Professional Documents
Culture Documents
Indications
• Restore lost tooth structure
• To change the shape of the teeth
• To close diastemata
• To improve the colour of the teeth
• To improve the position of the teeth??
Considerations
• Enamel ➔ Bonding ➔ Key for successful
treatment
• Non-crowded teeth ➔ Path of insertion
• Mild to moderate discolouration!!!
• Occlusion ➔ Posterior support, overbite,
occlusal interferences and para-function
• Gingival contour ➔ You can’t change the
gingival contour using veneers
• Low caries experience/risk patient
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Approach
• History and examination
• Understand what the patient wants
• Assess if it is possible
• Plan the treatment
• Urgent/Emergent care
• Stabilisation
• Rehabilitation
• Additive
• Subtractive
• Combined
• Treatment plan execution
Examination
• Micro and micro elements of the
smile
• Smile line and Lip support!
• Occlusal plane orientation ➔
Facebow record!
Diagnostic wax-up
• Try-out possible teeth
modifications
• Assess the feasibility of the
treatment
• Communicate with the patient
and technician
• Follows the principles of
functional-aesthetic smile
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Shade taking
• No later than at the beginning of
the tooth preparation session
• Agreed on with the patient
• Oral hygiene and bleaching
procedures should have been
completed at this point
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Resin mock-up
• Visualize the final outcome
• Verify
• Reduce the amount of tooth
structure removal➔ How?
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Teeth preparation
• Axial reduction
• Gingival third➔ Reduction of 0.3 mm
(feldspathic porcelain) to 0.6 mm
(leucite and lithium disilicate material).
The enamel thickness at the gingival
third is 0.3–0.5 mm ➔ What if we have
a discoloured tooth ➔ Need more
reduction
• Middle third➔ 0.5mm
• Incisal third➔ 0.7mm
• Incisal reduction ➔ 1.0 to 1.5 mm
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Classification (LeSage
Classification)
• The most modern classification considers the
amount of enamel available, and the amount of
dentin exposed:
• Class I – without preparation or minimum
preparation with the maintenance of
approximately 95% of the enamel
• Class II – minimally invasive preparation with a
reduction of up to 0.5 mm and the maintenance
of approximately 80% enamel
• Class III – conservative preparation with tooth
reduction between 0.5 to 1.0 mm and the
maintenance of approximately 50% to 80%
enamel
• Class IV – conventional preparation with more
than 50% enamel reduction
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Teeth preparation
• Creating the finish line/veneer
outline
• Round bur
➔ 1mm diameter ➔ Goes
half-way into the tooth
➔Handpiece can be angled
more freely as the centre of
the bur will not be altered
➔Can also be used to
create depth orientation
duvets on the labial surface
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Teeth preparation
• Axial reduction:
• Self-limiting depth reduction bur
➔Also known as triple
wheel
➔Cutting wheel and non -
cutting shank of 0.6 or
1mm diameter
➔ Used to create depth
orientation grooves on the
labial surface
➔Three planes of reduction
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Teeth preparation
• Axial reduction is completed
using a chamfer bur
• Three-plane reduction
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Teeth preparation
• Incisal reduction
• Completed first or last, and why?
• Bur/handpiece inclination?
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Teeth preparation
• Incisal edge
rounding ➔ Why?
• Using diamond
finishing discs
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Teeth preparation
• Incisal edge design
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Teeth preparation
• Contact area
• Break the contact ➔ Why and
how?
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Teeth preparation
• Contact area
• Break the contact ➔ Why and
how?
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Teeth preparation
• Contact area preparation
• Where should I place the margin?
• Visibility
• Black triangles
• Restorations
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Teeth preparation
• Contact area preparation
• Where should I place the margin?
• Visibility
• Black triangles
• Restorations
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Stump shade
• Especially for dark teeth
• Maximise shade matching
accuracy
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Provisionalisation
• Apply separating medium on the
teeth➔ Water soluble
• Fill in the template with the resin
material
• Trim excess around the gingival
margin and the interproximal
areas to facilitate removal
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Provisionalisation
• Trim the excess material extra
orally
• Open the embrasures
• Polish the restoration
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Provisionalisation
• Spot etch and bond
• Mechanical retention➔
Composite without etching and
bonding
• Temporary cement ➔ light cured
resin
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Veneer try in
• Try in paste ➔ Clear or coloured
• Check:
• Shade
• Marginal adaptation
• Sequence of insertion!
• Protect the veneer (adhesive
tips) and the patient’s airway➔
Gauze
• Don’t mix the veneers!
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Bonding
• Rubber dam isolation
• Teflon isolation and acid
etching (Ph)
• Veneer acid etching (HF)
• Veneer cleaning ➔ Special
solutions (IvoClean) or Ph
acid then in ultrasonic bath
• Silane coupling agent
application ➔ Universal
adhesives?
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Bonding
• Application of the adhesive
on the tooth structure
• Application of the adhesive
on the veneer
• Application of the bonding
cement on the veneer
• Seat the veneer➔ Labial
and incisal pressure
• Tack curing or cure from the
lingual surface
• Remove excess material
• Full cure
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Colour modifications
• Using bonding cement ➔ Comes
indifferent shades and opacities
➔Importance of the try-in
cement
• Staining by the dental technician
to change the shade from bright
to dark
• It is nearly impossible to use
staining to brighten a shade that
is too dark
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Material selection
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Additive
• Diastemata closure case
• Diagnostic wax-up
• Silicon putty indices
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Additive
• Intraoral mock-up
• Create depth orientation grooves
into the mock-up
• Mark the grooves with a pencil
• Remove the resin material
• Prepare until the marks
disappear
• Sometimes all you need to do is
creating a finish line and
eliminating undercuts
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Additive
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Additive
• Finish preparation
• Impressions
• Lab can use the silicon templates
to build up the ceramic veneers
• Veneers insertion
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Final result
• Natural!
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Crowding
• Moderate crowding can often be
successfully treated be a
combination of removing tooth
material (1-1.5 mm) and adding
restorative material on the mesial
and distal surfaces (additive
subtractive)
• How to plan and assess the
changes?
• Radiographs➔ Assess pulp size and
proximity
• Study casts➔ Remove➔ Wax-up
➔ Mock-up
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Combined
• Moderate crowding case
• Planning and executing teeth
modifications on the diagnostic
cast
• Wax-up to ideal contours
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Combined
• Transferring tooth modifications
from the cast to the patient’s
mouth
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Combined
• Complete teeth preparation
according to the reduction guide
• Insertion and final outcome
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