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Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Cerec Veneers
How, when & why
www.cerecsolutions.com
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
This presentationThis was part of a presentation given at Dr Kennedy’s Atlanta CEREC day on 10/26/2002.
This is given freely in good faith.
The only condition that applies to its receipt is that where any part of it is used, acknowledgement of the source must be given, and there must be no charge for the provision of the presentation and any images within it.
Hey I can’t help it – I am a lawyer as well !
Brad Wright Gympie Qld Australia
www.cerecsolutions.com
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Veneer Procedure
• Case Selection• Preparation• Design• Shading• Naturalise / Glaze• Cementing• Finishing
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Why would you do a CEREC Veneer ?
Veneers are almost always done to improve aesthetics.
We consider CEREC Veneers because of a balance of clinical indications and practicalities.
We would only consider CEREC if it is easier better or faster, or some other practicality………….
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Characteristics Of Cerec Veneers
VERY Translucent
Ultimate Shade Control by operator
Characterisation is excellent
Can be time consuming for multiples
Not great for VERY big Value changes
Not great for a smile that is manufactured
Inexpensive to construct
Can be stressful
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Characteristics of Laboratory veneers
Not time consuming
Very Good for multiples
Can be expensive
Can create tension with Technicians where expectations are not met
Little Shade Control by the dentist
Remakes expensive and time consuming
Can accommodate large value changes because of opacity built into ceramic.
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
BENEFITS OF CEREC VENEERS
Fast
No temporary
Have them today
Great Translucency
Great Ability to Individualise
Great Control
Remake is quick
Because you don’t need temporaries, you can prep dentin without concerns about sensitivity (Dr. M. Hodish)
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
DISADVANTAGES OF CEREC VENEERS
Translucent – must block out
Time Consuming
Individualising can be difficult
Preparations may need to be less conservative
No temporaries means you have to get them RIGHT
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
INDICATIONS For CEREC
Not too great a shade change
Where you have room to block out
Single and double cases
Where tooth symmetry and shape are not at issue
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
CONTRAINDICATIONS
Large shade and Chroma changes
Multiples, “Chiclet” style
VERY Fussy patients who will take a lot of time
Where there are issues of Symmetry and Shape
Where you have a lot of teeth showing and not a lot of time
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
PREPARATION INDICATIONS
Normal porcelain veneer requirements
Thicker if there are shade changes (more tooth reduction)
Go into the interproximal areas
Finish on enamel
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
PREPARATION RULESButt Joints interproximally
Labial Inciso Chamfer
Flat and smooth as possible
Gingival can be a chamfer also
Think about colour change
Think about labial and proximal emergence profile
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Incisal Edge
The problem is poor palatal margin fit.
This may not be new, but a vary small inciso-labial chamfer will help
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
The Camera Problem
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Conventional Incisal Wrap Prep
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Why this happens
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Try this…..
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Makes it easier for the Camera
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
You get this
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Instead of this
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Also Try this
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
TECHNIQUESYou can do crowns with the veneer programme, you just MUST be able to visualise all margins from the labial.
Camera angle is what influences success with all CEREC, no less with Veneers
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Crown vs Veneer – What is the difference ?
Veneer – where occlusion is not absolutely critical
Crown where occlusion is more of an issue, and where the dentine enamel walls externally are all gone
Veneer is quick simple but needs adjusting
Crown is fast complex but needs adjusting
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
DATABASE VENEERSimplest Programme to use
Fast Effective
Gives plenty of Ceramic to remove
Must obey certain prep rules
Where you have a freestyle tooth to work on ( so not when you are doing a row of chiclets)
How much tooth can you add, and when does a veneer become a crown ?
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
This is easy…
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
This is still easy with database
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Even this can be done!!! With Veneer !
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
CORRELATION VENEERIdeal where you send the patient home with a mock up veneer
Allows you to copy the labial contour and emergence profiles as well as the embrasures
Ideal for cases where a copy is required
Can still do large incisal additions, but can need adjustments
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
CORRELATION VENEER ENDOCROWN
Variation on Correlation veneer where endo crown programme and milling characteristics ensure a well fitting veneer
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
SHADING
The biggest problem with CEREC veneers, are that the shading work done by our technicians must be done by the dentist.
We have to be as good as technicians are at shading.
This can be done internally, or externally
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
INTERNAL
Most commonly with dark teeth, some extra dentin must be removed so that an opaque layer can be added.
This is really pre-shading prior to imaging so that the baseline characteristics of the tooth are such that a translucent Cerec Veneer can be constructed over it.
This includes the cement !
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
EXTERNALNaturalise and glaze with Vita Akzent and Atmomat Furnace or similar
This adds the lab feel to a veneer
It can add 15-20 minutes onto the procedure
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
TRY INAdjust to seat.
Bond (no etch on Ceramic or tooth) with flowable
Adjust shape
Polish
Cement before Etch with your cement and set
Check Colour again
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
CEMENTATION
Do a try in with your cement of choice – cured but not bonded. MOST cements give a significant value shift ( darker) on light curing !!
As per normal CEREC
Use light or dual cure (I prefer dual cure)
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Miscellaneous
Perhaps make a resin provisional where you are to make a significant shape or length change at the consultation
If you have to temporise, some flowable is fine if it is not bonded to the veneer or tooth structure
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
To conclude..
Be Prepared to give veneers a try – its fun
It is the most underused (except perhaps Function) of the suite of programmes.
Is very cost effective
Can make a veneer with Cerec and add porcelain or have your technician chraracterise them
Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002
Thanks
I would like to sincerely thank Dr Jim Kennedy Decatur GA, for the opportunity to speak at his weekend.
I would like to acknowledge Dr Sam Barr Oneida NY for his help in this presentation. If it wasn’t for selfless distribution of material on Cerec, many of us would not being enjoying the success we are.
I would like to thank Mr Geoff Staples of Halas in Brisbane Qld Australia and Mr Roddy McLeod of Shalfoon in Auckland NZ for their assistance and encouragement.