Dental Esthetics include the use of bonded ceramic veneers and laminates. This presentation helps to understand various concepts relating to the preparation and utility of such restorations. - Dr. Abhishek John Samuel, MDS (Endodontics)
1. DR.DR. ABHISHEK JOHN SAMUELABHISHEK JOHN SAMUEL
MDS, Endodontics & Conservative DentistryMDS, Endodontics & Conservative Dentistry
2. VENEER: layer of tooth colored: layer of tooth colored
material that is applied to amaterial that is applied to a
tooth for esthetically restoringtooth for esthetically restoring
localized or generalized defectslocalized or generalized defects
or intrinsic discolorationsor intrinsic discolorations
-Sturdevants Art & Science of Dentistry Pg. 322
Made of chairside composite,
porcelain or cast ceramic materials
3. 1. Closing spaces.
2. Minor tooth position improvements (correcting rotation or
overlap).
3. Lengthening short or worn teeth. Improving tooth shape.
4. Making aged teeth look youthful.
5. Correcting teeth in lingual version.
6. Post orthodontic treatment.
7. Shade change/Brighten shade/Stain Correction
4. Discoloration leading to deep
dentinal defects
Enamel defects
Large Diastamata
Malpositioned teeth
Poor restorations on labial sufaces
Aging
Wear pattern
Available enamel
Ability to etch
enamel
Oral habits
5. Shape or form
Symmetry and proportionality
Position and alignment
Surface texture
Color
Translucency
6. Feminine smile
Rounded incisal angles,open
incisal and facial embrasures and
softened facial line angles
Masculine smile
More closed and
prominent incisal angles
7. Prominent areas highlighted by
light
Depressed areas shadowed
Change in apparent size of a
tooth- narrower by positioning
mesiofacial and distofacial line
angles together
8. Sense of balance and harmony –
subconscious visulisation
Augmentation of proximal surfaces
with composite
Restorations at midline- incisal and
gingival embrasure form
Tooth position tooth alignment,
arch form, configuration of smile
9.
10. ‘Golden proportion’
Proportion of smaller tooth to larger tooth
0.618
‘Repeated ratio’
Golden proportion only in 17% of casts
(Preston et al)
The golden ratio (also known as the golden
mean, golden section or divine proportion)
is a height to width ratio that measures
0.618 and manifests itself in nature, art and
architecture
11. RED- the proportion of the successive widths of the teeth as viewed from the frontal
should remain constant as one moves distally.
In other words each tooth becomes smaller by a fixed percentage as you move back in
the mouth.
The RED proportion is not limited to one particular proportion but allows the desiredallows the desired
RED proportion to be selected and consistently applied for each individualRED proportion to be selected and consistently applied for each individual
case.case.
Studies have shown that smiles which maintain a constant 78% width/height ratio of
the upper central incisors are preferred.
The taller the teeth the smaller the RED Proportion usedThe taller the teeth the smaller the RED Proportion used. The shorter the teeth
the larger the RED Proportion used.
14. Cervical areas darker than incisal
areas
Young patients-lighter teeth
Older- incisal edge enamel thinned
due to wear and is darker
Shade selection
Metamerism
15. Esthetics and function
Anterior guidance and occlusal harmony
Physiologic contours
Emergence Profile
16. Mayekar (2001)
Laminate maintains colour. Usually requires no Tooth Prep.
Veneer- change in colour, requires Prep. (endodontically
treated teeth and tetracycline stained teeth)
Constructing a veneer and bonding it to tooth structure is
referred to as laminating
17. 1930-40s- Charles Pincus- Thin porcelain
veneers
1970-80s- Direct composite resin laminates- No
tooth preparation
2nd
evolution- Preformed veneers/crowns
1980- Etching of glazed porcelain with
hydrofluoric acid and silane coupling agents
18. Partial Veneers- Localized defects or as
areas of discoloration
Full Veneers- More generalized defects/
intrinsic staining
Direct
Indirect - less technique sensitive
- more esthetic
-longer lasing
- multiple teeth
19. For opaque, tinting, bonding or veneering
material for maximum esthetics without
overcontouring/overprep
Remove acid resistant, fluride rich enamel
Rough surface for bonding – diamond abrasives
Definite finish line
20. Preferred in Direct Composite
Veneers.
Preserve lingual and incisal surfaces
Significant occlusal function
Preservation of functional surfaces
Reduces wear of opposing tooth
23. Outline extent of defect
Coarse elliptical/round diamond
0.5-0.75mm
Subgingival extention- if defect is
subgingival
Microfilled or more opaque
composite depending on
remaining defect
24. Half the depth of enamel-0.5-0.75mm mid facially and 0.2-0.5mm along
gingival margin
Chamfer for definite cavity margin
Incisal edge not included.
If included for anterior guidance, tooth reduction of at least 1mm.
Shade selection- very important (3D Master)
No.212 retainer
Margin at crest of gingival tissue
25. 1. Processed composite
2. Feldspathic porcelain (+++esthetics)
3. Cast or pressed ceramic (+++ fit and
finish)
26. Superior properties- Light, heat , vacuum,
pressure etc.
Superior shading and characterizing
Better control of facial contours
Easily repaired
Children and adolescents as interim
restorations
Wear pattern
Lower cost
Window-Prep is ideal!
27. Limited bonding- surface
conditioning or sand blasting
required
Multiple large existing restorations
compromise bonding
28. Window preparation
recommended due to
limited bond strength
Incisal lapping if incisal
defect
Intraenamel preparation
Elastomeric impressions
No temporization
First Appointment
29. 1. Evaluate fit of veneer
2. Tooth side of veneer (preetched) is primed
3. Tooth etched, rinsed and dried. Adhesive is
applied but not cured
4. Adhesive cement applied
5. Veneer placed and excess cement removed
6. Check for fit with no.2 explorer
7. Light cured for 40-60sec facial & lingual
Second
Appointment
30. ADVANTAGES
Color
Bond strength
Periodontal health
Resistance to abrasion
Inherent porcelain strength
Resistance to fluid
absorption
Esthetics +++
DISADVANTAGES
Repair difficult
Technique sensitive
Color modification not
possible
Tooth preparation
required
Extremely fragile &
difficult to manipulate
Expensive
PORCELAIN
VENEERS
31. 0.3-0.6mm/ half enamel thickness
of available enamel
Adequate space for porcelain
veneer
Remove convexities
Space for opaquer
Enamel surface conducive to
etching & bonding
Definitive seat
Margin placement clarified
32. Labial- LVS no.1 and LVS no.2
Depth guide
Interproximal- Margin halfway into proximal
contact area
- Wrap around effect
- Procelain bulk
Sulcular – 0.05-0.1mm into sulcus
- retraction cord
- chamfer/ bevelled shoulder
Bi-Planar Reduction:
0.5-0.75mm – Facio-Gingival margin
1-1.2mm – Facio-Incisal margin
33. A) The facial surface should be reduced in two planes; one nearly
parallel with the path of insertion, and one parallel with the incisal two-
thirds of the facial surface of the tooth
B) One plane reduction parallel with the path of insertion may result in
insufficient space for porcelain in the incisal 1/3 of the tooth
C) One plane reduction which creates adequate space for the
restoration both in the shoulder and the incisal areas, will endanger the
pulp entity and produce overtapered restoration.
34. Featheredge or knife edge
Pointed end tapered fissure bur to provide this type of margin.
It’s the most conservative type.
But the margin is weak. Impression tearing
It form >135 cavo surface line angle.
Therefore a definite finish line (chamfer) is adviced.
Should stop just facial to the proximal contact point – easier placement
35. Incisal - definite stop
- 0.5mm if restoration of
original length
Lingual - rounded/heavy
chamfer
1. Prevent shearing of
porcelain
2. Bulk of porcelain of at
least 1mm
3. Increased strength
Elastomeric impression
36. Silane coupling agent – increases
wettability
Etching ceramic with Hydoflourous acid
7-10%
Porcelain polishing paste
• NX3 from Kerr, Variolink
• Veneer or Variolink II from
Ivoclar
• Vivadent or RelyX Veneer
Cement system from 3M ESPE
37. 5-15% opaque porcelain
Deeper tooth preparation
Die spacer (engage the cement’s shade)
38. IPS empress
Mild to moderate discoloration
Better marginal fit
Little marginal finishing necessary
39. Thinness and fragility of ceramic
veneers
Computer programmed oversized
dies
Highly sintered high purity
alumina-0.25mm
Simple to use
Excellent esthetics
40. Pre-fabricated nano-hybrid-
composite enamel-shells
Attractive teeth and a new smile
after only one visit
Very little removal of healthy
tooth structure – 0.3mm max
Individual, customized shaping
of the front teeth
Shine can be refreshed by
polishing at any time
Unlike porcelain veneers, they
can be easily repaired
45. Repair with composite resin.
Preparing surface to resist functional stresses and thermocyclic loading
High-energy ceramic reparative surface (the exposed chipped ceramic) and a
chemical/mechanical link to the restorative composite resin.
micro-etcher (20-µm aluminum oxide under 35 psi)
etch the ceramic surface with 5% to 9% hydrofluoric acid
This is completed by applying a minimal amount of a pre-hydrolyzed silane
the ceramic surface should still have a "frosty" appearance as it did after etching. If
the surface is "shiny" then the silane is too thick and should be removed by
sandblasting and re-applied in a lesser amount
The last step is to apply a bonding adhesive which should be light-polymerized
before application of the restorative composite resin.
46. Condition Whitening Veneers
Teeth stained by tobacco Y Y
Teeth stained by coffee/tea Y Y
Teeth stained by fluorosis N/Y Y
Age-related staining Y Y
Teeth that have been dark
since childhood
N Y
Teeth darkened by trauma N Y
Teeth darkened by root
decay
N Y
Stained teeth with
extensive gum recession
N Y
Gapped teeth N Y
Crooked teeth N Y
47. Same function and benefits.
When placing lumineers, the structure of the tooth remains unchanged.
Are as thick as a contact lens, but this does not make them less durable.
Might feel a little bulkier than the classic porcelain veneers.
The tooth is still protected by its natural enamel, even if the lumineers need to be taken
off.
In terms of costs, lumineers have similar costs as the porcelain veneers.
Not
Notas del editor
Therefore with tall teeth, a wider central incisor is preferred resulting in a more dominant central incisor and a smaller RED Proportion. Conversely shorter teeth have a narrower central incisor and the front teeth are more similar in size.
The 70% RED Proportion is recommended for average length teeth so the upper lateral incisor should be 70% the width of the central incisor.
1. First degree. Mild tetracycline staining. This staining is minimal expression of tetracycline. Varies from yellow to grey with no banding.
2. Second degree. Moderate tetracycline staining. Yellow -brown to dark grey banded staining.
3.Third degree. Severe tetracycline staining. Blue grey or black with significant banding across the tooth.
4. Fourth degree. Extended and more severe staining