Full veneer versus traditional veneer preparation: A discussion of interproximal

extension
Jeffrey S. Rouse, D D S ~
San A n t o n i o , Texas

Statement o f p r o b l e m . Traditional venecr preparation has come to reprcscnt an almost univcrsallv

acccpted guideline o f veneer prcparation. It calls for an interproximal finish line at or just into thc contact
point. However, in certain situations, such an approach can have flmctional and esthctic limitations.
P u r p o s e . This article reviews thosc functional and esthetic limitations and discusses an alternative
tcchlqque, thc full veneer preparation. Thc advantages and disadvantages of this approach arc discusscd in
rdati,:m to venecr cases with malaligned tccth, diastcma, discoloration, black spaces, restorations, a n d / o r
veneers next to crowns. (J Prosthet Dent 1997;78:545-9. )

W t h its introduction in the early 1980s, porce-

lain laminatc veneers redefined conservativc cosmetic
dcntal t r e a u n c n t . Initially, practitioners focused on
whether thcs,~ thin, fragile porcelain shells would bond
on the tooth, resist fracture under load, and keep from
lcaking. With a clear conscnsus that they have been suc-
cessfifl, ~,e porcclain laminate veneers now arc evolving
into more thnctionallv and csthctically dynamic restora-
tiOl]S.
Much o f t~c rapid acceptance of this technique can
be attributcd to the ease and simpticib~ o f the original,
traditional veneer preparation design. However, this ar-
ticle suggests that altcmative preparations designs, spe-
cifically the fLtll veneer approach, should be considered
in certain situations to maximize the functional and es-
thetic results possible with porcelain veneers. In particu-
lar, the advantages and disadvantages o f this approach Fig. 1. Traditional veneer preparation design, 0.5 mm facial
ate discussed in relation to veneer cases with malaligned and 1.5 nqm incisal reduction, interproximal finish line facial
to contact.
teeth, diastcma, discoloration, black spaces, restorations~
a l l d f f o r v e n e e r s n e x t to c r o w n s .

TRADITIONAL VENEER PREPARATION
The traditional proximal veneer preparation dcsign
cxtcnds to the interproximal stopping facial to the con-
tact (Fig. 1 ). It attempts to maintain all bonding sur
thces in enamel, provide a positive seat for cementation,
and hide mari~ins intcrproximally without removing con-
tacts. ~'~' This traditional preparation outline allows a
simple, quick, and conservative reduction of tooth struc-
ture. Because all prcparcd surfaces are in enamel and
contacts arc left undisturbed, the traditional veneer
prcparation ~t[so prccludes the need for temporization.
Bccausc of thc relative ease of the preparation and the
lack o f telnp~raries, these "ideal" guidelincs o f v c n c c r
preparation have become almost universally acccptcd.
Plesented at the American Academy of Restorative Dentistry annual
meeting, Chicago, IlL February 1997.
q~rivate practio~, and Director, Fellowship in Aesthetic Dentistry,
{Jniversity oF ]e~as t tealth Science Center--San Antonio.
To hide the veneer tooth interface and to in~pr()\c
retention by bonding at right angles to the direction of.
displacement, many practitioners now cxtcnd prepara
tions into the contact area. Christenscn =suggcsts prc
paring halfway through the contact and Garbcr '~rccom
mends two thirds as a more appropriatc depth. Hoax
ever, neither onc mentions extcnsion through the cntirc
contact.
FULL VENEER PREPARATION
Thc advantages of hiding margins and increased rc
tention are also obtained if the preparation design brcaks
interproximal contact and continues to thc lingual. The
term f u l l ~cnecr can be used [o describc this style (H
preparation (Fig. 2), v which highlights the continuum
of design between a traditional veneer and an all ceramic
crown. Thc f'ull veneer preparation is continued to the
lingual extent of the tooth to break contact on one or
both sides and allow the laboratory technician ample

DECEMBER 19:)7 THE JOURNAL OF PROSTHETIC DENTISTRY $45

THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. Traditional preparation stops short of or slightly into
contact; whereas, full veneer preparation extends to lingual
extent of tooth.
Fig. 3. Pretreatment view of patient with malaligned teeth.
room to make cosmetic and functional changes. Fortu-
nately, the interproximal area has a thicker band o f
enamel that allows extension to the lingual aspect with-
out extensive dentin cxposure. This design is in essence
an enamel-based, reverse one-half or three-quarter ve-
nccr preparation. Besides the csthetic advantages,
Garber 8 claims an increase in bond strength to proximal
prepared surfaccs by developing bonds at right anglcs
to thc direction o f displacement. Likcwisc, a full veneer
may have the additional benefit o f greater retention, re-
sistance, and improved longevity. 10
When the interproximal contact is opened, the teeth
must be tcmporizcd to reduce sensitivity and prevent
migration. It should be stressed that this design is not
appropriate fbr every situation or every tooth. However,
whcn cnamel augmentation is necessary; tooth position
or size is altered, or significant color masking is required,
546
ROUSE
Fig. 4. Full veneer preparations used to adjust patient's
malaligned teeth,
a full vcnccr prcparation can bc an advantage. Examples
of possible full veneer situations include malaligned teeth,
diastema closure, discoloration or staining, black space
closure, replacing restorations, and venecrs adjacent to
crowns.
Malaligned teeth
The key to rcpositioning malaligned (Fig. 3) or mis-
shapcn tceth is the location o f the contact. The move-
ment o f the contact from one tooth to the adjacent tooth
laterally changes the t o o t h size, and a buccolingual
change can alter tooth position. Thcrcforc simply pre-
paring the teeth to or into the contact limits the
technician's ability to create an acceptable illusion o f
alignment and proportion. In addition, poorly positioned
teeth tend to require aggressive proximal extension to
develop a path o f inscrtion for the veneer (Fig. 4). H
Furthermore, the lingual and thc facial surfaces o f the
malaligned teeth must be brought into ideal alignmcnt.
This could be accomplishcd by recontouring malaligned
lingual surfaces and optimally contouring with composite
the rotatcd surfaces to match adjacent marginal ridges. 12
Alternatively, the lingual surfaces can bc realigned with
the venccr if the preparation extends far enough to thc
lingual to allow the technician to augment the defective
contour (Fig. 5). In addition to rccontouring the teeth,
an alteration o f the 6:ee gingival margin may be requircd
to provide symmetry, as in this situation.
Diastema
Most authors 6'1~ 13 agree that extension o f the prepa-
rations to the lingual is rcquired to allow room for the
technician to dcvclop the illusion o f space closure and
the appcarance o f corrcct anatomic proportion. How-
ever, there is no consensus regarding how far lingual is
appropriate. Suggestions range from "1 mm toward the
lingual ''L4 to "the interproximal line angle "Is or "the
VOLUME 78 NUMBER6
ROUSE THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 5. Patient's final veneers present as straight teeth. Fig. 6. I)iastema closure with traditional preparation desigv,
(an yield wide, flat, and unattra(ti\e ~ e n e e r ,

linguo-proximal line angle. ''L2 Robbins ~1 summarized

these approaches by concluding that the greater the spacc
to be closed, the f:arther thc prcparation must be to thc
lingual. ~%t, visualizing thc p r o p e r depth required to
p r o d u c e the illusion o f natural c o n t o u r s is difficult. Tra-
ditional prcparation cxtcnsion is inadequatc and will
makc thc fina vcnccr t o o convex OF EOO flat (Fig. 6).
In addition to the visual illusion dcntists attempt to
create, thcrc is the proprioceptivc illusion that must be
dcxclopcd. If the interproximal extension is t o o shal-
loxv, it crcatcs an indentation b c t w c c n the teeth, which
is constantly noticeablc to the patient/' Whereas, i f t h c
t(~oth is prcparcd dccp to the lingual, the vcnccr can
blcnd into the c o n t o u r s o f the lingual t o o t h structure.
Finally, it i:~ i m p o r t a n t to extend thc intcrproximal
prcparation subgingivally in diastema closure situations
to recontour the papilla. If the papilla is not rccontoured,
propcr anatomic form can not bc achicvcd. Nash ~' dc- Fig. 7. Inadequate preparation extension on tetta(ycline
stained teeth produ(es peripheral halo interproximaHv, espe
scribes thc p~'oblem as a V-shaped diastcma closurc,
ciall~,' noticeable on mesial of (anines of this patien[
whcrc thc vcnccr is prcparcd "ideally" with a supra gin
gival finish linc, leaving thc widc, flat intcrproximal tis
suc undisturbcd. W h e n thc vcnccr is insertcd, the mc- the preparation is rcquircd to deal with discolored or
sial surf:acc o : the veneer angles o f f dramatically as it tctracvclinc stained tccth. ",~ ~_,~-,~s Ho\~cxcr, thesc dis-
approaches the papilla, which leads to an unnatu,'al cussions arc limited to the propcr a m o u n t o f ihcial rc
V shape bctx\ccn the tccth. The natural c o n t o u r o f a duction that leaves interproxima] rcduction at a s t a n
central incisor includes a trigonal shape, with a straight dard dcpth o f 0.5 m m or lcss. Yet, as Robbins ~ notcd,
mesial surface. This straight mesial surfhcc c a n n o t bc the prcparation o f dark tccth must brcak contact o n t o
a c h i c \ e d \vitllout s u p p o r t i n g proximal structure and the lingual surface to dccrcasc the risk o f h a x i n g a dark
r c c o n t o u r i n g the papilla with thc vcnccr. Thcrcfbrc the shadow around thc pcriphery o r t h e veneer ( Fig. 7 ). The
p r c p a r a t i o n :;hould c x t c n d 1 m m bclo\~ thc tissue idcal prcparation tbr discolored teeth therefore calls fi)r
intcrproximally. The papilla \\,ill r c c o n t o u r during tom extension t h r o u g h the contact as well as subgingivaliy, if
porization and c o n t i n u c affcr placement o f t h c final \'c- thc gingival third is discolored.
IlCCrS. N o t o n h ' will an u n d e r r c d u c e d t o o t h incrcasc the risk
o f a periphcral halo~ but it will also require thc labora-
Discoloration
t o r y to use o p a q u c porcclains proximally to mask the
As with f:acial rcduction, color is an i m p o r t a n t dctcr- discoloration. >' Thc natural esthetics o f an anterior tootl~
minant (~fthe a m o u n t o f i n t c r p r o x i m a l reduction. Most dictate incisal and proximal t r a n s l u c e n t \ ' . 1~,\ placing
practitioncrs : c c o g n i z e that alteration o f the depth o f opacity whcrc transluccncv should bc t~tlnd, ~hc tcch

DECEMBER 199," 347

 THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 8. Preoperative view of patient's teeth with negative spaces
and old restorations.
Fig. 9. Patient's final veneers replace previous restoration and
close black spaces.
nician destroys the cosmetic potential o f the veneer. In-
stead o f a dynamic presentation, the perception tends to
be a fiat, m o n o c h r o m a t i c tooth.
Black spaces
When there is recession o f the gingiva in the gingival
embrasure, unsightly negative spaces can appear between
the teeth (Fig. 8). This occurs with malaligned teeth,
age- or disease-related recession, and surgical reposition-
ing of the tissue. I f the veneer is prepared with a tradi-
tional design, the technician is locked into filling the
defect directly below the contact, widening the facial
contact, and elongating the tooth. In contrast, a full
veneer preparation gives the technician the flexibility to
close the black spaces and contour the contact deep into
the proximal, preventing these anatomic irregularities
(Fig. 9).
548
ROUSE
Fig. 10. Lingual extension of veneer preparation on central
incisor is used to match lateral incisor crown preparation.
Restorations
In the traditional preparation, all margins should re-
main on sound enamel. However, often anterior teeth
have preexisting restorations that must be removed or
replaced. Each dentist must establish a criterion as to when
incorporating an existing composite restoration into the
veneer margin is acceptable. This article suggests that Class
IV restorations should not be left and should be incorpo-
rated into the veneer preparation. Also, Class I I I restora-
tions more than half o f the incisal-gingival height should
always be removed and included as part o f the veneer. I f
the Class III restoration is to remain, it should be re-
placed be~bre veneer fabrication and the patient should
be informed o f the possible complications. 1~ An alterna-
tive to leaving the margin on composite is to prepare over
it, placing the margin on enamel. Unfortunately, estab-
lishing a good path o f insertion and creating a bond to
the existing composite makes this technique difficult.
Veneer n e x t to c r o w n s
At times porcelain veneers must be placed adjacent to
ceramic crowns. Interproximal finish lines o f the veneer
should be extended to the linguoproximal line angle or
deeper in such cases (Fig. 10). When a c o m m o n veneer
preparation is cut in such a situation, there is usually a
cosmetic mismatch interproximally due to the differing
thicknesses o f the confluent restorations. This ceramic
discrepancy can be corrected if the interproximal aspect
of the veneer is prepared deeper and extended farther
lingually to match the crown. This preparation will al-
low the crown and veneer to be made with the same
ceramic and bonded with the same resin.
SUMMARY
Porcelain veneers, well-established as a successful cos-
metic procedure, continue to evolve. Dental porcelains,
VOLUME 78 NUMBER6
ROUSE THE JOURNAL OF PROSTHETIC DENTISTRY

'!. (Tri~t)i*l BJ FulL vcr~(,('~s: th(' tLlnt *i()rml cmd P, l l > t ! ( ,~I>l>Ik , m ( ) ~ d > n < i < , ~ i
laboratory techniques, and bonding resins havc dramati-
(t~r,mqi( >. C ( ) n l l > n d i u m 1994;t S:2~4 8
call)' improvec, adding to an already dynamic, depcnd- I0. El-Shoril .\I, ]d( (il)i }~. IlIu ( (!I,Imi( [( \{'P,<' [hK'c qHmlt't < ~(l\',r ):, ,!l!hq!(~
ablc rcstorati( n. Howcver, practitioncrs arc still view- teeth: I)rCl),>lii(m & s i g n I Prosthet I)('m l q ~ 9 ; ( ~ / : 4 (~
1 I. Rd)bins Jk~ r. I>i)rc d i l i n \ onoe)~, In: F u n d < m ) ( ' n [ 4 ] ' , ()f u p e k l t i \ ( , (i('!!liS[l'~ : <:
ing prcparatioJ design in 1980s tcrms. This articlc sug
( ()ni0ml>r,1)\ <>l))a<)t }~ ( - h k <~g(~: ()U~n{(I%q('[]( (' t > d )l i d m ; !v ( <, % ; I < ) %
gcsts that it is t mc fbr dentists to rcthink porcclain vcnecr I) ~ 4 0 -7 1
prcparations, especially the intcrproximal cxtcnsions, t(> 12. ".liNm MB P()i{d<li)l \(ll('t'l'~. R(',)lil', hltoim Some<'> f:. h ' ! [),,~*i
1 ')()O; i 0 : 4 4 ) 0
maximize their csthctic and functional potential.
I ~. (;lil)I)I(,/Xl<.\'~uIlipI('di<>t('m,~ milil,l~('i~1('nL tr~ hm'.Ib.~ iplium\ p ! m m , h
r h e author aclcnowledges I)r. Bill R o l ) b i n s , M r . S t e v e M c G o w e n , l Esthot I)unt 199,1:0:()7 I))2.
<rod I)r. Ruby Rouse for their assistance in ~eviewing this mdl~uscril)t. I 1 Rosc'nlhiH I [)J,lsl(H]]J ([{)HtlI(, ulili/i]~g p<>~(d,/h :(.)!u~ ), dl~ i iu ,rod ~1{I
~.an{ {'d. I)('nl E{ ()n I (){).-U~4:(>).4
I'orcelain v e n e m s i)) F i g u r e s 3 a n d 9 vvele fabricated by Stove
I ) Knight I [). / '~c ol I)(Irt ul<lil~ II)! il('illin<4 <! r/re,ilL I) \ ( Unthll lii<!q~'m</. { ;u!l
Mc(]owen. C D T , A r c u s L a l ) o r a t o r y . S e a t t l e , Wash.
[ )(>hi [ 992;40:49/~ <)
] f) N,)sh Rt,\, ( [ ( ) s i n g <1I<lrg{' ( ('nli//I (Iia<Ht'm.t [)(!111 k:( {)a/ I ct().7:1~I:;;() I
REFERENCES I 7. Ni-.(>il t<1 ',.bsldn<,-~ ,.c'~ert']\ h!tkl(:yclinu q < m > d m t t h ~>,lli~ ( ul nu( IJiiii
I ( ; i l m o u i A S , S olv.! t)C. P o r c d a i n liln~in.lte ',oneei'k a clinical <,m ((",<,? n,/t(, x.(!nu(,i., t)i</ct I)c,)iodonl ,~\{t':,thot I)c>l~( 1 9 9 ( > : ~ L 2 2 7 17g
I)entUpdate 199L20:1679 I?) l r c>hk(~v~,skx R I ) ",bsl<ing t('h.t{',( iim' 'q<firlhltz ,,,. iHi p(}r< ~, ,~ir~ ,, u r l ( u r >
2. Dtlr/lIO SM, Mi lar BJ, ,,\ longitudinal sltld\' of lhe dini( <ll p e l i o ) m , m c e <)1 I )('ill [:( ()n [ q()4:~/4:()4 .
pore d<~in ', ent, Trs. Br [ ) e n t J 19{7 ~717"J:; 17-2 I Iq li!1/ ( ( ( ,!h{' .,'lc,{t]()l~ . > l [)(>~(,,1<~ \ l , ~ ( , t , l ~ ()tiinh,--~'i<e h~
), Khlg D ( Z ,\/elh:)(l~, anct nlillOli{li$ it)l poicc21ain '~ciR)(!lS> (Trill ( ) p i n ( o'>!ql(q IqG]:2G: ;1 I r
I ) e n [ I t)5)5:4S- >{),
4 Chl)indol I>, ( 7 i s l o u M, I o o i h i)rcl)ar<~tion <met (<~l)fi(alion ol i)o)celai)/ I{el>l>t u'(/(l(',t • ',
\ on(!(!15 using <1 dc)til)ledaycr 1(,( hniclue. P),/( t P ( ' i i o d o n t ,'\o<d~ol t){'i~t
1994;6:1 (}-30,
] ( ]dtl)t!l [), POP( elain laminillc' \,(!i1{'(!r5,: lel~ \e<irs I<~l{'l I)<~l( I: 1o o t h i)wl)a b \/\\Iv<:,, {X ~L!>,0
i<][iOl]. I Esthcl D e n t 199 }:r5:-~()62.
6. C h a l i f o u x PR. } ' m c d a i n veneers. ( U l r ()pisl Co<,met I)ent 1 9 9 4 : 7 8 0(). ( i)p~,righl ( I ] [)( ) 7 J)~ lh~, k d i l o r m ] ((>uncil (>I I,Itu ,t<mn)S . I l',(,.,I:(,t~( i).,>
7 (Thiist(m<.('n (; Porcel,th~ k~?rl(~TI ul)d<ik' '9 ~ Clin R(,s iX..<.()( N(':x<,ltr INt~
199LI. ()022 191 q7 Sq. ~ I 10/1/85706
8. (;arhc'r DA. P ( ) r ( d a i n v(!n(,Ol<k l o i ) l e p i u o ul nol i)rep<~ro." Ihdl i~ IhP
queslion. C o n l Eslhet [)enl 1 9 9 6 ; 2 : 1 - 7

Anatomical shading technique utilizing the Synspar

N o t e w o r l h y Al)strads
porcelain system
of the
Kuwata M. Qui~tcssolcc l)cllt TcchT~ol 1997;20.'12,S-,75.
Current Literature
Purpose. Sincc its publication 20 years ago, the Alaatomical Shading Technique has bccn thc
standard for building up dcntal porcclain powdcrs for ccram()mctal rcstorations. With thc dcvcl-
()pmclat o f a ncw porcelain powder, Synspar porcclain system (lelacric/1)Clltron), the Anatomical
Shading Tcchniquc can be used practically and systcmaticall)' in commercial laboratories. This
article described the scientific basis and practical nature of this technique.
Methods. The main problem associated with this tcclmique has bccn shade guidc problcms rc
lated to vahic sclcction. The reason why vahlc or "transluccncy gradings" could not bc standard
izcd was because of the inconsistcncies in the manufacture of'porcelain powdcr. Thc dc\clopmcm
of a synthetically nmnufacturcd glass now allows thc manufacturc ()fporcelaii1 with standardized
tral>luccncv. The new synthetic glass, its powdering, and the creation of'this new dental porcelain
system, Synspar systcm, arc dcscribd. A dcscription of'the technique is given and a basic outline <)(
the basic buildup of a single crown is illustrated in a stcpwise fashion.
Conclusions. With the advent of this new systcm, the dental technician can rely (m a logical
approach to quanti~qng huc, chroma, and valuc. This ncw lllanuf:actttring proccss enablcs the
ceramist to rcplicatc natural tecth, accordilg to thc A~utomical Shading Tcchniquc, \vithout cx
pcriincntation, which was prcviously ncccssarv when making ccramometal restorations.
1 Rcfcrence.--RP R E N N E R

DECEMBER 199: 549