Porcelain Laminate Veneers

• A thin porcelain laminate bonded to the external surface of a

tooth to improve their color, shape and overall appearance..
1. Malformed
2. Discolored
3. Abraded, or eroded
4. Have faulty restorations
5. When we need to adjust the teeth length or alignment
(minor alignment adjustment)
6. Restore Enamel defects
7. Close space
8. Restore fractures
 Contra-Indications
1. Unhealthy Gingival Tissues
2. Lack of Enamel or Presence of Multiple Restorations
§ Sufficient peripheral enamel insures adhesion & proper
sealing

§ 50% or more of tooth structure should be in enamel

3. Deciduous Teeth (unless permanently retained)
4. Abusive Oral Habits
§ Bruxer (give them protection guard)
 butt-joint
incisal design ncisal-lapping
localized defects intrinsic discoloration.
 generalized defects intrinsic staining
involving most of the facial surface
 Direct Indirect
technique. technique.
Indications:
• Only a few teeth are involved (single discolored tooth)
• When the entire facial surface is not faulty
• Young children
• Patient’s time or money is limited
Can be completed chairside in one appointment

Disadvantages:
• Too difficult, fatiguing, and time consuming.
• Patients become uncomfortable and restless during long appointments.
• Veneer shades and contours can be better controlled when made outside.
Advantages:
1.Much less sensitive to operator technique.
2.Indirect veneers made by a laboratory technician are typically
more esthetic.
3.If multiple teeth are to be veneered, indirect veneers require less
time for delivery in comparison to indirect veneer.
4.Indirect veneers typically last much longer than do direct veneers,
especially if they are made of porcelain or pressed ceramic.

Require two appointments or more

Direct composite veneers
indirect veneers
outline form of the canine is intact
patient is canine guided
 no defects exist along the lingual
aspect of the incisal edge
simplest design
easily provide adequate reduction
 needs lengthening
incisal defect warrants restoration

incisal defect
resistance form desired
• Intra-enamel preparation
strongly
recommended
• Should it terminate short of the free gingival crest at the level of
the gingival crest or apical of the gingival crest?
depends on the individual situation

subgingivally
gingival area is carious or defective, warranting restoration,
or if it involves significantly dark discoloration
terminated just facial to the proximal contact except
diastema
• Primarily made of:

1- processed composite
2-Feldspathic porcelain
3-Cast to pressed ceramic )IPS e.max press)
4-CAD/CAM ceramics (CEREC )
 teeth are inherently under-contoured
interdental spaces open incisal embrasures are present when both
conditions
TREATMENT SCHEDULE FOR PORCELAIN
LAMINATETECHNIQUE

VISIT I. Diagnosis &Treatment Planning

VISIT II. Preparation, Impression, Temporization

VISIT III. Try--in, Cementation, Gross Finish

VISIT IV. Final finish, Photographs, home--care
 VISIT I. Pre--Operative Records

• Chief Complain, patient’s need

• Clinical examination, Radiographs
• Study models :
• diagnostic wax--up,
• templates, silicone indexes, mock up
 VISIT I. Pre-Operative Records

• Photograph with shade tab in picture

• Shade selection
–select shade slightly lighter than
desired (higher in value, lower in chroma)

• Smile Analysis:
– Number of teeth displayed
– Gingival symmetry

DO NOT FORGET to take Informed consent from the patient

 Pre--Operative Diagnostic Records

Using silicone matrix created from the

diagnostic wax--uphelps to visualize
For Temps/ Mock-ups
amount of tooth reduction

Used for
To check facial reduction
• Provisional fabrication
• Mock--up fabrication
• Preparation guide
To check Incis al r educ1t3ion
Pre--Operative Diagnostic
Records
Esthetic Mock--Up
PreparationThroughTechnique
• Functional and esthetic evaluation
completed before starting final tooth
preparation

• Depth cuts made into mock--up appropriate

for the selected restorative material

• Prevents over--preparation in areas that are

under--contoured preoperatively
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 Pre--Operative Considerations

• Evaluate existing restorations --size, number, condition

• Bleaching
• Select porcelain type:
• lucent (minimal color alteration)
• masking (to block dark stains)
• Occlusion
• Single/multiple teeth to be veneered ?
• Does treatment plan include other crowns and veneers?
• Patient expectations (are they reasonable?)
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VISIT II TOOTH PREPARATION

Uncomplicated when basic principles are

understood and followed
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 VISIT II. Clinical Guidelines

Intraenamel preparation is strongly recommendedTo:

§ Create a path of insertion and definite finish line
§ Prevent over contouring
§ For maximum esthetics
§ Remove outer, fluoride--rich layer
§ Create rough surface for improved bonding
• Preparation margins should be maintained in enamel whenever possible !
• Extent of reduction and extension of outline form dependent upon
required color alteration
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 VISIT II. Clinical Guidelines
§ Facial cervical reduction 0.3--0.5mm
§ Facial incisal reduction 0.5--0.7 mm
§ Proximal reduction:
§ stop facial to contacts
§ extends lingually (space)
§ Half way the contact

§ Sulcular extension 0.0 --0.2 mm

§ Incisal 1.0 --1.5 mm (when indicated)
§ Finish lines (modified chamfer)
§ Internal line angles (rounded)
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Interproximal Contact Areas…

Stop facial to contact Extend through contact

•Difficult
to accurately • Dark teeth, marginal discoloration
capture margins in final or for diastema closure
impression if within
contact
Incisal Edges

v For maximum esthetics 1.0--1.5 mm

incisal reduction

v Butt--joint with flattened edge & rounded Butt--joint

sharp inciso--facial line angles

 Gingival Finish Line (GFL)

§ For stronger bonds, margins kept on sound enamel

§ If no or minimal discoloration
§ GFL at gingival crest or slightly subgingivally
Labial deep chamfer
0.3 - 0.5 mm

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 Tooth Preparation
Facial Reduction 0.3--0.5 mm

determined by

1. Position of tooth in the arch

§ Facio-verted à more reduction

§ Linguo--verted à minimal reduction

2. Color of the tooth

§ More discoloration à more reduction

§ Little or no discoloration à minimal reduction

 Preparation Sequence

1-Connect depth cuts of facial

reduction and margins
2- Then incisal Reduction
3-Lastly smooth all surfaces and
round margins
VerifyTooth Reduction
Final Impression
 Temporization -Techniques

• Direct composite resin veneer

– free hand 1--3 veneers
• Direct composite resin or acrylic resin veneer
utilizing vacuum or silicon matrix

• Indirect composite resin or acrylic resin veneer

Temporization -Techniques (Direct approach)

no bonding agent is required for bonding

Temporization
VISIT III TRY--IN & CEMENTATION
 Visit III. Veneer Delivery Procedures

• Examine veneers under magnification and illumination (To

inspect the cracks, margins and internal etching )
• Check fit of veneers:
– on study casts
– in patient’s mouth
• place a drop or two of water on internal surface
• first try in veneers one-at-a time
• then try in veneers all together
• Check color using try--in paste if Masking the discoloration or not

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To proceed to cementation , there are 3 preparations should be done.
1-porcelaine veneer prep.
2-patient prep.
3-natural tooth prep.
 1st: veneer preparation

• After try- in ,Etch porcelain veneer internal surface

with Hydrofluoric acid.

• Apply silane coupling agent to etched internal

surface
 2nd : patient preparation

• Local anesthetic (if needed)

• Isolation
• Tissue retraction
• Clean prepared teeth
–pumice all surfaces, strip proximals, wash and
dry
• Protect adjacent teeth using
Teflon tape or mylar strips
3rd: tooth preparation

• Start with central incisors first

work your way distally
Visit III. Gross Finishing
Visit IV. PLVRs Final Finishing

Avoid excessive use of

polishing burs and
abrasive diamond paste!!
 Home Care

§ Use protective guard

§ Treat them as your natural teeth

-Brushing and flossing after each meal

-Avoid biting on hard objects
-Visit hygienist 3--4 times/yr
-Notify hygienist of veneers, and not use
acidulated--fluoride treatment or ultrasonic
scalers
 conservative repairs

not always remove all of the old restoration

most commonly u is light-cure
composite
Thank you