post operative view
clearance with dental floss

Patient Instruction sheet

 First 72 hours: Avoid any hard foods and maintain a relatively soft diet. Avoid
extremes in temperatures. Alcohol and some medicated mouthwashes should
not be used during this period.

Patient Instruction sheet

 Maintenance: Routine cleanings are must- at least every four months with a
dentist.
 Use a soft brush with rounded bristles, and floss, as you do with your natural
teeth.
 Use a less abrasive toothpaste and one that is not highly fluoridated.

Patient Instruction sheet

 Maintenance: Avoid excessive biting forces and habit patterns: nail biting,
pencil chewing etc.
 Avoid biting on hard pieces of candy, chewing on ice etc.
 Use a soft acrylic mouth guard when involved in any form of contact sports.

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Patient Instruction sheet
Mouth rinses:
 Acidulated fluoridated mouth rinses can damage the surface finish of your
laminates and should be avoided.
 Cholorhexidine antiplaque mouth rinses can stain your laminates.

REPAIRS OF VENEERS:
Failures of esthetic veneers occur because of breakage, discoloration, or
wear. Consideration should be given for conservative repairs of veneers.
If examination reveals that remaining tooth and restorations are sound.
It is not always necessary to remove all of the old restoration. The material
most commonly used for making repairs is light cured composite.

CONCLUSION:
New emerging concepts in esthetic dentistry with regards to materials,
technology and public awareness has made veneers on demand.

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 The objective of cosmetic dentistry must be to provide the maximum
improvement in esthetic with minimum trauma to the dentition. There are a
number of procedures to achieve this and the most notable is that of porcelain
laminate veneers.
But the process is highly technique sensitive and must be performed with
utmost care for optimum results.

REFERENCES
 Alberts H.F. tooth colored restoratives. 7th ed Cotali,calif.: Alto books, 1985.
 Garber, David A. Porcelain laminate veneers. Quintessence publication
co.1988.
 Goldstein RE. Esthetics in dentistry. Vol. 1- principles, Communication and
treatment methods. 2nd ed.
 Horn HR. Porcelain laminate veneers bonded to etched enamel. DCNA
27(4);1983:671-683.
 Goldstein RE. Diagnostic dilemma: to bond, etch or crown? Int J perio Rest
Dent 1987;5:9-27.
 Clyde, Gilmore. Porcelain veneers: a preliminary review. Br Dent J
1988;184(9):9-14.

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