Porcelain laminate veneers /dentist lab technician

Porcelain
Laminates
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Table of contents
 Tooth preparation.
 Impression making.
 Shade selection.
 Provisional restoration.

 Lab communication.
 Lab Fabrication.
 Try- in considerations.
 Luting of porcelain laminate veneers.
 Finishing and polishing
 Failures
 Lumineers
 Conclusion
 References. www.indiandentalacademy.com

Tooth preparation
9. Incisal preparation
If reduce, then how much??
A) window .
B) feather.
C) bevel .
D) incisal overlap.

Old concept
 1980s- the common trend was to preserve the incisal edge
in the interests of tissue conservation.
 higher number of fractures observed.
Why????
 Where the free edge is not overlaid, the occlusal third of
the laminate veneer is often very thin (less than 0.3 mm).
 When the teeth are very slender, the difference in
resilience between the prepared natural tooth and the
laminate veneer can, under certain occlusal constraints,
lead to cracking or fracturing of the ceramic.

Recent concept
 complete coverage of the incisal edge.
advantages
 It restricts angle fractures.
 It enhances the esthetic properties of laminate
veneers.
 It enables occlusion to be adjusted.
 It facilitates handling and positioning of the laminate
veneer at try-in and, in particular, during bonding.
 It enables the margin to be placed outside the area of
occlusal impact.

Tooth preparation
 The labial cusp(maxillary or mandibular)should be
reduced by at least 1 mm.
 The occlusal margin should be placed away from the
occlusal contact and grooves
The overlay extends to the occlusal three-quarters of
the labial cusp, the margin being produced with a
spherical bur and connected with the proximal margins
by a rounded angle.
Premolar :

Impression making
 Materials
 Rubber base impression materials such as
addition silicones or polyether.

 Trays:
 Custom made or stock full arch impression trays
are used.

Embrasure blockout

Inteproximal tear through margin.

Embrasure blockout.

Intact interproximal extension.

Provisional restorations
 Usually not necessary.
 In several clinical situations,
provisionalization may be required.

 If excessive reduction is done to align the
tooth.
 To prevent supraeruption of the prepared
tooth.
 If isolated teeth are prepared.
 High esthetic expectations.

 Materials that can be used for provisional
restorations:
Acrylics.(SNAP (PARKEL), TEMPLUS (ELLMAN)
,JET (LANG) , DURCALAY (RELIANCE)
Composites.( Revotec, Protemp Grant,
Unifast L C)

 Techniques :
Direct technique.( acrylic, composites)
Indirect technique. (acrylic, composites)

 Direct technique ( acrylic resin).
JPD 1989;2;4;139

 FACIAL IMPRESSION
OF PROPOSED SITE IS
MADE ON A TONGUE
BLADE USIND
IRREVRSIBLE
HYDROCOLLOID
IMPRESSION
MATERIAL.
 IMPRESSION CAN BE
OBTAINED FROM
PATIENT OR FROM AN
ESTHETICALLY
ALTERED
DIAGNOSTIC CAST

 PREPARE THE TOOTH
FOR LAMINATE
RESTORATION,
 USING NO. 2 ROUND
BUR MAKE
RETENTIVE DIMPLES
ON MESIAL AND
DISTAL AXIAL
WALLS, 1mm ABOVE
THE CONTACT AREA.

 WET THE TREATMENT
SURFACE WITH
EXACTLY ONE DROP OF
ACRYLIC RESIN
MONOMER.
 USING SPEEDI TEMP
POLYMER RESIN
BLOWER APPLY
ACRYLIC RESIN
POLYMER.
 REPOSITION THE
IMPRESSION
NTRAORALLY.

 RESIN WILL
SUFFICIENTLY
PENETRATE THE
DIMPLES
 AS ACRYLIC RESIN IS
APPLIED SPARINGLY
ONLY SMALL EXCESS
WILL BE EXPRESSED
OUTSIDE
 PROVISIONALS ARE
FINISHED AND
POLSIHED

DIRECT TECHNIQUE
 ( J. ESTHET RESTOR DENT 2001,13;115-
119)

STOCK TRAY IMPRESSION MADE
PRIOR TO TOOTH PREPRATION
USING BITE REGISTRATION
MATERIAL ( REGISIL RIGID,
DENTSPLY )

 VENEER PREPRATION ACCOMPLISHED WITH SLIGHT
SUPRAGINGIVAL MARGINS
 SELF ETCHING DENTIN – ENAMEL ADHESIVE SYSTEM
(PROMPT L-POP ESPE AMERICA INC.) WAS APPLIED

TEMPHASE (KERR CORP. ) – TWO
COMPONENT ( CATALYST AND BASE
) BIS- METHYACRYL HYBRID
TEMPORARY CROWN AND BRIDGE
MATERIAL
LOADED IMRESSION IS SEATED
OVER THE PREPARED TEETH
HELD IN PLACE TILL
THOROUGHLY CURED .

 IMPRESSION IS REMOVED
AND THE RESIN REMAINING
ON THE TEETH IS EXPOSED
TO VISIBLE WAVELEGNTH
CURING LIGHT
 USING CARBIDE FINISHING
BURS, FLASH IS REMOVED
 OCCLUSION IS CHECKED
AND ADJUSTED ,
PROVISIONALS ARE
POLISHED USING
CONVENTIONAL
COMPOSITE POLISHING KIT

 Indirect method:(composites)

BONDING OF PROVISIONAL
RESTORATION
 Composites.
 Provisional Non- eugenol cements.

THINGS NEEDED FOR GOOD
COMMUNICATION ARE.
 Laboratory prescription.
 Pretreatment models.
 Photographs of the teeth.
 Accurate impressions.

Lab prescription.
 A complete lab prescription consists of the
following:
 1. shade of the prepared teeth.
 2. shade of the veneer: cervical, body,
incisal.
 3. appropriate interface space in die spacer
coats.
 4. veneer length, contacts, incisal shape.

Shade selection
 Because ceramic veneers are thin, color
from the underlying tooth may alter the
final veneer shade.
 Without prescribing the background of the
tooth to be veneered it is difficult to select
the shade of the veneer.

 Shade of the prepared
tooth:

 Shade gradation of the veneer:

 Die spacer:
0.1 mm die spacer for two- shade shift.
0.2mm for profoundly stained teeth.

 Translucency and opacity levels:
 Use of highly opaque porcelain gives
non-vital look.
 Trend is to use translucent and highly
characterized porcelain combined with
increased die spacing.

Length, contacts and incisal shape:
 Veneer length relative to the prepared tooth.
 Contact zone (long or short)
 Tooth shape( tapered, square)
 Incisal shape (round, square, variable).

Communication with desired contour
and tooth shape.

Lab fabrication
 Platinum foil technique.
 Refractory die technique.
 Direct casting
 CAD-CAM technique

Platinum foil technique

 Stone working model seperating dies

Die spacer

Platinum foil adapted on the die

APPLY GINGIVAL CERAMICS

Apply dentine porcelain.

Cutting back mesial and distal
surfaces for enamel porcelain

Application of enamel porcelain.

Yellow stains on the incisal edges

Completed veneer

The veneers should be colored and
glazed prior to foil removal.

Refractory die technique.
 Advantages:
1. Overall accuracy and fit is generally
better.
2. Easier technique.

 Disadvantages:
1.Requires duplication of stone dies.
2.Divestment is required.
3.Fit must be verified on stone dies.
4.More difficult to control veneer
thickness.

 Refractory cast trimmed with stone base.

Dies are placed in the ceramic oven.

Cooled to room temperature and
soaked in distilled water.

Application of the opaque layer.

Full contour ceramic buildup.

Contouring the veneers on the dies.

Disc used to cut the veneer away
from the die.

Excess is removed from the stone.

Air abraded.

Porcelain etching
 Hydrofluoric acid is applied to the fitting
surface of the veneer.
 Provides good bonding strength by partly
dissolving the glassy matrix of the
porcelain.

Apply wax to the areas
not etched

Internal bonding surface etched with
hydrofluoric acid.

Properly etched-
foggy appearance

Under etched-
shiny appearance

 Swift B et al., (BDJ 1995; 179: 203-20)
 Do not place the etched veneers back on the
master cast because it will contaminate
their fitting surfaces and adversely affect
bonding strength.

Veneer try-in

Chair side try- in.
 Three steps:
1.Dry try-in of individual veneer for marginal fit.
2.Wet try-in of all veneers collectively with a clear
liquid medium, for proximal fit.
3.Resin cement try-in.

Dry try-in for marginal fit.
 Place the gingival retraction cord
subgingivally to prevent sulcular moisture
or bleeding from contaminating the surface.
 Try each veneer individually in dry to
determine marginal accuracy.

Each veneer is placed dry on the
prepared tooth to check marginal fit.

Wet try-in for proximal fit.
 Fill the internal etched surface with water
soluble glycerin to minimize dislodgement
if a vertical position is assumed.
 Try veneers on appropriate teeth in
sequential manner.
 If the veneer resists seating remove the
veneer and carefully reduce using microfine
diamond bur.

All veneers are seated to check the
marginal fit.

Veneer try-in for color and color
modifications.

 If the try-in is lighter than a intended
shade.
 Use resin cement that is darker or
approximately same degree.

 If it is darker than the intended shade
 Mix one part of light opaque resin cement
with ten parts of light translucent resin
cement.

If generalised polychromatic
shade modification needed
only for a portion of veneer .

 High chroma composite tint on inner gingival
surface.

 Grey tint on the inner incisal third.

TRADE NAMES OF RESIN
CEMENTS.
 NEXUS (KERR)
 PVS PORCELAIN BONDING
 KIT(JELENKO)
 INSURE (COSMODENT)
 COMPOLUTE (ESPE)
 VIRIOLINK (VIVADENT)

 VENEER LUTING AGENT (BISCO)
 RECOVER(TELEDYNE GETZ )
 MIRAGE FLC(CHAMELEON)
 RELY X VENEER CEMENT(3 M
ESPE)

Cementation and finishing
 Good moisture control is necessary.

Gingival retraction
 Gingival cords:
•Retraction cord is of great help to prevent
contamination from gingival crevice

 Gingval cords come in
different sizes:
 Ultrapak plain and
ultrapak E (epinephrine
impregnated)
 Knitted.
 # 00,#0,#1,#2.

Veneer preparation.
 Ultrasonically clean
the veneer in acetone
for 5 mins

Dry thoroughly and apply silane
coupling agent

Tooth preparation.

CLEAN TOOTH WITH PUMICE

Check interproximal contacts of the
teeth using metal strips(0.0005’’)

PASSING OF ULTRA THIN DIAMOND
COATED METAL STRIP TO LIGHTEN THE
CONACTS

METAL STRIP PLACED

LOADING VENEER WITH RESIN
CEMENT

SEATING THE VENEER

VENEER CARRYING STICKS
(GRAB IT-CHAMELEON
DENTAL PRODUCTS)

EXCESS CEMENT

REMOVING EXCESS RESIN

REMOVING EXCESS
CEMENT FROM
LINGUAL MARGIN

VENEER TACKED BY LIGHT
CURING A SMALL SEGMENT

REMOVE ANY EXCESS LEFT

CURED RESIN CEMENT EXCESS
REMOVE
LONG POINTED 30
FLUTED CARBIDE BUR
SCALER OR CURETTE

FINISHING STRIPS-
REMOVE INTERPROXIMAL
EXCESS

ADJUST OCCLUSAL CONTACTS

POLISH USING CERAMIC
POLISHING RUBBER CUPS

Failures

Failures
 between resin and veneer is likely due to poor
etch of veneer or old silane
 between tooth and resin the problem is bonding
materials, placement technique, bonding substrate

 To re-bond a veneer all resin must be removed
from the veneer. This is done in the lab by heating
to 600* C and re-etching, washing, drying, and
re-silanating the veneer
Failures
 Etch with 9.5% hydrofluoric acid for 4 mins.
or 1.23% acidulated phosphate fluoride, or air
abrasion with 50mu aluminum oxide
 wash, dry, silanate
 then use conventional bond/C.R. system

Newer clinical applications

Differences between lumineer and traditional
laminates
Laminates
1. More tooth preparation
2. Not reversible
3. Anesthesia needed.
4. gingival cord placement
5. Temporaries needed.
6. 0.5 to 0.75mm thickness
Lumineers
1. No or minimal preparation
2. Reversible
3. No anesthesia
4. No gingival cord
5. No temporaries
6. 0.2mm thickness

refereneces
1PORCELAIN LAMINATE
VENEERS:GRABER,GOLDSTEIN,FEIN
MAN
2.THE SCIENCE AND ART OF DENTAL
CERAMICS:JOHN W. McLEAN(VOL.I
AND II)
3.PORCELAIN LAMINATE VENEERS
FOR DENTISTS AND
TECHNICIANS:ROGER J. SMALESwww.indiandentalacademy.com

4.FUNDAMENTALS OF ESTHETICS:CLAUDE
R. RUFENACHT
5.CONTEMPORARY ESTHETIC
DENTISTRY:BRUCE J. CRISPIN
6.PORCELAIN LAMINATE VENEERS:A
PRELIMINARY REVIEW(BDJ 1988:9:9-14)

6.A PROVISIONAL RESTORATION
TECHNIQUE FOR LAMINATE
VENEER PREPARATIONS:(JPD
1989:62:139-142)
7.ADVANTAGES AND LIMITATIONS
OF PLV:(JPD:1990:64:406-411)
8.PREDICTABILITY OF COLOUR
MATCHING :(JPD 1991:65:619-22

9.THE SCIENCE AND ART OF DENTAL
CERAMICS:J.W.MCLEAN:
(J.OPERATIVE
DENTISTRY:1991:16:149-156)
10.REMOVAL OF PARTIAL OR FULLY
POLYMERISED RESIN FROM
PORCELAIN VENEERSJPD
1993:69:443-444)

11.COMPARISON OF FIT OF
PORCELAIN VENEERS
FABRICATED USING
DIFFERENT TECHNIQUES:IJP
1993:6:36-42
12.CASE SELECTION FOR
PLV:QUINT INT;1995;26;311-315

13.A REVIEW OF ALL CERAMIC
RESTORATIONS:JADA 1997:128:297-307
14.FIVE YEAR CLINICAL PERFORMANCE
OF PORCELAIN VENEERS:QUINT INT
:1998:29:211-221)
15.VITAPAN 3D-MASTER:THEORY AND
PRACTICE:QDT:1999;43-53

Porcelain laminate veneers /dentist lab technician

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