C O N T I N U I N G E D U C A T I O N 10

RESTORATION OF THE ANTERIOR MAXILLA

WITH ULTRACONSERVATIVE VENEERS :
CLINICAL AND LABORATORY CONSIDERATIONS
Jeffrey Rouse, DDS*

ROUSE
Steven McGowan, CDT†

11
3
One significant challenge in aesthetic dentistry is to inte- While increased preparation depth allows for
grate individual restorations with the adjacent natural improved color masking, it is not always necessary and

dentition. In order to achieve a seamless result postoper-
atively, the clinical preparation and the laboratory fabri-
cation phases of treatment must be performed in concert.
The use of ultraconservative laminate veneers is a restora-
tive modality that permits the development of a functional,
aesthetic outcome while preserving the greatest degree of
natural tooth structure. This article highlights the prepara-
tion design and material considerations that are involved
with ultrathin porcelain laminate veneer restorations.
Key Words: veneer, preparation, ultrathin, color, bonding
APRIL
may even be counterproductive. If the tooth shade is cor-
rect, a thicker porcelain veneer can compromise the
natural value and chroma, which results in a restoration
with an artificial appearance (Figure 1). In addition,
while the success of enamel-bonded veneers cannot be
disputed, bonding a veneer to dentin is less predictable.
Unfortunately, a traditional veneer preparation can yield
a significant degree of dentin exposure, particularly in
the cervical one third. The mean thickness of enamel
at the gingival third is 0.4 mm on maxillary central incisors
and only 0.3 mm on maxillary lateral incisors.4 A gin-

D ue to their lifelike appearance and long-term

dependability, porcelain laminate veneers are often
selected for the aesthetic restoration of the anterior denti-
gival reduction of 0.5 mm could therefore expose a
significant amount of dentin and make the veneers more
susceptible to microleakage, pulpal irritation, recurrent
tion.1 In order to maximize aesthetics, improve fracture caries, fracture, and debonding.5 Despite the use of
resistance, optimize laboratory artistry, and maintain soft dentin bonding agents, research shows no significant
tissue health, tooth preparation is generally required for decrease in microleakage of porcelain veneers cemented
these restorations.2 The standard facial enamel reduction on dentin margins.6
(0.5 mm to 0.7 mm) for a veneer provides the laboratory
technician ample space to stack, fire, and finish the lami-
nate without fracturing it. This reduction can also facilitate
space for porcelain layering techniques while avoiding
the fabrication of restorations with an opacious, mono-
chromatic, or bulky appearance.3 An increase in prepa-
ration depth allows for improved color masking as well.

*Director, Fellowship in Aesthetic Dentistry, University of Texas

Health Science Center, San Antonio, Texas; private practice,
San Antonio, Texas.
†Dental technician, Arcus Laboratory, Seattle, Washington.

Jeffrey Rouse, DDS

2803 Mossrock, Ste. 201
San Antonio, TX 78230
Tel: 210-341-4409 Figure 1. Facial view of thick porcelain veneers on preparations with
Fax: 210-341-4483 normal color. Note the opaque, monochromatic appearance of the
E-mail: TXAcademy@aol.com veneer restorations.

Pract Periodont Aesthet Dent 1999;11(3):333-339 333

Practical Periodontics & AESTHETIC DENTISTRY

Ultraconservative preparation techniques require cervi-

cal reduction of 0.3 mm and midfacial reduction of 0.3 mm
to 0.5 mm. This process is designed to enhance the trans-
lucency of a veneer. A minimal reduction of tooth structure
allows the translucency of the veneer — rather than the
porcelain — to render a natural appearance. Further-
more, by preserving the dentinoenamel junction, the ultra-
conservative preparation increases the available enamel
for bonding, thus decreasing the risk of veneer failure.

Ultraconservative Preparation Design

The ultraconservative preparation is initiated with an
incisal edge reduction of 1.5 mm to 2.0 mm from the Figure 3. A bur with a single 0.3 mm depth gauge is utilized to mark
proper facial reduction.
final incisal edge position. For example, if 1.0 mm will
be added to the incisal edge, then a reduction of only
0.5 mm to 1.0 mm is required to provide the laboratory
technician with sufficient space for the creation of trans-
lucency and an incisal halo for the veneer. The finish line
on the lingual aspect of the restoration is a butt joint
and should not end on a wear facet (Figure 2). Although
an enamel-bonded veneer finished with a lingual butt
joint has the same fracture resistance as a natural tooth,
a lingual chamfer finish line appears to increase its sus-
ceptibility to fracture.7 Horizontal depth grooves can be
used to gauge proper buccal reduction and prevent over-
preparation of the enamel. In order to ensure a proper
reduction, a bur with a single 0.3 mm depth gauge
is used to mark proper cervical and facial reduction
Figure 4. Facial reduction of 0.3 mm with interproximal separation
(Figure 3). When a three-diamond cutter crosses the allows the maximum alteration of tooth form.
tooth mesiodistally, the labial convexity of the surface
produces uneven enamel reduction.8 Final preparation to
the depth of the grooves is completed with a medium-grit, rounded-end cylindrical diamond (KS-0, Brasseler USA,
Savannah, GA). The depth of reduction into the contact
varies with each patient. While the preparation can be
stopped facial to the interproximal contact or extended
through the contact to the lingual surface, it should not
be finished in the interproximal contact area. Generally,
increasing the interproximal reduction allows the labo-
ratory technician greater freedom in the alteration of tooth
form and position (Figure 4).9

Figure 2. Occlusal view demonstrates the lingual finish line (butt
joint) placed below the wear facets.
Laboratory Considerations
Ultrathin veneers have become possible and popular due
to improvements in clinical and laboratory techniques
and the development of natural illuminating porcelains.
The optical properties of new generation, “renaissance”
porcelains more closely mimic the interaction of the

334 Vol. 11, No. 3


A B
Figure 5A. Opalescence of traditional porcelain. 5B. Opalescence
of new ceramic. In transmitted light, its natural illumination allows
transmission of long wavelengths (ie, red, yellow) of light.
A B
Figure 6A. Opalescence of traditional porcelain. 6B. Opalescence of
new ceramic material. In reflected light, its natural illumination reflects
short wavelengths (ie, blue, violet) to impart a blue appearance.
natural dentition with light. The “illusion of reality” is devel-
oped by carefully blending opalescence, fluorescence,
and translucency.
Opalescence is a general term that applies to the
phenomenon whereby an intense scattering of visible
light is facilitated by a body with strong optical inhomo-
geneities.10 The opalescent properties of enamel increase
the value of the underlying dentin. Prior attempts to fabri-
cate ultrathin veneers reduced the value of the restoration
and resulted in a graying effect due to the use of older
nonopalescent enamel porcelains with two-dimensional
color that did not manipulate light. Contemporary ceramic
systems are composed of opalescent enamel porcelains
that distribute light in a more natural manner and change
depending on the light source (Figures 5 and 6). These
materials eliminate the graying effect and maintain the
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high value of the restoration. The opalescent effect becomes
more critical in veneer restorations with reduced thickness.
Fluorescence, which is defined as the ability of a
substance to absorb light of a narrow spectrum and
instantaneously emit light in another spectrum, has also
received increased emphasis in porcelain and compos-
ite technology (Figure 7).11 Natural teeth fluoresce blue
when exposed to ultraviolet light below the visible spec-
trum. Dental manufacturers, in order to mimic natural tooth
luminescence, began in the 1970s to add inorganic
oxides (including uranium) to base porcelain.12 Due to
health concerns, the material was changed to alternate
rare earth ions whose primary excitation wave is 330 nm
and emission peak is 420 nm,13 which corresponds to the
blue emission wavelength of the natural dentition. Since
fluorescent porcelains reflect more light than standard
opaque porcelains, the former are preferable as masking
agents in ultrathin veneer restorations.
Although the terms are often used interchangeably,
translucency is different from transparency. All the light
that strikes a transparent material is transmitted. Small
particles inside translucent porcelains, however, scatter
light in all directions.14 Transparent porcelain is often uti-
lized at the margins of porcelain inlay, onlay, and veneer
restorations. In theory, this “contact lens” effect allows
complete transmission of light to the underlying prepa-
ration and establishes undetectable margins.15 While this
effect can provide adequate results for the occlusal mar-
gins of inlay and onlay restorations, experience has indi-
cated that transparent margins on veneers instill a gray,
dead look in the gingival one third. In the intraoral envi-
ronment, composite luting cement of any thickness has
Figure 7. Fluorescent ceramic materials can achieve emission peaks
(420 nm) similar to the natural dentition.
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Practical Periodontics & AESTHETIC DENTISTRY

a tendency to absorb water, which can cause the restora-

tion to appear gray.16 Therefore, a veneer that appears
aesthetic at insertion may exhibit dull, dead margins over
extended function. The placement of colored translucent
— rather than transparent — porcelains at the margins,
can reflect light and mask the dulling of the marginal
composite material.

Ceramic Buildup
Several difficulties (eg, fabrication, risk of fracture, over-
contouring the veneers) have previously been encoun-
tered with the use of ultraconservative preparations.17 The
evolution of sophisticated fabrication techniques and con- Figure 8. The extremely thin veneer exhibits “reverse translucency.”
The most opaque portion of the restoration is the incisal one third.
temporary porcelain materials, however, has allowed
these concerns to be addressed. Today, the masking of
the junction between the preparation and unsupported
porcelain, the control of value, and the color blockout
are primary challenges of the laboratory phase.
Laboratory fabrication of the incisal 2 mm of the ultra-
conservative veneer, traditional veneer, metal-ceramic,
or all-ceramic crown restoration is very similar. The ultra-
conservative veneer, however, requires a fundamental
alteration in laboratory porcelain concepts. A distinction
between these restorations is the transition point between
the incisal ceramic material and the tooth preparation.
Clinicians often indicate that this point of transition can
be observed, particularly in patients with fractured teeth.
The junction of the incisal and body materials cannot
be detected in full-coverage crown restorations due to Figure 9. Traditional veneers feature techniques that mimic metal-
the thickness of porcelain. In an ultrathin veneer, however, ceramic layering. The opacity is located in the gingival two thirds
of the restoration; translucency is in the incisal region.
it is not possible to conceal the junction with a bulk of por-
celain. The key in masking the transition is through the
application of a highly reflective modifier (Flu-Dentin,
Duceram Plus, Degussa, South Plainfield, NJ), which has
the same relative opacity and fluorescence as natural
dentin. Consequently, it will provide a highly reflective
band that conceals the junction and allows an invisible
transition to be achieved.
The ceramic buildup technique on the body of an
ultrathin veneer varies significantly from other porcelain
restorations (eg, traditional veneers). In order to match
chroma and control value, the ultraconservative veneer
is designed with “reverse translucency.” In traditional
veneers, color and value are controlled by masking or
opaquing the underlying colors of the tooth and allow-
Figure 10. Facial view of conservative veneer preparations, which is
ing the veneer to become more translucent in the incisal used as a reference by the technician to localize and minimize the
third only. Using reverse translucency, however, the most use of opaque porcelain materials.

336 Vol. 11, No. 3


Figure 11. Ultrathin veneer restorations with internal characteriza-
tions and/or maverick colors can be masked in the laboratory.
Figure 12. Preoperative facial view demonstrates fracture of the
maxillary central incisors, which had been unsatisfactorily restored
with composite resin.
Figure 13. Facial view demonstrates ultraconservative veneer
preparations that taper into the fracture site.
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opaque portion of the restoration is the incisal third and
the most translucent section is the body (Figure 8).
Therefore, these veneers have minimal dentin porcelain
in the body, which allows the tooth rather than the
ceramic material to dictate color. Yet, this concept can-
not be applied to all types of veneer restorations. The
fabrication of a veneer with a thickness of 0.5 mm to
0.7 mm and reverse translucency would significantly
reduce the value of the laminate restoration (Figure 9).
In the absence of an opaque base, light striking the
restoration will be absorbed by the ceramic material.
Therefore, thicker porcelain absorbs more light and
causes a greater shift in value. If the veneer is ultrathin
and the porcelain is highly opalescent, however, light
will be reflected naturally and maintain the high value.
With an ultrathin veneer restoration, color blockout
can be difficult to achieve. The color of the tooth prepa-
ration will be used for the development of natural color.
It is important, therefore, that clinicians provide the lab-
oratory with a photograph of the final preparation. With
this photograph, the tooth can be measured by the tech-
nician to locate maverick colors or discolorations that
will be concealed (Figure 10). Failure to communicate
this information prevents the masking of maverick colors;
opacious porcelain will, by necessity, be added indis-
criminately to conceal blemishes and reduce the translu-
cency of the veneer. Once the blemishes have been
identified, masking agents can be selectively added to
the restoration. Color-modifier porcelains (feldspathic
porcelains with added color pigments) are routinely used
to create optical effects and conceal discolorations in
restorations. At a depth of 0.3 mm, the color of the porce-
lain and the modifiers is less significant. As translucent
materials become thinner, the color pigments have less
of an impact on the overall color. Therefore, color char-
acteristic stains are utilized to achieve similar effects in
ultrathin veneers. These stains are opaque metal oxides
that are painted into wet porcelains. The stains are placed
into cuts to simulate cracks and craze lines or painted
over areas to mask or further characterize the tooth and
subsequently covered with a thin layer of opalescent
porcelain prior to firing (Figure 11).
These layering techniques can also be utilized to
satisfy the expectations of patients who present for aes-
thetic enhancement. In general, when the underlying tooth
is the correct hue, it is possible to modify the tooth by
one shade for every 0.2 mm of tooth reduction. In fact,
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Practical Periodontics & AESTHETIC DENTISTRY

at a depth of 0.3 mm, the chroma of the porcelain is

almost insignificant; it is the brightness that is critical.
Consequently, ultraconservative veneers can provide an
efficacious means of matching existing tooth color or
performing minor color alteration.

Case Presentations
Case 1
A 28-year-old female patient presented with a fracture
of both maxillary central incisors (Figure 12). The teeth
had been damaged by trauma 7 years previously and
the teeth remained vital. The incisal edges had been
repaired with composite resin that would either stain or Figure 14. Postoperative facial view of 0.3 mm ceramic veneers.
Note that the low chroma of the natural teeth was duplicated in the
fracture after a brief period of service. Due to previous restorations without lowering the value.
difficulties with direct bonding, this restorative option was
rejected by the patient, who requested aesthetic treat-
ment. Since enamel-bonded veneers are more reliable
than dentin-bonded crown restorations, the decision was
made to restore the maxillary central incisors with porce-
lain laminate veneers. In this instance, 3 mm of unsup-
ported porcelain would remain following treatment.
Although research indicates that 2 mm of unsupported
porcelain does not increase the risk of subsequent frac-
ture,18 3 mm appears to be acceptable in patients with
minimal parafunction. The patient gave consent to the
treatment plan, which was then implemented.
Since the original line angles of the teeth still existed,
re-creating the shape of the missing segments was not Figure 15. Preoperative facial view of diastema closure. Note
difficult; the challenge was to match the high value and compromised aesthetics of the dentition and gingival tissue.
low chroma of the natural dentition and to conceal the
fracture demarcation in the veneer restoration. In order were subsequently bonded with a light-cured adhesive
to mask the junction between supported and unsupported and composite resin (Figure 14). The postoperative results
porcelain, the preparation design was modified. An achieved the aesthetic expectations of the patient.
ultraconservative reduction was chosen for the bulk of
the preparation to ensure an adequate enamel bond Case 2
and easier color match. If the 0.3 mm preparation had A 53-year-old female patient presented with discolored
been extended to the fracture, it would not have pro- composite resin that had been placed to close a diastema
vided the technician with sufficient space to incremen- between the maxillary central incisors (Figure 15). The
tally build up fluorescent porcelains. Since the definitive patient was dissatisfied with the aesthetics of the exist-
restoration would display the fracture line, the preparation ing restorations and requested treatment with porcelain
was tapered midfacially into the fracture (Figure 13). The laminate veneers. Measurements of the teeth confirmed
incisal aspect was reduced 1.5 mm and finished lingually that the space could be closed without creating an unnat-
with a butt-joint margin. This preparation design allowed ural length-to-width ratio. Since the shade of the adja-
the laboratory technician to match the chroma and value cent teeth was within one shade of the desired final result,
of the natural dentition and taper the porcelain into the an ultraconservative veneer was selected as the restora-
fracture to reestablish the missing segment. The veneers tive modality.

338 Vol. 11, No. 3


Figure 16. The interproximal aspects of the veneers were over-
contoured by the technician to close the diastema and recontour
the papilla.
Figure 17. Facial view of the definitive restorations postoperatively.
The veneers altered the shape of the papilla to close the diastema.
In order to perform aesthetic closure of the diastema,
it was critical to adjust the interproximal contours and
embrasures and to reshape the interdental papilla in
the laboratory phase.8 While the depth of the prepa-
ration remained 0.3 mm, the interproximal preparation
extended to the linguoproximal line angle and 1.0 mm
subgingivally. This ultraconservative design allowed the
laboratory technician to overcontour the restoration prox-
imally, which altered the tissue contour while maintain-
ing the proper visual face of the teeth by controlling
heights of contour (Figure 16). In addition, the matching
of the chroma and value was simplified by allowing the
natural underlying tooth color to dictate the chroma and
value through the ultrathin veneer restoration (Figure 17).
Light-cured adhesive material and composite resin were
utilized to bond the veneer restorations. As a result of the
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prosthetic manipulation of the gingival tissues, the treat-
ment was able to enhance the aesthetic appearance of
the definitive restorations and the gingival architecture.
Conclusion
The use of ultraconservative preparation techniques and
veneers allows the restorative team to effectively match
the natural dentition and achieve the increasing aesthetic
demands of their patients. In addition, the conservative
gingival reduction ensures the development of an
improved enamel bond that could potentially reduce
microleakage, staining, and debonding.
This article has also provided a discussion of con-
temporary or “new generation” porcelain materials that
are characterized by physical and optical properties
(eg, opalescence, fluorescence, translucency) that more
closely resemble those of the natural dentition. Utilized
in combination with advanced stratification and prepa-
ration techniques, these characteristics allow the devel-
opment of ultrathin veneers that mimic natural contour
and color while masking the incisal-tooth interface.
References
1. Banowetz J. Porcelain veneers, the esthetic alternative. AGD Impact
1996;6:12-16.
2. Chalifoux PR. Porcelain veneers. Curr Opin Cosmet Dent 1994:58-66.
3. Garber D. Porcelain laminate veneers: Ten years later. Part I: Tooth
preparation. J Esthet Dent 1993;5(2):56-62.
4. Ferrari M, Patroni S, Balleri P. Measurement of enamel thickness
in reduction for etched laminate veneers. Int J Periodont Rest Dent
1992;12(5):407-413.
5. Wat PY, Cheung GS, Kei LH. An improved preparation for indi-
rect porcelain veneers. Dent Update 1993;20(2):72-76.
6. Sim C, Neo J, Chua EK, Tan BY. The effect of dentin bonding agents
on the microleakage of porcelain veneers. Dent Mater 1994;10(4):
278-281.
7. Castelnuovo J, Tjan A, Phillips K, et al. Fracture strength and failure
mode for different ceramic veneer designs. J Dent Res 1998;77:803
(Abstract No. 1373).
8. Liebenberg WH. Porcelain laminate veneers — Preparation and
isolation innovations. Gen Dent 1995;43(1):50-58.
9. Rouse JS. Full veneer versus traditional veneer preparation: A discus-
sion of interproximal extension. J Prosthet Dent 1997;78(6):545-549.
10. Chen S, Chu B, Nosal R. Scattering techniques applied to super-
molecular and nonequilibrium systems. In: Encyclopedia of Science
and Technology. 8th ed. Blacklick, OH: McGraw-Hill, 1981.
11. Zwimpfer M. Color, Light, Sight, Sense. West Chester, PA: Schiffer
Publishing, 1985.
12. Wozniak WT, Moore BK. Luminescence spectra of dental porce-
lains. J Dent Res 1978;57(11):971-974.
13. Baran GR, O’Brien WJ, Tien TY. Colored emission of rare earth
ions in a potassium feldspar glass. J Dent Res 1977;56(11):
1323-1329.
14. Gibilisco S. Translucent Transparent. The Concise Illustrated
Dictionary of Science and Technology. Blacklick, OH: McGraw-
Hill, 1992:459.
15. Friedman M. Multiple potential of etched porcelain laminate
veneers. J Am Dent Assoc 1987;116 (special issue):83E-87E.
16. Fruits TJ, Duncanson MG Jr, Miranda FJ. In vitro weathering of
selected direct esthetic restorative materials. Quint Int 1997; 28(6):
409-414.
17. Bichacho N. Porcelain laminates: Integrated concepts in treating diverse
aesthetic defects. Pract Periodont Aesthet Dent 1995;7(3):13-23.
18. Wall JG, Reisbick MH, Johnston WM. Incisal-edge strength of
porcelain laminate veneers restoring mandibular incisors. Int J
Prosthodont 1992;5(5):441-446.
PPAD 339
CONTINUING EDUCATION CE 10
CONTINUING EDUCATION

(CE) EXERCISE NO. 10 NEW YORK UNIVERSITY

College of Dentistry
Center for Continuing Dental Education
New York City, NY

To submit your CE Exercise answers, please use the answer sheet found within the CE Editorial Section of this issue and
complete as follows: 1) Identify the article; 2) Place an X in the appropriate box for each question of each exercise; 3) Clip
answer sheet from the page and mail it to the CE Department at Montage Media Corporation. For further instructions,
please refer to the CE Editorial Section.
The 10 multiple-choice questions for this Continuing Education (CE) exercise are based on the article “Restoration of the
anterior maxilla with ultraconservative veneers: Clinical and laboratory considerations” by Jeffrey Rouse, DDS, and Steven
McGowan, CDT. This article is on Pages 333-339.

Learning Objectives:
This article describes preparation design and material considerations for the fabrication of ultrathin porcelain laminate
veneer restorations. Upon reading and completing this exercise, the reader should have:
• An improved understanding of conservative tooth preparation for ultrathin veneers.
• An awareness of the layering process involved in the laboratory fabrication of the restorations.

1. Which of the following is NOT an advantage of 6. In the ultraconservative veneer, fluorescing

the ultraconservative veneer as compared to
traditional veneer preparations?
a. It requires less cervical and midfacial reduction.
b. It enhances the clinician’s ability to bond to
enamel.
c. It improves veneer translucency.
d. It has less susceptibility to fracture.
2. The mean thickness of enamel found in the
gingival one third of a maxillary central
incisor is:
a. 0.3 mm.
b. 0.4 mm.
c. 0.5 mm.
d. 0.7 mm.
3. The ultraconservative veneer preparation
requires facial reduction of:
a. 0.5 mm to 0.7 mm over the entire
preparation.
b. 0.5 mm tapering midfacially to 0.7 mm.
c. 0.3 mm tapering midfacially to 0.3 mm
to 0.5 mm.
d. 0.5 mm tapering midfacially to 0.3 mm.
4. Incisal edge reduction:
a. Is never necessary.
b. Is 1.5 mm to 2.0 mm from the final incisal
edge position.
c. Is 0.5 mm to 0.7 mm from the final incisal
edge position.
d. Is 0.3 mm from the final incisal edge position.
10. The incisal transition area where the veneer
5. The lingual finish line should:
a. End on a wear facet and be a chamfer.
b. End on a wear facet and be a butt joint.
c. Not end on a wear facet and be a butt joint.
d. Not end on a wear facet and be a chamfer.
porcelain is primarily used:
a. To lower the value.
b. As a masking agent.
c. To increase the chroma.
d. Instead of dentin porcelain.
7. Contemporary ceramic systems composed of
opalescent enamel porcelains enabled the use
of ultrathin veneers by:
a. Masking the graying effect by adding color.
b. Distributing the light in a more natural manner.
c. Reflecting the shade of the underlying dentin.
d. Masking the dulling of the marginal composite.
8. The three critical optical properties of porcelain
are:
a. Hue, chroma, and value.
b. Opalescence, fluorescence, and transparency.
c. Opalescence, fluorescence, and translucency.
d. Opacity, translucency, and luminescence.
9. The term ”reverse translucency” refers to:
a. More translucency existing in the gingival
one half of the veneer.
b. More translucency existing in the incisal one
half of the veneer.
c. More translucency existing on the outside
of the tooth.
d. The difference between a veneer and a
metal-ceramic restoration.
starts and the preparation ends is masked by:
a. Fluorescing dentin porcelain.
b. Opacious dentin porcelain.
c. Composite build-up materials.
d. A bulk of porcelain.

340 Vol. 11, No. 3