Realizing Minimal Preparation with Pressed Ceramic Veneers

1 And the emphasis again is being placed on Minimal or no tooth reduction!'. facial and incisal reduction (Figure 7 and Realizing Minimal Preparation Figure 8), as well as to ensure uniformity in the thickness of the Using a combination of a depth-cutting bur and with Pressed Ceramic Veneers Preparation guides helped to conserve tooth structure and achieve predictable '14. Thomas E. Dudney, DMD Supragingival margins, which would promote gingival health,16 were formed Tooth Preparation for porcelain by such factors as the successful market- for an esthetic and functional smile that because the natural teeth demonstrated a Veneers has undergone a cyclical evolu- ing to both dentists and the general pub- were evaluated included the symmetry light shade.

2 Although interproximal elbows tion. It began in the early 1980s with min- lic of the "prepless" veneer , thus creating a across the midline, anterior and central were created in the preparations, none of imal or no Preparation , progressed to more greater demand; the teachings of respect- dominance, and regression the interdental contacts were broken, and aggressive tooth reduction in the 1990s, ed clinicians who advocate Minimal or Additionally, the overall esthetic analysis all internal line angles were rounded and and today, has returned to very little, if any, no tooth Preparation whenever possible included an evaluation of the patient's lip smoothed.

3 Tooth reduction when possible. (ie, depending on the clinical condition thickness, incisal curvature, tissue posi- After the tooth Preparation was com- When porcelain laminate Veneers were and the desired result8); and the ability tions, tooth shape and texture, occlusal pleted, a polyether impression (Impregum , first introduced, the technique of acid-etch- of technicians to cut back, layer, and thin relationship, and other factors that would 3M ESPE, St. Paul, MN) was made, along ing the internal surface of a thin porcelain down Pressed Ceramic Veneers to dimen- lend themselves to determining whether with a stick bite for horizontal reference.

4 veneer and then adhesively bonding it to sions that require Minimal or, in some cases, Minimal preparations would be appro- A shade of the prepared teeth and an oc- the acid-etched enamel surface was new no tooth reduction. In fact, some ceramists priate for this clusal bite registration were also taken. and untested. Most clinicians reduced very are now pressing laminate veneer restora- Based on the examination findings, a Because the preparations were very con- little, if any, tooth structure to keep the tions as thin as mm. treatment plan was developed and the servative, an intraoral, lock-on technique preparations within the enamel There are many benefits of minimally restorative options were discussed with the was used to provide the patient with provi- Doing so enabled them to achieve the high invasive preparations, including the preser- patient.

5 The patient agreed to the place- sional restorations. A provisional materi- bond strengths necessary to attach the vation of tooth structure, less postopera- ment of 10 maxillary Pressed Ceramic ven- al that in the author s opinion demonstrates thin porcelain shell to the facial surface tive sensitivity, less flexibility of the pre- eers, which would increase incisor display,9 excellent handling properties, favorable of the '4 pared tooth, healthy soft-tissue response, decrease the negative space in the buccal tissue response, and esthetics (Luxatemp.)

6 Time and research have demonstrated higher bond strengths, and longer lasting corridors, and improve the color of her Zenith/DMG Brand Division, Foremost that the early success of porcelain Veneers restorations. This article provides an exam- teeth to a lighter shade (Figure 3). The Dental EEC, Englewood, NJ) was selected was most likely because of Minimal or no ple, through the case presentation, of the pressable material selected for this case for this case in shade BE. A putty matrix Preparation . An often-cited advantage of use of a pressable Ceramic in conjunction (IPS Empress Esthetic, Ivoclar Vivadent, feldspathic porcelain is its need for only with very Minimal tooth Preparation to Inc, Amherst, NY) requires significantly a to reduction in tooth achieve a beautiful, natural-looking restora- less tooth Preparation than previous mate- structure, an amount that is considered tive result.

7 It also emphasizes the impor- rials in its minimally tance of the provisional restorations and Impressions for study models were In the 1990s tooth Preparation philoso- laboratory communication to ensure the taken, along with a face-bow transfer (ar- phies began to change when Pressed ceram- overall success of a case. tex , Jensen Industries, Inc, North Haven, ics were introduced and dentin bonding CT), centric relation bite registration, and agents proved clinically successful. Pressed CASE PRESENTATION several photographs. This information ceramics became tremendously popular, A 28-year-old woman presented for a enabled the laboratory technician to work but the materials and the techniques for consultation because she was unhappy through the case in the most predictable their placement required more tooth re- with the appearance of her smile (Figure 1).

8 Manner possible to achieve the patient's duction than the placement of feldspath- She specifically felt that she did not dis- desired esthetic and functional ic Their Minimal thickness should play enough of her teeth when she smiled This information was forwarded to the be mm to mm, which sometimes (Figure 2), and she wanted her teeth to be dental laboratory with a prescription re- can result in aggressive tooth lighter in color. Thorough clinical and peri- questing a diagnostic wax-up of the antic- Figure 1 Preoperative full-face view of the pa- Today, Preparation philosophies have odontal examinations were performed, ipated '1 'According to Gurel, tient.

9 At the time of presentation, she felt that she come full circle, and the emphasis again is radiographs were taken, and an esthetic using mock-ups, wax models, temporaries, did not have enough tooth display when smiling. being placed on Minimal or no tooth re- analysis of the patient's smile was conduct- and silicone indices provide the best esthet- duction. This trend most likely is caused ed. The composition elements necessary ic, phonetic, and functional outcomes and enables better communication with the patient and the laboratory Thomas E. Dudney, DMD.

10 Private Practice Preparation and Temporization Esthetic, General, and Restorative Dentistry During the Preparation appointment, a Alabaster, Alabama depth-cutting bur was used as a guide to ensure Minimal facial reduc- tion13'14 (Figure 4). Incisal reduction was also Minimal because the incisal length Figure 2 Close-up preoperative view of the would be increased (Figure 5 and Figure patient's natural smile. From this view, the limit- 6). Preparation guides made from the ed tooth display when smiling is evident. 44 INSIDE DENTISTRY FEBRUARY 2009. Figure 3 This close-up retracted view demon- Figure 4 Facial view of the preparations, for Figure 5 Right lateral view of the preparations.