Variations Of Porcelain Veneer Usage, Case 1
by Dr. Greg Janikian, D.D.S.
An aesthetically pleasing smile is a delicate balance of shape contour and color. Congenitally missing or malformed teeth can be a special challenge to the restorative dentist. The lateral incisor is the most likely anterior tooth to not form or exhibit a malformation. Luckily, we have both restorative and orthodontic solutions. Sometimes the answer is a combination of movement and cosmetic restoration.
An eighteen year old white female presented, post orthodontically, with a chief complaint of diastemas between the upper anterior teeth. (Image 11, 12 and 13; all images can be clicked for close-ups.)
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Porcelain veneers are exceptionally aesthetic, durable and more conservative than a crown. Due to these factors, veneers are the restoration of choice. Without local anesthesia, the upper right and left lateral incisors were prepared. Using a thin diamond bur as a depth guide, .5mm of enamel was removed from the facial surface of the laterals. The preparation also included reducing the incisal edge by 1-2mm finishing down 2mm on the lingual surface and interproximally. Note: if some contact remains it should not be broken. An impression was taken, shade selected and a provisional fabricated.
Provisionalization after preparation for porcelain veneers is optional. Placement of composite, without etching or application of a bonding agent, can be quick and easily pops off before placement of the final restoration. To ensure that the composite will not bond to the preparation, a light coat of Vaseline can be applied to the preps and adjacent tooth structure.
Details can dramatically enhance the final result of an aesthetic case. The lab was instructed to fabricate veneers. Included with the prescription were pre-op and post-op photos. A picture will serve as the best aid to the dental technician in helping them create the illusion of reality. With this in mind, the technician was asked to place areas of hypocalcification at the incisal edge of the veneers. (Image 14.)
Placement of the veneers was accomplished using a light activated composite bonding system. A critical factor in achieving a good bond between veneer and tooth is the use of a silane coupling agent. The internal surface of the veneer must be highly etched to maximize bondable surface area. (Image 15.)
After thorough curing finishing was completed with finishing strips and fine fluted carbides. Care must be taken to produce the smoothest most highly polished finish at the gingival margin. A seamless finish line will decrease the chance or recession and/or tissue irritation. (Image 16,17 and 18.)
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Dentistry can offer a variety of solutions to cosmetic problems. Occasionally, a team approach integrates treatment and facilitates a result that, otherwise, would not be possible.
Next month we'll present Case 2, dealing with restoration of traumatic fractures.