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PorcelainVeneerHandoutIMargeas Wash-2
PorcelainVeneerHandoutIMargeas Wash-2
Porcelain Veneers
Preliminary appointments
1. Perform thorough hard and soft tissue exam.
2. Evaluate occlusion.
3. Gingival tissue must be free of inflammation.
4. Perform prophylaxis to remove calculus and external stain.
5. Restore any caries, defective restorations, or exposed dentinal areas (if
necessary).
6. Make study models.
7. Take digital photographs
a. Intra-oral close-up (1.2 magnification)
b. Commissure to commissure ("smile")
c. Full-face
d. Corresponding shade guide tab next to teeth
Shade selection
Preparation technique
3. Gingival reduction:
a. Prepare a light chamfer just above or at the gingival crest (this chamfer may
be lowered to 0.5 mm below the gingival crest late with discolored teeth).
b. Remember, enamel in this area is very thin.
c. Depth of emergence profile preparation:
-- for slight color change: 0.2 mm
-- for moderate color change: 0.3 mm
-- for profound color change: 0.4 mm
d. Extend preparation onto proximal surfaces just labial to or slightly into contact
areas.
e. Prep must approach lingual-proximal line angles and may be slightly
subgingival when closing diastemas.
c. Blend facial, gingival, and lingual preps; eliminate sharp angles and undercuts
(check proximal areas carefully).
6. Finishing touches:
a. Open incisal embrasures slightly
b. Round any sharp angles.
c. Use Gateway strips (Brasseler) to lighten contacts if necessary. Use an S-
pattern to avoid complete opening of contacts. Contact should be light
enough to permit easy passage of a thin matrix strip. This helps to prevent
gross tears in the impression and facilitates die separation.
d. Polish facial surfaces of preparations as desired. Stay away from margins.
Impressions
1. Use retraction cord if desired. May not be necessary with minor shade change.
2. Make a full-arch impression with a an accurate and stable polyvinylsiloxane or
polyether impression material.
3. Make a stable bite registration.
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Temporization techniques
1. Minimal shade change veneers may not need temporization if the shape is
unchanged.
2. Individual direct composite resin veneers:
a. "Spot-etch" enamel.
b. Use unfilled resin only, not a 4th, 5th, 6th or 7th generation bonding agent.
c. Apply and contour resin veneers using "free-hand" technique.
3. Multi-unit composite resin veneers: (Not removed from teeth for polishing)
a. Make a polyvinyl impression using a clear impression material such as RSVP
(Cosmedent) in a clear non-retentive tray of your diagnostic model.
b. Cover all gingival margins. Once set, remove from model and tray.
c. Trim the lingual polyvinyl impression to just cover the lingual margins
approximately 1mm. Trim the facial portion just incisal to the papilla
d. Spot-etch each prepared tooth for added retention. This is not necessary if
there is adequate mechanical retention.
e. Place unfilled resin on the teeth and light cure. (Only unfilled resin, no dentin
bonding agents.)
f. Load matrix with appropriate shade of incisal RSVP composite material.
g. Apply composite-filled matrix to prepared teeth.
h Remove excess composite resin on facial and lingual with instruments.
i. Light-cure the composite for 3 seconds on each tooth.
h. Peel matrix from cured composite and trim excess prior to final cure.
i. Light cure each tooth for 20 seconds.
j. Freehand the gingival half and margins with RSVP cervical composite and
light cure.
k. Finish and polish as needed with finishing burs, discs, points, and cups
without damaging preparation. A glaze, such as Temp Glaze or Biscover may
be used.
Laboratory communication
1. Take digital photograph of prepared teeth for veneers with shade guide of desired
veneer shade next to teeth.
2. Select an opacity level. Opaqueing should be in the veneer as much as possible.
3. Tell laboratory the desired shade of the finished veneers. Also, describe the shade
of prepared teeth and diagram any localized discolored areas. Whenever possible,
have laboratory use translucent porcelain in the cervical area to provide a nice
blend with the enamel (“contact lens effect”). Subopaqueing of preparations with
composite may be necessary for tetracycline teeth.
4. Send digital pre-op and post-preparation with shade tab photographs.
5. Send model of provisionals for lab to replicate.
6. Specify veneer length and location of finish line (e.g., wrap incisal).
7. Describe desired surface anatomy -- smooth, moderate, heavy.
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8. Although location of proximal finish line should be obvious, some labs want the
dentist to tell whether these are labial, proximal, or lingual. (Lingual finish lines are
indicated for diastema closures.)
9. If major contour changes are desired, send ideal waxed up model.
10. Keep instructions as simple as possible.
Veneer try-in
Silanation
Ideal Way
a. Have the laboratory return the veneers unetched and unsilanated. They may be
sand blasted with glass beads.
b. Try veneers on the model for fit.
c. Try veneers in the mouth with glycerine or try-in paste.
d. Clean in ultra sonic with acetone.
e. Etch inside of veneers with Hydrofluoric acid per manufacturers instructions.
f. Apply 1-2 coats of a 2 part silane that was just mixed.
g. Seat the veneers.
Practical Way - A
a. Have the laboratory sand blast and hydrofluoric acid etch the veneers.
b. Have the laboratory silanate the veneers
c. Try on model
d. Try in mouth
e. Clean in ultra sonic with acetone.
f. Seat the veneers
Practical Way - B
a. Have the laboratory sand blast and hydrofluoric acid etch the veneers.
b. The dentist should silanate the veneers.
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Veneer cementation
1. Lingual surface
a. Check occlusion.
b. Adjust occlusion and finish lingual margins using football-shaped diamonds.
Always use water spray when using diamonds to grind porcelain.
2. Gingival margins
a. Remove excess resin and adjust contour (emergence profile) as needed.
b. Instruments:
-- #12 scalpel blade
-- Extra fine diamond
3. Proximal surfaces
a. If necessary, strip with Gateway Strips (Brasseler):
c. Follow with Sof-Lex strips (3M), Flexi-strips(Cosmedent) or Epitex strips (GC
America).
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4. Polishing
a. Use 30-fluted carbide finishing burs, Ceramisté points, or Porcelain Polishers
(Brasseler) to smooth any ground porcelain. Do not use severely pointed
finishing burs, which can scar cementum.
b. Use flexible discs (3M or Cosmedent) for accessible areas.
c. Polish with porcelain polishing paste (Truluster -- Brasseler) on a rubber cup.
Some operators follow with an aluminum oxide composite polishing paste also
(e.g., Enamelize - Cosmedent).
d. Work the paste interproximally with floss.
e. Rinse following the use of each abrasive instrument.
Recall