Porcelain veneers/ orthodontic continuing education

PORCELAIN VENEERS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Key Terms
• Veneer :
A thin sheet of material usually used as a
finish
A protective or ornamental facing
A superficial or attractive display in
multiple layers, frequently termed a
laminate veneer

Key Terms
• Esthetic :
Pertaining to the study of beauty and the
sense of beautiful. Descriptive of a specific
creation that results from such study;
objectifies beauty and attractiveness, and
elicits pleasure.

THE PIONEERS
• Dr. Charles Pincus (1930) :
Developed thin facings of air fired
porcelain, which were temporarily held in
place with adhesive denture powder.
“Hollywood Smile”

THE PIONEERS
• Buonocore (1955) :
Acid etch technique
Bowen (1958) :
Development of filled resins.
Enabled mechanical bonding between
etched tooth and filled resins.

THE PIONEERS
• Rochette (1975):
– Described the innovative restoration of a
fractured incisor with an “etched silanted
porcelain block”.
– Introducing the concept of acid etching
porcelain.

THE PIONEERS
• In the early 1980’s American laminate
developments –
• McLaughlin G.
• F.R. Faunce
• D.R. Myers
• J.R. Calamia
• H.R. Horn
• R.E. Goldstein

TYPES OF VENEERS
• Directly fabricated veneers
– Composite Veneers
Indirectly fabricated veneers
Preformed laminates
Laboratory fabricated veneers
Acrylic resin veneers
Microfill resin veneers
Porcelain veneers

ADVANTAGES
• COLOR
– Better inherent color control
– Natural look
– Color stability

ADVANTAGES
• Bond strength
– Better bond strength to the enamel surface
than any of the other veneering systems.

ADVANTAGES
• Periodontal Health
– Highly glazed porcelain
– Less depository area for plaque
accumulations
– Some authors say that they actually deter
plaque accumulation

ADVANTAGES
• Resistant to Abrasion
– Wear and abrasion resistant exceptionally
high as compared to composite resin.

ADVANTAGES
• Inherent porcelain strength
– Veneer itself is rather fragile, but once it is
luted to enamel develops both high tensile
and shear strengths.
– Clinically evident by the fact that veneers
cannot be “popped” off teeth but actually
have to be ground away using rotary
diamonds through to the original tooth
surface.

ADVANTAGES
• Inherent porcelain strength
– Cohesive strength of porcelain is considerably
greater than the bond between the resin and
filler particles in a composite resin
– Thus can be used to increase the length of
tooth by extending it over the incisal edge
• High bond strength to enamel.
• High adhesive and cohesive strengths.

ADVANTAGES
• Resistance to fluid absorption
Absorbs less fluid than any other
veneering material.

ADVANTAGES
• Esthetics
– Considerably better
– Stained both internally and superficially
– Natural Fluorescence lending certain vitality.
– Surface texture can be readily developed to
simulate that of adjacent tooth.

DISADVANTAGES
• Time
– Very technique sensitive and therefore time
consuming.

DISADVANTAGES
• Repair
– Cannot be easily repaired once luted to the
enamel

DISADVANTAGES
• Cumber some
– Indirect one
– Two patient appointments
– Impression making
– Laboratory fees

DISADVANTAGES
• Color modification
– Difficult to modify color once luted in position
on the enamel surface.

DISADVANTAGES
• Tooth preparation
– Requires some tooth preparation to prevent
potential problems associated with over
contouring.

DISADVANTAGES
• Fragility
– Extremely fragile and difficult to manipulate.

DISADVANTAGES
• Cost
– More expensive than other veneering systems.

INDICATIONS
• Discolorations
– Tetracycline staining
– Devitalization
– Fluorosis

INDICATIONS
Discolorations

INDICATIONS
• Enamel defects
– Hypoplasia
– Malformation

INDICATIONS
Enamel Defects

INDICATIONS
Diastemata
Single
Multiple

INDICATIONS
Single Midline Diastema

INDICATIONS
Multiple Spaces

INDICATIONS
• Malpositioned teeth
– Developing the esthetic illusion of straight
teeth where the teeth are actually rotated or
malpositioned can be accomplished in people
who have relatively sound teeth and do not
wish to undergo orthodontic treatment.

Indications
BEFORE
AFTER

INDICATIONS
• Malocclusion
– The configuration of the lingual surface of the
incisors can be changed to develop increased
guidance or centric holding areas in
malocclusions or peridontally compromised
teeth

INDICATIONS
• Poor restorations
– Teeth with numerous small, unesthetic
restorations on the labial surface can be
dramatically restored.

INDICATIONS
• Aging
– The ongoing process of aging can result in
color changes and wear in teeth. Can be
improve by bleaching alone or sometimes
bleaching with subsequent veneering.

INDICATIONS
• Wear patterns
– Also useful in cases that exhibits slow
progressive wear patterns.
– If sufficient enamel remains and the desired
increase in length is not excessive, porcelain
veneers can be bonded to the remaining
tooth structure to change shape, color or
function.

INDICATIONS
• Agenesis of lateral incisor
– In the problem of canine erupting adjacent
to the lateral incisor, the veneer can be used
to develop better coronal form in the canine
thus simulating a lateral incisor.
– This may have to be combined with veneers
on central also, to develop a more ideal ratio
in the relative proportion of teeth.

CONTRAINDICATIONS
• No specific contraindications
• But some considerations to be taken into
account:
– Available Enamel
– Ability to etch Enamel
– Oral Habits

Available enamel
 Should be enamel around the
periphery of laminate
Adhesion
To seal the veneer to tooth surface
 Should be sufficient enamel for
bonding
Bonding to dentin is relatively less retentive
Better to go for crowns

Ability to etch enamel
• Deciduous teeth and teeth that have
been excessively fluoridated may not etch
effectively.

ORAL HABITS
• Patients with certain habits such as
– Tooth to tooth habits : bruxism
– Tooth to foreign objects habits
• Not ideal candidates for veneers as the
shearing stresses may be too great for
porcelain to withstand.

ENAMEL REDUCTION
Different opinions.
Little or no reduction
A full deep chamfer preparation on the
labial aspect of the teeth and most or all the
way through the interproximal areas.
Best is to decide how to approach the preparation
on an individual basis.

ENAMEL REDUCTION
– To provide for an adequate dimensions of
available space for the porcelain material.
– To remove convexities and provide for a path
of insertion in those situations where either
the incisal or interproximal areas are to be
included in the veneer; the best path of
insertion is that which will require the least
amount of enamel reduction.
RATIONALE FOR ENAMEL REDUCTION

ENAMEL REDUCTION
– To provide space for adequate opaquing
where necessary and for the composite resin
luting agent.
– To provide a definite seat to help position the
laminate during placement.
– To provide a receptive enamel surface for
etching and bonding the laminate.
– To facilitate sulcular margin placemen in
severely discolored teeth.
RATIONALE FOR ENAMEL REDUCTION

ENAMEL REDUCTION
– Esthetics : In lingually inclined teeth
advantageous not to reduce or reduce less.
– Relative tooth position: If one or more teeth
are out of line with respect to others, this will
influence the degree of preparation
necessary.
– Masking of tetracycline stain
– Margin placement
Decision of whether to reduce enamel depend on the
following biological or technical factors:

ENAMEL REDUCTION
• Age of the patient
• Psyche : The attitudes of the patient to
reduction should be determined prior to
proceeding.
• Plaque: the patient should be evaluated
for the ability to remove plaque at a
porcelain/tooth interface.

If restorations are to be esthetic and
biologically compatible, they will often
necessitate adjustments to the tooth surface.
This reduction in enamel can then be
replaced with a similar thickness of
porcelain, thereby making the end result
the same size or, at worst, only nominally
larger than original.
ENAMEL REDUCTION

• Usually the enamel reduction necessary,
will be in the realm of 0.3 to 0.6 mm or
about half the thickness of the available
enamel.
ENAMEL REDUCTION

Five distinct aspects
• Labial Reduction
• Interproximal extension
• Sulcular extension
• Incisal or occlusal modification
• Lingual reduction
ENAMEL REDUCTION

LABIAL REDUCTION
• Ideally, one would like to replace the
same amount of enamel that is removed
by the preparation.
• Certain situations
– Rotated teeth
– Teeth in labial version
ENAMEL REDUCTION

• The preparation should remain within the
enamel wherever possible and most
certainly at all the preparation margins.
• Some cosmetic situations, dentin may
have to be exposed.
– Fraction of bond strength
– Less effective seal
– Pulpal hyperemia
ENAMEL REDUCTION

AS A GENERAL RULE, OVER
50% OF THE PREPARATION
SHOULD BE IN ENAMEL.
ENAMEL REDUCTION

DEPTH GUIDE
• LVS depth cutter diamond burs( Brasseler,
Savannah, Ga.)
ENAMEL REDUCTION

DEPTH GUIDE
LVS no. 1 – 0.5 mm reduction
LVS no. 2 – 0.3 mm reduction
ENAMEL REDUCTION

DEPTH GUIDE
Gently draw the diamond across the labial surface
of the tooth from mesial to distal side.
ENAMEL REDUCTION

DEPTH GUIDE
ENAMEL REDUCTION

Alternative Method
• Use a no. 1 diamond bur
• Depth from the peripheral aspect of the
bur to the shank is 0.4 mm
• Hold the bur at a slight angle so that
indentations can be made into the
enamel to the depth limited by the base
of the shank.

Alternative Method
• Create these indentations randomly
across the surface of the enamel
• Problem with this type
– Depth cuts can vary depending upon the
angle the bur is held
– More time consuming

Reduction of remaining enamel
• The bulk of the reduction should be done
with a coarse diamond in order to
facilitate added retention and better
refraction of the light being transmitted
back out through the laminate.
• At the marginal area, desirable to use a
fine-grit diamond to develop a definitive,
smooth finish line to enhance the
peripheral seal.

Two grit LVS diamond burs
LVS No. 3
LVS No. 4www.indiandentalacademy.com

Interproximal extension
• Margin should be hidden within the
embrasure area.
• Extend about half way into the
interproximal area.
• Ensures a wrap around with etched resin
bonds at right angles to the labial surface
for increased bond strength.

Interproximal extension
• Move the margin just lingual the buccal
surface of the interproximal papillae so
that it will not be visible from lateral
oblique view or directly from the front.

Treatment of contact areas
• Modify the contacts by passing a very fine,
one sided diamond abrasive strip through
the adjacent teeth.
• Use it in ‘S’ configuration so that the
abrasive side will reshape the contact
areas rather than separate them.
• Thus, a thinner contact is maintained as
measured in the buccolingual direction.

Treatment of contact areas
• The contact area is then clearly
demarcated on the model, and easy,
clean snapping apart of this model into
dies is facilitated
• Dental floss passed through these contact
areas should still just catch, so arch
integrity and stability are not disturbed.

Dentin exposure
• If surrounded by enamel, it can be
managed by dentin bonding agent.
• May be a conventional dentin bonding
agent, a phosphorus ester of the BIS-GMA
molecule, or one of the newer systems
such as aluminum oxalates or
glutaraldehydes.

Dentin exposure
• If dentin exposure occurs at the periphery, such
as the cervical region, it is advisable to prepare
a little deeper into this area.
• Use a layer of GIC can be used as a base.
• The GIC will bond to dentin, and seal it as
opposed to a dentin bonding agent, which may
only adhere but not seal effectively.

Dentin exposure
• The GIC can subsequently be etched
concomitantly with the enamel when
placing the veneer, and the composite
resin luting agent will then bond to it.

Sulcular extension & Marginal
Placement
• Desirable to place it just within the sulcus.
• 0.5 to 1 mm into the sulcus or even to
remain supra-gingival if a dramatic color
change is not a high priority.
• Place a narrow gingival displacement
cord in the sulcus for about eight to ten
minutes.

Placement
• Advantages:
Access for the diamond bur
Less gingival trauma
Direct vision of margin placement
during all procedures.

Placement
• This region of the sulcus has the least
potential for inducing gingival reaction
because the sulcular supporting enamel
has not been tampered with and the
subgingival coronal contour remains the
same.

Finish line configuration
• Somewhat controversial
• Feather edge to a rounded shoulder.
• Requires a cervical reduction of minimum
0.25 mm

Benefits of modified chamfer
finish line
• Increased bulk of porcelain at margin and
hence increased strength contour without
overcontour.
• Correct enamel preparation exposing
correctly aligned enamel rods for
increased bond strength at cervical
margin.
• A well defined finish line for the
laboratory.

Benefits of modified chamfer
finish line
• A definitive stop to aid in seating the
laminate in the correct position.
• A sound marginal seal

Incisal reduction
• Indicated if length has to be increased.
• Definitive flattening of the incisal edge to
create increased enamel width and
potential bonding surface for laminate.
• Never end the incisal edge where
excursive movements of the mandible will
cause shearing stresses at the junction of
porcelain laminate and tooth.

IMPRESSION MAKING

DIRECT COMPOSITE
RESIN
TEMPORARIZATION

DIRECT COMPOSITE RESIN VENEER
UTILISING VACUFORM MATRIX

INDIRECT
COMPOSITE
RESIN/ACRYLIC
RESIN VENEER

Shade selection
• Advisable to select a shade that is slightly
lighter than desired by the patient.
• Subtle shade modification possible with
composite resin systems
• Easier to darken any given shade.
• In general, select a shade that is higher in
value and lower in chroma.

Shade selection
• Final shade depends upon
– Porcelain shade selected
– The original tooth color
– Amount of opacifier added
– Color and opacity of composite resin luting
agent
– Use of resin shade modifiers and
characterizers

Laboratory procedures
• The refractory investment technique
• The platinum foil technique
• The IPS Empress system.

Processing principle – easy and
efficient
An anatomical wax-up of the restoration is
fabricated, sprued, and invested.
After preheating the investment ring, the ceramic
material is pressed into the investment ring.
After divesting the pressed objects, complete the
restorations according to the esthetic requirements
using the IPS Empress staining technique and the
IPS Empress Esthetic Veneer materials.

Material
Leucite-reinforced glass-ceramic
The IPS Empress glass-ceramic material is made of
a glass phase and a leucite crystal phase.
The growth of the leucite crystals starts at the
grain boundaries of the glass frit.
The leucite crystals are grown in a multi-step
fabrication process up to a size of few microns.
The semi-finished product in powder form is then
pressed to ingots and fired.

The new, phosphate
bonded IPS Empress
Esthetic Speed
Investment is used .
The system consists
of a powder and a
liquid

Sprueing the wax pattern
• Depending on the size of the waxed-up pattern,
directly attach a wax sprue (diameter 2.5–3
mm / 8 gauge) to the object.
• The length of the sprues depends on the size of
the objects.
• The sprues should measure 3 mm to max 8 mm
in length.
• large (long) wax pattern = shorter sprue
• small (short) wax pattern = longer sprue

The sprue and wax pattern should not be longer than
15–16 mm. Observe a 45-60° angle.

Provide sprues in the direction of flow of the ceramic material.

Always attach the sprue to the thickest part of the
wax pattern. The internal surface of the wax pattern
points outwards.

The attachment points of the sprues must be
rounded. Observe a 45–60° angle.

Observe a distance of at least 3
mm between the individual wax
pattern.
Observe a distance of at least 10
mm between the paper ring/ring
gauge and the wax patterns to be
pressed.
Consider the direction of flow of
the ceramic material when
positioning the sprues.

Investing
• Investment is carried out with the IPS Empress
Esthetic Speed.
• Determine the accurate wax weight:
– Weigh the ring base (seal the opening of the ring
base with wax).
– Position the wax patterns to be pressed on the ring
base and attach them with wax. Weigh again.
– The difference between the two values is the weight
of the wax used.

Investing
• Large investment ring
– Up to max. 1.4 g wax weight and two
ingots
• Small investment ring
– Up to max. 0.6 g wax weight and one
small ingot

Investing
• Remove the protective
tape from the paper
ring. Form a cylinder
exactly along the
marked line.
• Tightly press the two
ends together along
the entire line.
• When working with
ready-to-use paper rings,
double-check the
adhesive area for
optimum adhesion.
Form a ring exactly along
the marked line.

Set the paper ring on the base of the investment ring and check for
correct fit. Use the ring stabilizer to stabilize the paper ring.
Mix IPS Empress Esthetic Speed Investment material under vacuum.
Pour the investment material slowly. Avoid the formation of air bubbles.www.indiandentalacademy.com

Remove the stabilizing ring and
slowly place the ring gauge on the
investment ring with a hinged
movement.
Remove rough spots on the bottom surface of the investment cylinder
with a plaster knife. The light material overlap created by the paper ring is
also removed with a plaster knife until the line is no longer visible.www.indiandentalacademy.com

Preheating
Always preheat IPS Empress
Esthetic ingots
Always place the investment rings in the rear part of the firing
chamber. This allows homogeneous preheating.
The investment rings must be placed in the hot preheating furnace
as quickly as possible. Make sure that the furnace temperature does
not drop significantly.
Always place in the investment rings in the preheating furnace with
the opening pointing downwards.
The investment rings must not touch each other. This would
negatively influence the heat absorption and stability.www.indiandentalacademy.com

Pressing
• Placing the ingots
• Remove the investment ring from the
preheating furnace.
• Place the corresponding preheated ingot that
matches the desired tooth shade.
Large investment ring
– Max. 2 ingots per pressing cycle
Small investment ring
– Max. 1 ingot per pressing cycle

Remove the investment ring from the
preheating furnace. Place the
preheated IPS Empress Esthetic
ingot in the investment ring. Place the
rings in the preheating furnace as
quickly as possible.
Next, position the AlOx plunger.

Divesting
After approx. 60 minutes
After cooling, the investment ring may show
cracks. These cracks develop (immediately around
the AlOx plunger) during cooling as a result of the
different CTEs of the various materials (AlOx
plunger, investment material, and pressed
materials).
They do not compromise the result of the pressing
cycle.

Mark the length of the AlOx
plunger on the cooled
investment ring.
Separate the investment ring using a
separating disk. This predetermined
breaking point enables reliable
separation of the AlOx plunger and the
ceramic material.
Break the investment ring at the
predetermined breaking point using a
plaster knife

Rough divestment is carried out with Polishing Jet Medium at 4 bar (60 psi)
pressure. For fine divestment, only 2 bar (30 psi) pressure is applied.
When divesting the object, blast from the direction indicated in the
schematic at the top.

Placement of veneers
• Three stage Try-in procedure
– Check Intimate adaptation of each
individual porcelain laminate to the
prepared tooth surface.
– Evaluate the collective fit and relationship of
one laminate to another and the contact
points.
– Assess the color and if necessary, modify.

The preliminary procedure
• Remove the temporaries, if any.
• Expose the finish line if extended at or
below the gingival margin with a thin
retraction cord.

• Veneers returned from lab in a protective
box in their etched state.
• Very fragile and must be handled with
utmost care.
• Handle at their edges and at the
unetched labial surface.

• Examining the veneers
– Inspect inner aspect for even etching all the
way to the marginal periphery. Drop of
water on a correctly etched surface will
spread and wet it evenly.
– Check periphery to see that it is smooth
– Check for crack lines and foreign body
inclusions using the composite resin light as a
transilluminator.

Stage I: Check for individual fit
• Clean the teeth with a slurry of fine flour of
pumice with a non webbed rubber cup.
• Clean contact areas with a fine composite resin
finishing strip
• Patient in supine or horizontal position so that
the labial surface to be veneered can be made
horizontal or parallel to the floor, thus
preventing it from sliding off.

• Select the most distal veneer and try it on
the respective tooth.
• If it does not fit in position, do not force it.
• Check for any undercuts or contact point
impingement and use a microfine (LVS
no. 6) bur under magnification to adjust it
until it seats easily.

• Check the margins for accuracy and
intimacy of fit. A drop of glycerin placed
on the etched surface can facilitate
adhesion of veneer to tooth surface.
• Try-in each laminate individually

Stage 2 : Collective fit try-in
• Try all veneers together.
• Verify interproximal contacts.
• Adjust any contacts that are too tight
with LVS no. 6 bur.
• All veneers should passively fit in place.

Stage 3: Color check
• Difficult to ascertain the actual color because
there is a space between enamel surface and
veneer itself.
• This “air refraction” prevents underlying tooth
surface from being transmitted to the surface of
the veneer.
• The porcelain tooth interface is filled with
glycerin, which will then transmit some of the
underlying color to the veneer.

Stage 3: Color check
• Place one laminate in position with
glycerin and compare with the shade tab
selected.
• If laminate appears darker than the
shade tab selected, the a lighter colored
composite resin should be selected and
conversely.

Composite resin color check
• The actual composite resin selected can
be placed on the veneer next and veneer
seated on the tooth.
• Excess resin is removed with an explorer
and the ‘Final’ color will become evident.

Points of caution
• Avoid exposure to operatory light as it
may initiate the curing process, especially
with ‘dual’ cure type of composite resins.
• Most composite resin change color on
initial curing.
• Most composite resin undergo a further
shift in color over the next 72 hours in
moist oral environment.

• Better technology is
to use specially
formulated and
colored keyed try- in
paste.

• The composite resin material used during
the try in stage will generally need to be
removed in its entirety by placing the
veneer in a container of pure alcohol in
an ultrasonic solution for 10 minutes.

Characterization & staining
• Characterized on the internal surface by the use
of composite resin color characterization kits.
• Veneer is etched and silanated and color resin is
painted onto this etched surface.
• Veneers can then be tried and if found
satisfactory the resin stain can be cured onto the
veneer in very thin layer.

Characterization & staining
• Characterized on the external surface by
using a special laminate low-fusing stain
system.

Opaquing
• P.A. opacity system
• Using a thicker layer of luting composite
resin specially in localized areas
• Laying down striae of opaque porcelain
as a base and building over it.
• Leads to some loss of vitality for the
veneer.

Luting agents
• Desirable features for luting agents
– Thin film thickness: 10 to 20um.
– High compressive strength
– High tensile strength
– Relative low viscosity
– Ability to opaque, tint and characterize
– Low polymerization shrinkage
– Color stability.

Luting agents
• Light cured composite resin system
preferred.
• In case of thick or very opaque veneers,
dual cured system are preferred.
• “Submicrofill Hybrid” type preferred

Veneer placement procedure
1. Tissue management
Place patient in supine or recumbent
position.
Place retraction cord in gingival sulcus
Decrease crevicular fluid
Displace the tissue.

2. Layout
• Layout the cleaned, etched veneers in
their respective tooth order, in easy reach.
• Assemble the necessary instruments and
materials in appropriate sequence.
• Prevents any slowing down during the
bonding procedure.

3. Silanation
• Treat the etched veneer with a silane coupling
agent to enhance the adhesive properties of
resin.
• A pre-activated silane is painted onto the
veneer surface and allowed to dry for one
minute.
• Then the excess alcohol vehicle is gently
evaporated by passing a stream of air parallel
to and approx. 6 in. above the surface of
veneer.
• This leaves a dry, silanated veneer.

Silanation
• In the non-hydrolyzed from the surface of
laminate must first be conditioned with
an acid medium to hydrolyze and
activate the subsequent layer of silane.

4. Enamel Activation
• Clean the teeth with a slurry of fine
pumice and water using a rubber cup to
remove all traces of salivary glycoproteins
and previous composite resins from try-in.
• Wash and air dry the teeth

5. Isolation
• Isolate with check retractors and cotton
rolls.
• Place a saliva ejector near the back of the
throat and instruct the patient to breathe
through the nose, further decreasing the
moisture contamination that is caused by
humid vapors.

6. Enamel etching
• Tooth is isolated on both sides by placing
either mylar strips or soft metal matrix
band mesially and distally.
• Tooth is etched with 30 to 37 %
phosphoric acid solution for 15 to 20
seconds.
• The etching material is washed from the
enamel surfaces with copious amount of
water for full 30 seconds.

Enamel etching
• Do not let the patient rinse or in any way
contaminate this etched surface with
saliva.
• If this occurs, the surface must be re-
etched for 10 seconds, washed and dried
again.
• The enamel surface is ideally dried with a
stream of warm air to ensure an
uncontaminated, oil-free surface.

7. Application of dentin bonding agent
• Coat the etched tooth surface with
bonding agent of the light activated type,
which is gently air dispersed into a thin,
even layer.
• Gently blow aside all excess bonding
agent
• Light cure this evenly dispersed layer to
seal the tooth surface.

• Next coat the internal aspect of veneer
with an unfilled resin bonding liquid; blow
it into a thin layer but do not light cure it.
• Place the composite resin luting agent on
the laminate, using some form of syringe
and express the material into the center
so that it spreads laterally, without
trapping air bubbles.
7. Application of dentin bonding agent

8. Seating Sequence
• Best to seat one laminate at a time.
• Move the light away from the operatory
field
• Some feel it is useful to sticky wax and
attach some form of handle( such as a
tooth pick) to the labial surface of veneer.

9. Placement
• Rotate the veneer onto the buccal surface
of the tooth and ten gently manipulate it
until contact is made in the region of the
gingival finish line.
• Motion must be gently rocking or
“pulsing” motion that slowly allows the
excess material to escape from all sides of
the veneer.

9. Placement
• Gross excess is removed by a firm, pointed paint
brush or curette.
• Important not to slide veneer in place.
• Hold the laminate firmly in place to prevent “
suck back” and begin the polymerization
process with light.
• Cure for just 20 sec from the lingual aspect and
a further 20 sec from the labial aspect in the
incisal half of the tooth.

9. Placement
• Remove the rest of the excess partially
cured material-still holding the veneer
firmly in place- from the gingival margin
and interproximal area, using a sharp
scaler and/or an explorer.
• The two matrix strips are now pulled from
the buccal aspect toward the lingual
aspect to clear the interproximal area of
excess material.

9. Placement
• The matrix strips must be reinserted between
the teeth to prevent them from bonding to one
another.
• The light is then reapplied to the labial and
lingual surfaces to complete the polymerization.
• The polymerization process is completed by
curing the various areas of the veneer for at
least 2 minutes each.

9. Placement
• This extra time is important due to the
fact that the light has to travel through
the porcelain to reach the underlying
composite resin.
• The more excess resin is removed prior to
the finishing process, the easier the final
finishing will be.

10. Curing
• Time: the greater is the time resin is exposed,
greater is the percentage of cure.
• Angle of contact: Should contact resin at right
angles for maximum effectiveness.
• Shade of the resin: Darker shades of resins and
increased opacities of resin need an increased
amount of time for curing.

10. Curing
• Composite resin composition: Vary from
resin to resin with a variation in degree of
cure when exposed to the same light.
• Distance: should never be more than 1
mm.

11. Finishing
• Best accomplished with some form of x2
or x4 magnification.
• Following complete polymerization, chip
off any excess composite resin with a
carbide interproximal carver or gold foil
knife.

11. Finishing
• LVS no. 5 bur ( carbide finishing bur with
straight profile) : Remove any resin at the
gingival margin.
• LVS no. 7 bur ( microfine diamond point):
Gently machine down any excess
porcelain horizontal ledge beyond the
preparation. And to get the emergence
profile.

11. Finishing
• LVS no. 6 or 7 bur( polishing diamond):
refine the tooth-resin-porcelain interface.
• LVS no. 8 ( Football shaped diamond):
For finishing the lingual veneer-enamel
interface.

11. Finishing
• Final polishing: Ceramic polishing points
followed by a diamond dust impregnated
paste with a non webbed rubber cup.
• Can take 5 min or more per tooth.
• Interproximal areas polished with
composite resin finishing strips.
• Floss passes through smoothly and does
not catch or tear.

12. Occlusal assessment
• Ensure no excessive contacts with
opposing arch in any excursive
movements.
• More critical when incisor edge is lapped.

13. Cosmetic contouring
• After several days( to ensure complete
polymerization of resin) the veneer can
further be refined with fine diamonds for
esthetic harmony.
• The bonded veneer, at this stage, are
extremely strong and readily amenable to
cosmetic contouring.
• Never contour unsupported porcelain
veneers until bonding is complete.

Atlas of laminate placement
1. Enamel Activation
Preoperative view of
an esthetically dark
canine
Porcelain laminate
returned from the
laboratory

Clean the canine with a
slurry of pumice and
water

Isolate the tooth with
two soft matrix bands
placed mesially and
distally and etch
enamel for 15 to 20
seconds.
ENAMEL ETCHING

Wash the tooth with
copious amount of water
for 30 seconds
Dry the teeth with an
oil free syringe and /or
utilize a jet of warm air

APPLICATION OF BONDING AGENT
Isolate the tooth once
again and coat the
etched enamel surface
with DBA and/or
unfilled resin
Disperse the bonding
agent ito a fine thin
layer using a stream of
dry air and light cure
and seal the surface of
the tooth. www.indiandentalacademy.com

Clean the inner aspect of
the veneer with
orthophosphoric acid or
citric acid. Wash and dry.
Drying is further facilitated
by coating with a drying
agent. Then coat this
surface with a layer of
silane which is allowed to
evaporate dry.
Over the dry silane
layer, place a layer of
unfilled resin. Disperse
into a fine layer with a
stream of air.

Fill the laminate with
the selected composite
resin luting agent..

VENEER PLACEMENT
Hold the laminate
firmly in place to
prevent suck back an
light cure for five
seconds to tack the
laminate in place.
Place the laminate in
position on the tooth
rotating it about the
incisal edge and toward
the gingiva. Ensure that
excess luting material
extrudes from all
peripheral aspects.

Cure the laminate for
at least two minutes on
each aspect of the
buccal surface and
similarly on the lingual
surface. Two lights
used simultaneously
are preferred.
Remove excess with a
explorer or sharp
scaler.

FINISHING
Use the LVS no. 8 bur
to remove composite
resin along the incisal
margin.
Use carbide finishing
bur to remove excess
cement.

Clear the contacts with
a extra fine metal strip
to ensure they are free
If there is excessive
amount of porcelain
beyond the enamel,
refine this with a LVS
no. 6 bur to develop
emergence profile.

Polish the
tooth/composite resin
luting agent/porcelain
interface with diamond
polishing paste. Wash
and dry.
Polish contact area
with composite resin
finishing strip

Post operative view
Check interproximal
areas for clearance
with dental floss

A cross sectional view of final laminate placedwww.indiandentalacademy.com

Patient Instruction sheet
• First 72 hours: Avoid any hard foods and
maintain a relatively soft diet. Avoid
extremes in temperatures. Alcohol and
some medicated mouthwashes should not
be used during this period.

• Maintenance: Routine cleanings are must-
at least every four months with a dentist.
• Use a soft brush with rounded bristles, and
floss, as you do with your natural teeth.
• Use a less abrasive toothpaste and one
that is not highly fluoridated.

• Maintenance: Avoid excessive biting forces
and habit patterns: nail biting, pencil
chewing etc.
• Avoid biting on hard pieces of candy,
chewing on ice etc.
• Use a soft acrylic mouth guard when
involved in any form of contact sports.

Mouth rinses:
• Acidulated fluoridated mouth rinses can
damage the surface finish of your
laminates and should be avoided.
• Cholorhexidine antiplaque mouth rinses
can stain your laminates.

Conclusion
• The final veneer provides the patient with the
durability and beauty of porcelain, coupled
with minimal tooth reduction and dentin
exposure.
• This also provides a good treatment option in
certain situations when patient does not wish to
undergo extensive orthodontic treatment.
• But the process is highly technique sensitive and
must be performed with utmost care for
optimum results.

References
• Alberts H.F. tooth colored restoratives. 7th
ed Cotali,calif.: Alto books, 1985.
• Garber, David A. Porcelaim laminate
veneers. Quintessence publication co.1988.
• Goldstein RE. Esthetics in dentistry. Vol. 1-
principles, Communication and treatment
methods. 2th ed.

References
• Horn HR. Porcelain laminate veneers
bonded to etched enamel. DCNA
27(4);1983:671-683.
• Goldstein RE. Diagnostic dilemma: to
bond, etch or crown? Int J perio Rest Dent
1987;5:9-27.
• Clyde, Gilmore. Porcelain veneers: a
preliminary review. Br Dent J
1988;184(9):9-14.

THANK YOU

Success is not final, failure is
not fatal: it is the courage to
continue that counts.

Porcelain veneers/ orthodontic continuing education

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