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Case Report Porcelain Laminates Veneers: Case Report

Article · January 2015

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Case Report
___________________________________________________ ____________________
J Res Adv Dent 2015; 4:2:16-20.

Porcelain Laminates Veneers: Case Report

Harleen Sachdeva1* Sumit Khare2 Rama Shankar3 Nishit Kumar4 Ashutosh Sthapak5

1Reader, Department of Prosthodontics Crown & Bridge, Bhabha College of Dental Sciences, Bhopal, MP, India.
2Reader, Department of Prosthodontics Crown & Bridge, People’s Dental Academy, Bhopal, MP, India.
3Senior Registrar, Department of Dentistry, Tata Main Hospital, Jamshedpur, Jharkhand, India.
4Assistant Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Jamnagar, Gujarat, India.
5Senior Lecturer, Department of Prosthodontics Crown & Bridge, People’s Dental Academy, Bhopal, MP, India.

ABSTRACT

Background: The Porcelain Laminates Veneers (PLVs) is one of the most esthetic restorations. These are
conservative and durable restorations provided the correct techniques and indications are followed. This case
report describes in detail the case selection, tooth preparation, laboratory procedures and cementation of
laminates on maxillary six anterior teeth. The article also outlines the indications, contraindications, risk factors
for veneer failure and advantages of using PLVs over other treatment modalities available.

Keywords: Feldspathic porcelain, Refractory cast, Etched enamel.

INTRODUCTION

PLVs have become the esthetic alternative to ceramic crowns and the traditional porcelain-fused-to-
metal.1,2 With the successful use of laminates smiles can be transformed painlessly, conservatively and quickly
with long lasting results.3 Laminates show an excellent tissue response, and their finished surface is very similar
to the natural teeth.2,3 Veneers exhibit natural fluorescence and absorb, reflect and transmit light exactly as does
the natural teeth structure. 1,2,3 PLVs are the restoration of choice ( Magne & Belser) where discoloured teeth are
resistant to bleaching such as degree III and IV tetracycline stains, when anterior teeth require major
morphologic modifications such as conoid teeth, diastemas, to prolong the incisal edge of the tooth to increase its
length4, for extended rehabilitation of compromised anterior dentition such as coronal fractures, congenital and
acquired malformations where dentinoenamel junction is not altered. 5,3,6

CASE REPORT OPG and IOPA. After examination, a provisional

A 20-year old female patient reported to
the Department of Prosthodontics, College of Dental
Sciences Davengere with a chief complaint of
discoloured anterior teeth and wanted cosmetic
rehabilitation for the same.
Diagnosis and Treatment Planning:
A thorough case history of the patient was
taken followed by diagnostic impression, mounting
with facebow transfer and radiographs including
_______________________________________________________________________________________
diagnosis of enamel hypoplasia due to moderate
fluorosis was made. Dentofacial Analysis and shade
selection was done. Then shade was selected for the
anterior laminates.3 (Fig 1)
The treatment objectives were to manage
the discoloration and modify the contours of the
teeth in most conservative method possible.
Porcelain laminate veneers were planned on the six
maxillary anterior teeth. Patient was informed
about the existing condition, treatment procedure
was explained and the consent was taken.

Copyright ©2015
Fig 1: Preoperative frontal view. Fig 4: Bonding agent applied.

Fig 2: Prepared teeth with retraction cord placed. Fig 5: Cemented laminates frontal view.

Fig 3: Finished and polished veneers. Fig 6: Cemented laminates incisal view.

Teeth Preparation A key element in success with PLV is carefully

controlled but appropriate tooth preparation.
A well adapted, horizontally sectioned
silicon matrix was made from the diagnostic cast The aims of tooth preparation are to:
which was later used as a reference for teeth
reduction.3,5,7,8

17
  Provide some space into which the
technician can build porcelain without
over-contouring the tooth.
 Provide a finished preparation that is
smooth and has no sharp internal line-
angles thus avoiding areas of high stress
concentration in the restoration.
 Maintain preparation within enamel
whenever possible.
 Define a finish line to which the technician
can work.
Facial Reduction
 The preparation depth of the order of
0.4mm close to the gingival margin, rising
to 0.7mm for the bulk was achieved by
using depth cutting burs (model S850 ,
0.314.0.016 Brasseler, Germany). 1
 To mimic the natural curvature of the tooth
and to provide even thickness of porcelain
two plane facial reduction was done.2
 The appropriate tooth reduction was
verified with the use of silicone matrix. 8
Fig 7: Post operative view.
Proximal Reduction: Proximal reduction was kept
just short of breaking the contact.5,9
Incisal Edge Reduction:
Incisal reduction of 1mm was done with incisal
overlap to improve translucency and to provide
positive seat for luting.2,5,9,10,11
Cervical Finish Lines: Equigingival Chamfer finish
line of 0.4mm maximum depth were made. All the
internal line angles were rounded to reduce
stresses in the margins of the veneers.
Recording an impression
Retraction cord (No.000) was placed in the
facial gingival sulcus for 5 minutes.(Fig 2) Full arch
impression was made using poly vinyl siloxane
material using putty reline technique. An
impression of the opposing arch was made using
irreversible hydrocolloid material.
Laboratory Procedure
The refractory material was poured into
the impression and was allowed to set for 30
minutes. After removing the refractory cast, it was
kept in furnace for hardening at 6000C for 10
minutes. Once the hardened cast was cooled, the
prepared teeth on the cast were sealed with 30 ml
glaze liquid. Again refractory die was hardened for
5 minutes at 6000C. Feldspathic porcelain ( Vitadur
Alpha all-ceramic was layered and fired over the
refractory die. 2,3 . (Fig 3)
Try-in Procedure:
The teeth were cleaned prior to the trial.
The quality of fit, gingival extension and color match
of the veneer was assessed.
Cementation
The intaglio surface of the veneers were
etched using 30% Hydrofluoric gel, rinsed and
coated with a silane coupling agent.2,3,12,13 The
prepared tooth were well isolated and etched with
37% orthophosphoric acid ( Universal Etch) , rinsed
and Prime & Bond NT dentin bonding agent was
applied following manufacturer’s instructions.(Fig
4) Calibra (Dentsply) resin luting cement was used
for the cementation of the porcelain laminate
veneers. Once all gross excess was removed , the
luting resin was cured using visible light activation
unit for 40 seconds each. PLVs were finished using
rotating abrasive disks (Soflex discs). (Fig 5,6)
Home care instruction:
The patient was given oral hygiene and
home care instructions for the adequate care of the
18
porcelain laminate veneers and asked to follow a
strict followup protocol 1 week, 3 months, and 6
months for the assessment of the treatment
procedures and oral hygiene measures.(Fig 7)
DISCUSSION
Patient selection is integral for success of
PLVs, in the present case because of young age a
conservative method of treatment PLVs were
selected. Presence of normal overjet and overbite
with favorable smile line and absence of
parafunction and presence of sufficient enamel
made PLVs most acceptable treatment option.
The advantages of using these restorations
are they are biologically acceptable to the body
owing to their increased chemical stability, lesser
cytotoxicity and reduced risk of causing irritation or
sensitivity. These restorations exhibit reduced
plaque build-up and its easy removal due to their
smoothly glazed surface.2,3,6
Owing to their ceramic thickness (0.3-
0.5mm), the PLVs can be easily fractured even
before they are bonded. However, once bonded to
the etched enamel surface they integrate with the
tooth structure and become extremely durable. The
union of etched enamel and porcelain, combined
with the bonding composite resin-luting agent with
a silane coupling agent provides a long lasting
restoration.2,3,12,14
PLVs should be avoided when enamel is
insufficient, tooth is pulpless, parafunction,
unsuitable anatomical presentation of teeth and
poor dental care. The risk factors for veneer failure
are bonding onto pre-existing composites
restorations, placement by an inexperienced
operator, using veneers to restore worn or
fractured teeth where large areas of exposed dentin
and insufficient tooth structure is left. Another risk
factor, shown up by in-vitro work, is the tendency
for thermal changes in combination with
polymerization contraction stresses to cause
cracking of the veneer when the porcelain is thin
and the luting composite is thick.2 A thick composite
lute may occur as a result of a poorly fitting veneer
or the use of copious die spacer in an attempt to
mask underlying tooth discolouration. Least
cracking was seen with a ceramic and luting
composite thickness ratio above 3. 9,12,15
It is possible to use composite restorations
instead of porcelain laminate veneers to cover up
tooth discolouration or unesthetic forms. However,
the longevity of composites is questionable as they
are susceptible to discolouration, marginal fractures
and wear.2,3,6
CONFLICT OF INTEREST
No potential conflict of interest relevant to this
article was reported.
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