The Veneers
Definition
A dental veneer is a thin labial plate of
esthetic material retained by cement
through etching and bonding
mechanism
Indicatio
n
Improve extreme discolorations such as
tetracycline staining, flourosis, devitalized
teeth, and teeth darkened from age.
Repair chipped or fractured teeth.
Closing of diastemas between teeth.
Ability to lengthen anterior teeth.
Improve the appearance of rotated or
misaligned teeth
Contraindic
ation
If little or no enamel is present, full
crown should be considered.
Certain tooth-to-tooth habits like
bruxing or clenching, or other parafunctional habits such as pencil
chewing or ice crushing.
Teeth that exhibit severe crowding.
Certain types of occlusal problems
such as Class III & end-to-end bites.
Types of laminate veneer
(1) direct : composite resin
added directly to tooth
A.R
(2) in
direct;
COMPOSITE PORCLIA
N
Conventional Porcelain Veneers.
A conventional porcelain veneer
is a thin piece of porcelain that is
bonded to the front of a tooth.
In mostiscases,
Conventional
Porcelain
a durable,
translucent,
strong, naturalPorcelain Veneers
will create the
looking,
and beautiful
material.
most beautiful
results,
and are
thus the most common type of
veneer used.
It is done either in one
appointment by using the
prefabricated porcelain(ready
made) veneer or in two
appointments by using
porcelain veneer fabricated in
the lab.
Diagnosis &treatment plan of
Esthetic bonded porcaline
Dental Veneer
It is a thin labial plate of
cosmetic material retained by
cement through etching
&bonding mechanism
It is a conservative alternative
to full coverage to increase
esthetic of anterior teeth
Case Selection
Before starting treatment planning, the patients
expectations should be completely understood by the
clinician . A complete oral examination must be
conducted to note the following conditions: Patients with
poor oral hygiene or mouth breathers should be
considered for treatment with prosthetics other than
veneers. One of the most common causes of debonding
or fracture is placing veneers on teeth that have
insufficient tooth substrate, eg, parafunctional habits
(clenching, bruxism), large composite restorations, or
endodontically treated teeth with large defect
Dignosis &Case selection
1. discoloration
2.lip line
3.occlusion
4.distima closture
5.gingival resision
6.existing restoration
7.incisal attration
1.Discoloration
Management of discoloration
depend on type of discoloration
1.polishing
2.microabration
3.macroabration
4.bleeching
5. veneer
6.full crown
Laminate Veneer
How to mask
discoloration
1.do maximum preparation 0.7
2.choice cement more opaque
3.choice shade of veneer more
opaque
4.lab make more space for
cement
2.Lip line
High lip line
Medium lip line
Low lip line
Always note the
lip line because
the position of
the teeth plays
an important
role in lip
support .
Lip line
High (finishing line sup
gingivaly)
Medium(finishing
line
gingivally)equa
Soft tissue and periodontal tissue examination is
also important. If the patients smile line is very
high, or the teeth are passively erupted, teeth
appear short, or more than 1.5 mm to 2 mm of
attached gingiva is visible, crown lengthening or
osseous re contouring should be considered
3.Occlusion
1. class 1
2.class 2
3. class 3
While planning for
veneers it is important
to never ignore the
rule of stabilizing the
posterior occlusion
before placing anterior
veneers, and to
eliminate any lateral
and anteriorposterior
excursion interference.
Occlusion
Because most porceline veneer are fabricated on the facial
surface of maxillary anterior teeth . occlusion is often
considered critical to the success of these cases . on the
contrary occlusion is of vital importance .not only in vertical
occlusion but also in lateral &protrusive movement . even a
slight lengthening of the maxillary anterior teeth over the
incisal edge can have sever consequences on the
unrestored mandibular dentition because of the difference in
hardness between porcelain& the natural enamel. veneers
should be avoided in cases with edge-to-edge and cross-bite
occlusion & avoid use in bruxisium &
4.Distima closture
A diastema is a space
between front teeth.
Diastemas are closed by
orthodontics or restoration.
A highly successful
technique is addition of
composite..
Diastema not more than 3
mm closed by veneer
Sever problems occur in this
clinical condition
1.improper emergency profile
2. presence of black triangle cervically
the back of the mouth is a dark area
because it receives no light. Composite must
block out darkness or a restoration appears
dark. Placement of opaque material to the
lingual covered with translucent material to
the facial achieves a natural looking
restoration that is not influenced by this
darkness
Diastema closure
Gingival recession
The exposed cementum will
make the adhesion
prognosis more doubtful
Creating the finish line on
the cementum (more
constricted ) require more
axial reduction to remove the
undercuts area in order to
obtain a path of insertion in
porcelain warp around or
butt joint design
5. Gingival recession
6.Existing restoration
Ceramic veneer are often
placed to Improve
The aesthetics of previously filled teeth .the larger the
restoration the more likely it is that full coverage restoration
will be a better choice .such teeth are likely to be weaker
perhaps as a result of a loss of vitality &will certainly have less
enamel available for bonding .when the decision is taken to
place veneers then the old restoration must be removed
&ensuring veneer placed within the two week period following
composite replacement to ensure adequate bond strength One
of the most common causes of de bonding or fracture is placing
veneers on teeth that have insufficient tooth substrate,
functional habits (clenching, bruxism), large composite
restorations, or endo dontically treated teeth with large defects.
7.Incisal attration
1.The cause of attrition should properly assessed
If the attrition is due to bruxism therfore laminate veneer
is not recommended
2.If the attrition is due to aging (phisiological)the case
should be properly assessed & laminate veneer can be used
as the main important parameter is the occluo_gingival
height of remaining tooth structure
3. In case of incisal attrition the proper incisal preperation
design in inscisal warp around design with 1_1.2mm
incisal reduction in case of feldspathic or leucite based
ceramics
8.Dignostic wax_up &composite mock
up
The most convenient method to plan a predictable
outcome is by taking impressions of both arches to make a
diagnostic wax-up This will help the clinician with the
amount of tooth reduction required to achieve the desired
results. An impression of your top & bottom teeth is
taken poured up to create a replica in stone &placed on an
articulator that simulates how you bite . the technician will
then grind down slightly the models(to replicate the veneer
preparation)&then wax up new teeth shapes so you can
see what your teeth would look like .this gives you a good
visual idea &provides a great basis for you to discuss
additional changes &features until you are happy.it also
allows the dentist to assess in more detail your bite .the
amount of preparation needed &predict potential issues
A wax-up allows the dentist and
patient to see the final results in
3-D before treatment is started.
This is often helpful to ensure
patient satisfaction with the final
result. The wax-up can also be
used to make a matrix for the
fabrication of the provisional
restorations, which are not only
highly esthetic, but allow for
accurate inspection of new
occlusal patterns and phonetics.
Composite mock _up
It use to established
length &contour of incisal
edge &anterior guidanes
&show how under bite
can treatent
9.Shade selection
Digital
These systems capture a
reading of an area
approximately the size of
a large curing light tip.
Therefore, in order to
capture the whole tooth,
multiple readings are
required to communicate
the cervical, middle, and
incisal areas. These
simpler systems are less
expensive and easier to
operate, but provide
less-detailed information
VITA Toothguide 3D-MASTER
With the VITA Toothguide 3D-MASTER, all natural tooth shades
can be determined accurately and systematically.
BLEACHED SHADE GUIDE
The VITA BLEACHED SHADE GUIDE enables the shades of
bleached teeth to be determined accurately and systematically
using the same principle as the VITA Toothguide.
Features/Benefits
Determination of the tooth shade in 3
steps
Unmistakable determination of the tooth
shade
Possibilities of comparison: Yes/No Better/Worse decision
Tooth shades precisely defined by science
(miscible)
Can be learned
10.Photographc &vediographc
Common Mistake Failure to photograph the case
Proper photography of any esthetic case is very
important on many different levels. Most importantly,
pre op and post op photography are your legal
documentation of the case. In the very rare event that
your cosmetic dentistry comes under legal scrutiny, Xrays and study models will be nowhere near as
important as your photography of the case. I feel so
strongly about this that I will not start a case without
complete photo documentation.
The photography of the case will be extremely helpful in
allowing your ceramist to see everything that you see
clinically. From face shape, complexion and lip fullness,
to stump shades and provisionalization, photos will help
an experienced ceramist provide you and your patient
with an even better result.
Before and after photos of completed cases are placed in
our book of completed cases, displayed on the walls of
our office and posted on our Web site. Photography of
well-done cases can be a wonderful marketing tool.
