Prep & No-prep Comprehensive Porcelain Veneers …

1 Volume 5 Issue 2 Clinical Techniques & Procedures Spring 2005. prep & No-prep Comprehensive Michael DiTolla, DDS. Director, Clinical Porcelain Veneers Techniques Education & Research Glidewell Laboratories Graduated from UOP. 1988 with Honors P orcelain Veneers have become a standard procedure in many American practices, even Fellow Academy of General Dentistry Contributing Editor . Contemporary Esthetics &. Restorative Practice though this technique is still Contributing Editor . not routinely taught in most dental schools. For example, I Dental Economics had the opportunity to do the Graduate Las Vegas Institute of Cosmetic Dentistry (LVI). first set of Porcelain Veneers Graduate Rondeau in the history of my dental Orthodontic Institute school back in 1988, yet I. Graduate Force have never spoken with another graduate since then Orthodontic Institute who had that same opportu- Over 250 national and nity.

2 It is therefore left for international lectures most dentists to teach them- selves how to successfully This publication is accomplish this technique. designed to provide Glidewell customers with This issue of Chairside proven clinical tips and Perspective will serve as a techniques. If you have review for what I have any comments or sugges- learned since that first nerv- tions, e-mail Dr. DiTolla at ous set of six Veneers back in dental school. While Porcelain Veneers Continuing Education are a great treatment modality for many patients, they need For AGD & State to be considered as part of a approved CE Credits differential diagnosis in on this & other articles, which traditional orthodon- please visit tics, direct bonding, esthetic recontouring and bleaching are considered as options. While some clinicians advocate a No-prep approach to Porcelain Veneers , my experience has been that Cindy presented with advanced wear on nearly all of her anterior teeth.

3 Some type of preparation In addition, she had lost almost a third of the facial enamel volume on gives a more predictable her maxillary incisors. The teeth were prepped and Empress Veneers from Approved PACE Program Provider FAGD/MAGD Credit esthetic result. The most Glidewell Laboratories were placed on teeth #5-12 and #21-28. 02/15/04 to 02/28/07. C H A I R S I D E P E R S P E C T I V E. common problems I have about the bulkier margins seen with no-preparation and the need for excellent Veneers are overcontoured oral hygiene habits on the margins and bulky Veneers . part of the patient, you can go Unfortunately both of these forward with No-prep with a conditions can make a case a good degree of confidence. failure and both doctor and Also, be prepared to recon- patient unhappy. The biggest tour the gingival margin if it advantage of tooth prepara- feels too bulky to your tion is that it gives you control explorer.

4 I prefer the over a number of factors that Brasseler ET Carbide kit and ruin a case if left unattended. using the ultrafine grit in an Some of these factors include: electric handpiece to smooth off any speed bumps that Contour factors (emer- may be present at the margin. gence profile, facial profile, To protect the gingival you incisal third). will need to use a cord pack- Color change without over- er to retract the tissue, or if bulking the ceramic. you prefer, a Zekyra instru- Margin placement for con- ment to protect the tissue to cealment. ensure the bur does not con- Definitive margin for tech- tact tissue. The cord packer I. nician to work with. use to accomplish this has Allows correction of great- many bur marks on it, which er misalignment. is much more preferable to leaving those marks on the On the other hand, no- tissue itself. This patient was dissatisfied with her smile.

5 She did not want to have any prep Veneers can work well As always, be careful dur- injections or tooth preparation done. Because of the multiple diastema in additive type esthetic present in the arch, this type of additive case lends itself well to No-prep ing any veneer try-in (includ- cases. These would be cases Veneers . Vivaneers made with Prismatik ThinPress Ceramic were used in ing No-prep ) not to try to push where multiple diastema are this No-prep Veneers . the patient toward accepting present, the teeth are shorter Veneers they are on the fence than they used to be due to about. It has always seemed trauma or wear, cases where like you have definitely mar- there has been a loss of facial veneer Indications ried most veneer patients, enamel volume, and some and you want to make sure cases where the only goal is Improve extreme discolorations such as tetracycline staining, flourosis, they love their Veneers before the permanent bleaching devitalized teeth, and teeth darkened from age.

6 They are bonded to place. I do effect achieved. Repair chipped or fractured teeth. not look at No-prep Veneers as I believe No-prep Veneers Closing of diastemas between teeth. reversible at all. I make sure are an area where we need to patients are happy with the have effective, written in- Ability to lengthen anterior teeth. Veneers before proceeding. I. formed consent with the Improve the appearance of rotated or misaligned teeth. have removed No-prep patient about the different Veneers without any damage veneer options available to to teeth before using my them. The sound of No-prep , veneer Contraindications Waterlase YSGG laser from no shots, no temps is defi- Biolase, but most dentists have nitely music to any patient's If little or no enamel is present, full crown should be considered. not purchased this technology ears, but you still need to talk Certain tooth-to-tooth habits like bruxing or clenching, or other para- yet.

7 I do not believe you can with them about the down- functional habits such as pencil chewing or ice crushing. remove No-prep Veneers side of the No-prep Veneers . Teeth that exhibit severe crowding. bonded to enamel with a If the patient still wants to go handpiece without doing forward with the No-prep Certain types of occlusal problems such as Class III & end-to-end bites. some damage to the Veneers after explaining only time I consider Veneers C H A I R S I D E P E R S P E C T I V E. reversible is while they are with the use of a LVS bur set. still filled with try-in paste. These burs allow you to place Most of the veneer cases I depth cuts in all 3 planes, but do have some aspect of the handpiece does need to preparation to them. I have a be angled to ensure the gingi- very definite preparation val and incisal depth cuts are sequence that I use, and I deep enough.

8 Actually have a checklist that I After observing thousands use to ensure that nothing is of veneer preparations here forgotten, which helps lead to at the laboratory it becomes predictability and better clear that many of these results. Even pilots who have preps are reduced properly in been flying the same jet for the middle third, but are 20 years use a checklist to under-reduced in the gingival ensure that nothing is forgot- and incisal thirds. ten. For them the results of For teeth that don't not using checklists can be require major shade correc- life and death, but for us it tion and are fabricated with can be the difference feldspathic Porcelain , a between a patient who is mm depth cut is ecstatic or merely satisfied. I advantage of this minimal have also found that when I depth cut is that the resulting do things in the same order prep surface is all still in every time I get faster at the enamel, so the bond strength The patient above was dissatisfied with procedure, which is good for this smile due to the multiple diastema of the veneer to the tooth is me and the patients.

9 And darker shade of some of the teeth. excellent and the possibility No-prep Prismatik ThinPress Veneers of post-operative sensitivity is Preparation were used to close the multiple spaces practically nonexistent. For a and whiten the smile. With No-prep Technique Veneers there is little to no worry about more dramatic shade change, post-operative sensitivity. or if you are using a pressed Step 1 The goal of this step is ceramic such as Empress, the At left, the key to the Glidewell Prismatik to create three planes of depth cut should be used. ThinPress ceramic is the ability to press reduction: gingival, body Veneers mm allows you to (middle), and incisal. I find change tooth size, shape and alignment Step 2 When you prepare this is best accomplished in one appointment for most patients. the teeth make sure that the veneer Advantages veneer Disadvantages Colors are natural looking and stable.

10 Color cannot be modified once Veneers have been bonded into place. Use a bleach shade at try-in so patients can see what really white teeth Cementation strength permits tooth reshaping. Although Veneers are look like and choose the shade from there. somewhat fragile in your hand, once they are bonded to the tooth, they develop high tensile and shear strengths, allowing reshaping. Not as easy to repair. The bond of etched Porcelain Veneers to enamel is measured from More difficult to seat Veneers due to bonding and clean-up compared 2600 to 3200 psi, compared with composite resin veneer to enamel to cementing a single crown. bonds, which range from 900 to 1400 psi. Technical difficulties in avoiding overcontours and obtaining closely Long-lasting with exceptional resistance to wear, abrasion and stain. fitted gingival margins. When bonded properly, Veneers can last as long as other fixed restorations, while the highly glazed surface is very resistant to stain accumulation.