DR. DR. ABHISHEK JOHN SAMUELABHISHEK JOHN SAMUEL MDS, Endodontics & Conservative DentistryMDS, Endodontics & Conservative Dentistry

VENEER: layer of tooth colored : layer of tooth colored material that is applied to a material that is applied to a tooth for esthetically restoring tooth for esthetically restoring localized or generalized defects localized or generalized defects or intrinsic discolorationsor intrinsic discolorations

-Sturdevants Art & Science of Dentistry Pg. 322

Made of chairside composite, porcelain or cast ceramic materials

1. Closing spaces. 2. Minor tooth position improvements (correcting rotation or

overlap). 3. Lengthening short or worn teeth. Improving tooth shape. 4. Making aged teeth look youthful. 5. Correcting teeth in lingual version. 6. Post orthodontic treatment. 7. Shade change/Brighten shade/Stain Correction

Discoloration leading to deep dentinal defects

Enamel defects Large DiastamataMalpositioned teethPoor restorations on labial sufacesAging Wear pattern

Available enamelAbility to etch

enamelOral habits

Shape or form Symmetry and proportionality Position and alignment Surface texture Color Translucency

Feminine smile

Rounded incisal angles,open incisal and facial embrasures and softened facial line angles

Masculine smile More closed and

prominent incisal angles

Prominent areas highlighted by light

Depressed areas shadowed

Change in apparent size of a tooth- narrower by positioning mesiofacial and distofacial line angles together

Sense of balance and harmony – subconscious visulisation

Augmentation of proximal surfaces with composite

Restorations at midline- incisal and gingival embrasure form

Tooth position tooth alignment, arch form, configuration of smile

‘Golden proportion’Proportion of smaller tooth to larger tooth 0.618‘Repeated ratio’Golden proportion only in 17% of casts (Preston et al)

The golden ratio (also known as the golden mean, golden section or divine proportion) is a height to width ratio that measures 0.618 and manifests itself in nature, art and architecture

RED- the proportion of the successive widths of the teeth as viewed from the frontal should remain constant as one moves distally.

In other words each tooth becomes smaller by a fixed percentage as you move back in the mouth.

The RED proportion is not limited to one particular proportion but allows the desired allows the desired RED proportion to be selected and consistently applied for each individual RED proportion to be selected and consistently applied for each individual case. case.

Studies have shown that smiles which maintain a constant 78% width/height ratio of the upper central incisors are preferred.

The taller the teeth the smaller the RED Proportion usedThe taller the teeth the smaller the RED Proportion used. The shorter the teeth the larger the RED Proportion used.

YOUNG TEETH AND OLD TEETH

ANATOMICAL FEATURES

Cervical areas darker than incisal areas

Young patients-lighter teeth Older- incisal edge enamel thinned

due to wear and is darker Shade selection Metamerism

Esthetics and function

Anterior guidance and occlusal harmony

Physiologic contours

Emergence Profile

Mayekar (2001) Laminate maintains colour. Usually requires no Tooth Prep. Veneer- change in colour, requires Prep. (endodontically

treated teeth and tetracycline stained teeth)Constructing a veneer and bonding it to tooth structure is

referred to as laminating

1930-40s- Charles Pincus- Thin porcelain veneers

1970-80s- Direct composite resin laminates- No tooth preparation

2nd evolution- Preformed veneers/crowns1980- Etching of glazed porcelain with

hydrofluoric acid and silane coupling agents

Partial Veneers- Localized defects or as areas of discoloration

Full Veneers- More generalized defects/ intrinsic staining

Direct Indirect - less technique sensitive - more esthetic -longer lasing - multiple teeth

For opaque, tinting, bonding or veneering material for maximum esthetics without overcontouring/overprep

Remove acid resistant, fluride rich enamel Rough surface for bonding – diamond abrasives Definite finish line

Preferred in Direct Composite Veneers.

Preserve lingual and incisal surfaces Significant occlusal function Preservation of functional surfaces Reduces wear of opposing tooth

Lengthening of tooth Incisal defect Facilitates seating of veneer Lower anteriors not veneered

Outline extent of defect Coarse elliptical/round diamond 0.5-0.75mm Subgingival extention- if defect is

subgingival Microfilled or more opaque

composite depending on remaining defect

Half the depth of enamel-0.5-0.75mm mid facially and 0.2-0.5mm along gingival margin

Chamfer for definite cavity margin Incisal edge not included. If included for anterior guidance, tooth reduction of at least 1mm. Shade selection- very important (3D Master) No.212 retainer Margin at crest of gingival tissue

1. Processed composite

2. Feldspathic porcelain (+++esthetics)

3. Cast or pressed ceramic (+++ fit and finish)

Superior properties- Light, heat , vacuum, pressure etc.

Superior shading and characterizing Better control of facial contours Easily repaired Children and adolescents as interim

restorations Wear pattern Lower cost

Window-Prep is ideal!

Limited bonding- surface conditioning or sand blasting required

Multiple large existing restorations compromise bonding

Window preparation recommended due to limited bond strength

Incisal lapping if incisal defect

Intraenamel preparation Elastomeric impressions No temporization

First Appointment

1. Evaluate fit of veneer2. Tooth side of veneer (preetched) is primed3. Tooth etched, rinsed and dried. Adhesive is

applied but not cured4. Adhesive cement applied5. Veneer placed and excess cement removed6. Check for fit with no.2 explorer7. Light cured for 40-60sec facial & lingual

Second Appointment

ADVANTAGES Color Bond strength Periodontal health Resistance to abrasion Inherent porcelain strength Resistance to fluid

absorption Esthetics +++

DISADVANTAGES Repair difficult Technique sensitive Color modification not

possible Tooth preparation

required Extremely fragile &

difficult to manipulate Expensive

PORCELAIN VENEERS

0.3-0.6mm/ half enamel thickness of available enamel

Adequate space for porcelain veneer

Remove convexities Space for opaquer Enamel surface conducive to

etching & bonding Definitive seat Margin placement clarified

Labial- LVS no.1 and LVS no.2 Depth guide Interproximal- Margin halfway into proximal

contact area - Wrap around effect - Procelain bulk Sulcular – 0.05-0.1mm into sulcus - retraction cord - chamfer/ bevelled shoulder

Bi-Planar Reduction: 0.5-0.75mm – Facio-Gingival margin 1-1.2mm – Facio-Incisal margin

A) The facial surface should be reduced in two planes; one nearly parallel with the path of insertion, and one parallel with the incisal two-thirds of the facial surface of the tooth

B) One plane reduction parallel with the path of insertion may result in insufficient space for porcelain in the incisal 1/3 of the tooth

C) One plane reduction which creates adequate space for the restoration both in the shoulder and the incisal areas, will endanger the pulp entity and produce overtapered restoration.

Featheredge or knife edge Pointed end tapered fissure bur to provide this type of margin. It’s the most conservative type. But the margin is weak. Impression tearing It form >135 cavo surface line angle.

Therefore a definite finish line (chamfer) is adviced.

Should stop just facial to the proximal contact point – easier placement

Incisal - definite stop - 0.5mm if restoration of

original length Lingual - rounded/heavy

chamfer 1. Prevent shearing of

porcelain 2. Bulk of porcelain of at

least 1mm 3. Increased strength Elastomeric impression

Silane coupling agent – increases wettability

Etching ceramic with Hydoflourous acid 7-10%

Porcelain polishing paste

• NX3 from Kerr, Variolink• Veneer or Variolink II from

Ivoclar• Vivadent or RelyX Veneer

Cement system from 3M ESPE

5-15% opaque porcelain

Deeper tooth preparation

Die spacer (engage the cement’s shade)

IPS empress

Mild to moderate discoloration

Better marginal fit

Little marginal finishing necessary

Thinness and fragility of ceramic veneers

Computer programmed oversized dies

Highly sintered high purity alumina-0.25mm

Simple to use Excellent esthetics

Pre-fabricated nano-hybrid-composite enamel-shells

Attractive teeth and a new smile after only one visit

Very little removal of healthy tooth structure – 0.3mm max

Individual, customized shaping of the front teeth

Shine can be refreshed by polishing at any time

Unlike porcelain veneers, they can be easily repaired

Modeling MB5 Contour Guide

Unesthetic facial portion of metal restoration

No.2 carbide bur

Mechanical retention in no.1/4 bur- 0.25mm

4-META

Always place centrals, then laterals, and so on

Repair with composite resin. Preparing surface to resist functional stresses and thermocyclic loading High-energy ceramic reparative surface (the exposed chipped ceramic) and a

chemical/mechanical link to the restorative composite resin. micro-etcher (20-µm aluminum oxide under 35 psi) etch the ceramic surface with 5% to 9% hydrofluoric acid This is completed by applying a minimal amount of a pre-hydrolyzed silane the ceramic surface should still have a "frosty" appearance as it did after etching. If

the surface is "shiny" then the silane is too thick and should be removed by sandblasting and re-applied in a lesser amount

The last step is to apply a bonding adhesive which should be light-polymerized before application of the restorative composite resin.

Condition Whitening Veneers

Teeth stained by tobacco Y Y

Teeth stained by coffee/tea Y Y

Teeth stained by fluorosis N/Y Y

Age-related staining Y YTeeth that have been dark

since childhoodN Y

Teeth darkened by trauma N Y

Teeth darkened by root

decayN Y

Stained teeth with

extensive gum recessionN Y

Gapped teeth N YCrooked teeth N Y

Same function and benefits. When placing lumineers, the structure of the tooth remains unchanged. Are as thick as a contact lens, but this does not make them less durable. Might feel a little bulkier than the classic porcelain veneers. The tooth is still protected by its natural enamel, even if the lumineers need to be taken off. In terms of costs, lumineers have similar costs as the porcelain veneers. Not