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Laminate Veneers

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mohammed yyy

on 31 January 2013

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Transcript of Laminate Veneers

Tooth Preparation


Advantages and disadvantages of porcelain laminated veneers


Indications and contraindications of porcelain laminated veneers


Kinds of porcelain laminate veneers and their properties. Case Report 1


Case reports
Functional and parafunctional forces may cause:

Failure of the adhesive interfaces
Microleakge
Staining
Postoperative sensitivity
Secondary caries

Effect of Occlusion Veneer delivery procedures Veneer delivery procedures Tooth Preparation Multiple appointments.
Higher laboratory costs.
Fragility during fabrication.
Technique sensitive delivery procedures.
Fracture and repair difficulties.
Abrasive potential of porcelain on opposing dentition. Disadvantages
Better esthetics (color, translucency, texture, vitality)
Durability (strength, abrasion resistance, color stability/stain resistance)
Biocompatibility (excellent tissue response, less plaque accumulation)
Bond strength (etched porcelain to etched enamel is stronger than any other veneering system) Advantages of Porcelain Laminate Veneers (PLV) As a concept, veneers are best described as porcelain-fused-to-enamel restorations.
Although dentin can also be considered part of the framework, the main part of the supporting and bonding surface should be enamel, to avoid potential problems of cracks or debonding in the long-term. Note :

Veneers are a thin shell made out of porcelain or composite material. They are custom made and cemented to the front side of the tooth. A veneer can be made by the dentist or in a dental laboratory, depending on the materials used and the preference of the dentist. Definition
Definition.
Composite VS Porceline
Kinds of porcelain laminate veneers.
Indications and contraindications of procelain laminated veneers
Advantages and disadvantages of porcelain laminated veneers
Tooth preparation
Veneer delivery procedures
Case reports Outline Thank you Rosenstiel , S. Land, M. Fujimoto J.(2006). Contemporary fixed prosthodontics. Mosby selver.

George A. Freedman & Gerald L. Mcluaughin. Color atlas of porcelain laminte veneer. First edition. 1990. Ishiyaku EuroAmerica.

David Garber. Procelain laminate veneers: Ten years later part 1 : Tooth preparation. Journal of esthetic dentistry.1993. (5): 2: 57-61.

D. R. Bloom and J. N. Padayachy. Aesthetic changes with four anterior units. British Dental Journal 2006; 200: 135-138. Reference; Case report 2 Case Report 1 The survival of PLV is shown to be influenced by the following:
Patient gender.
Patient age.
Changing dentist.
Patient’s treatment need .
Patient charge-paying status.

Ceramic veneer longevity
Gingival retraction (anesthesia !!)

In most cases, PLV will play a role in some aspect of the patient occlusal scheme by providing protrusive or lateral guidance. For this reason, the cast should be made from full-arched impressions and they should be articulated. Impression -Avoid undercuts and visualize the path of insertion because an undercut will prevent placement of the veneer.

-Connect depth cuts and margins. To prevent areas of stress concentration in the porcelain, ensure the tooth preparation is free of sharp angles. All prepared surfaces should be rounded and smoothly flowing. Tooth Preparation

If possible, do not reduce the incisal edge ; this helps support the porcelain and makes chipping less likely. Tooth Preparation
Incisal Edge Preparations David Garber. Procelain laminate veneers: Ten years later part 1 : Tooth preparation. Journal of esthetic dentistry.1993. (5): 2: 57-61. The prep must be extended into embrasure areas to ensure that the margin between the veneer and the unprepared tooth structure is hidden. Tooth Preparation
Interproximal reduction: Immediate sealing of the dentin after preparation allows for optimized bond strength to dentin. So…. If in dentin !!! Closing Spaces Case report 4+5 Case report 2 Case Report 1

The finishing process for porcelain veneers involves using small particle size diamond burs or multi-fluted tungsten carbide burs in with water spray. Use finishing strips for the interproximal margins. Veneer delivery procedures Apply light cure composite resin luting agent to the restoration.

Be careful to avoid trapping air.

Light-activation of a luting agent through an opaque veneer or one of greater than 0.7 mm thickness, is not adequately effective. In these circumstances a dual-curing resin, which is initiated both by admixing the pastes to give a chemical set and by visible-light activation, should be used.

Position the restoration gently, seating veneer from incisal to gingival. Remove excess luting agent with an instrument. Veneer delivery procedures Preliminary inspection:
It is important that neither the dentist nor the laboratory place the etched veneers back on the die stone.

Examine veneers under magnification.

Check fit of veneers on dies by first trying veneers one-at-a-time and then all together.

Clean the restorations thoroughly in water with ultrasonic agitation. Veneer delivery procedures
Direct composite, acrylic resin veneers and indirect composite. Provisional restorations In preparing for diastema closure, the interproximal preparation is extended through the contact toward the lingual. The greater the space to be closed, the farther the preparation must be carried to the lingual side. It is also important to extend the interproximal preparation subgingivally to recontour the papilla. Preparing for diastema closure Tooth Preparation
Incisal Edge Preparations Rosenstiel , S. Land, M. Fujimoto J.(2006). Contemporary fixed prosthodontics. Mosby selver.
-Place a “long chamfer” margin with an obtuse cavosurface angle, which exposes the enamel prism ends at the margin for better etching. The margin should closely follow the gingival crest. Tooth Preparation
Labial reduction: Disadvantages:
It has much higher modulus of elasticity to enamel and dentin so poor stress distribution and may end up with root fracture
Poor bonding to resin cement
It is not strong enough to withstand bruxism and unfavorable occlusion Advantages:
Good mechanical properties
It mask severely discolored teeth
Marginal intergity is improved Alumina laminate veneers Disadvantages:
It can not be used for lost tooth structure for more than 2 mm
Low marginal integrity
Low mechanical properties
Translucent so it can not mask severely discolored teeth Advantages:
Similar modulus of elasticity to enamel and dentin so better stress distribution to the root structure.
Excellent bonding to resin cement Feldspathic porcelain laminate veneer Porceline

Laboratory
More expensive
More resistant to wear
More stable color Composite

Chaireside or Laboratory
Less expensive
Less resistant to wear
Less stable color Composite VS Porceline Case report 2 A 19-year-old woman diagnosed with hypoplastic-type amelogenesis imperfecta. Case Report 1 Thoroughly clean the preparations using nonfluoride pumice, making sure all provisional luting agents are removed. Wash and dry.


Retraction cord appliction.

Try-in restorations with water or glycerine to help the veneers to stay on the tooth, first one-at-a-time and then all together. Verify fit, shade, and insertion sequence Veneer delivery procedures There are four basic preparation designs:
a)Window, in which the veneer is taken close to but not up to the incisal edge.

b) Feather, in which the veneer is taken up to the height of the incisal edge of the tooth but the edge is not reduced..

c) Bevel, in which a bucco-palatal bevel is prepared across the full width of the preparation and there is some reduction of the incisal length of the tooth.

d) Incisal overlap, in which the incisal edge is reduced and then the veneer preparation extended onto the palatal aspect of the preparation. Tooth Preparation
:Incisal Edge Preparations D. R. Bloom and J. N. Padayachy. Aesthetic changes with four anterior units. British Dental Journal 2006; 200: 135-138
Reasons not to break contacts

1. improve prototype retention
2. laboratory convenience
3. ease of cementation
Reasons to break contacts

1. presence of pre-existing
restorations
2. diastema closure
3. colour considerations
4. idealise anatomical contour Tooth Preparation
Interproximal reduction:
Poor oral hygiene.
Tooth wear as a result of bruxism or abrasion.
Existing large restorations with little remaining tooth structure.
Facial oral habits such as nail or pencil biting.
Esthetic limitations if the underlying tooth structure is discolored, which may occur in cases of nonvital roots
Large spaces or diastema where cosure would result in a bell-shaped contour . Contraindication Disadvantages:
It has higher modulud of elasticity to enamel and dentin so poor stress distribution to the root structure
Poor bonding to resin cement
Opaque material Advantages:
Superior mechanical properties:
Easier to handle
Bruxer/clenching patients
It gives support for lost tooth structure more than 2 mm
Opaque so it mask severely discolored theeth
Bright teeth
Marginal integrity is improved Zirconia laminate veneers  Preparation of root surfaces for Gingiva-colored partial (GCP) porcelain laminate veneers. Nuray Capa .An alternative treatment approach to gingival recession: gingiva-colored partial porcelain veneers: A clinical report. The Journal of Prosthetic Dentistry Volume 98, Issue 2, August 2007, Pages 82–84. Facial appearance of patient
after 6 months. Case report 3 Initial curing for a few second then remove excess cement before full cure being careful not to pull cement out from veneer margin leaving a defect.




Apply liquid strip (glycerin gel) to prevent the oxygen-inhibited layer of composites.



Light cure for 40 seconds from several directions for 2-3 minutes cumulative cure time per veneer. Veneer delivery procedures Silane is painted onto the etched porcelain to enhance the adhesive properties of the resin. Allow to dry and gently air-dry the veneer surface.

Etch the enamel with 37% phosphoric acid for 30 seconds. Rinse thoroughly and dry.

Following the manufacturer’s instructions for cementing veneers, apply bonding agent to etched enamel and etched, silanated veneer surface but do not light cure. Veneer delivery procedures
Place one laminate in position and then compare it to the shade tab selected. If the laminate appears dark, then lighter colored resin cement should be selected


Some manufacturers provide trial pastes that will not set but have similar optical properties to the luting resin.


Check with the dental laboratory to see if the fabricated veneers were etched. If not, etch the internal surface of the veneer with hydrofluoric acid 5% . Rinse and dry. Veneer delivery procedures






Modification: In one clinical report the authors describe the restoration of root canal treated left maxillary first incisor using an all-ceramic one-piece coronal post and a laminate veneer feature. Cont….Indications Qassim University
College of Dentistry Dr. Mohammed Yehya BDS, MSc
Lecturer in Department of Fixed Prosthodontics,
Collage of Dentistry
Qassim university Laminate Veneers Masking increased crown length with wax Preoperative facial appearance of patient











.





Nuray Capa .An alternative treatment approach to gingival recession: gingiva-colored partial porcelain veneers: A clinical report. The Journal of Prosthetic Dentistry Volume 98, Issue 2, August 2007, Pages 82–84. Case report 3 David Garber. Procelain laminate veneers: Ten years later part 1 : Tooth preparation. Journal of esthetic dentistry.1993. (5): 2: 57-61. Traditional veneer preparation is a conservative reduction of tooth structure consisting of 0.3 to 0.5mm facial reduction with interproximal finish lines facial to the contact area.

Using 0.5 mm depth marker bur. As it is drawn across the labial surface, it creates three grooves with the same deep 0.5 mm.
The remaining enamel is reduced to the level of the depth cuts using round-end diamond.
Finish line : long chamfer Tooth Preparation
Labial reduction: Discolored teeth

Intrinsic Staining (Fluorosis, Tetracycline)

Discolered or uneasthetic restoration

Diastema

Enamel defect
enamel hypoplasia  
Amelogenesis Imperfecta

Slight malpositioning

rotated teeth

Malformations

(peg Laterals, Microdontia) Indications Peumans M. Van Mccerbock B, Lambrechts P, vuylstcke-wautcre M, vanherlg. Five-year clinincal performance of porelain veneers. Quitessence international 1998; 29:211-21. Burke FJT, Lucarotti PSK. Ten-year outcome of porcelain laminate veneers placed within the General Dental Services in England and Wales. J.Dent.2009:37-39.
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