2. A dental veneer is a thin layer of composite material or
dental porcelain bonded to the surface of a tooth
Definition
3. Indication
• Improve extreme discolorations such as tetracycline
staining, flourosis, devitalized teeth, and teeth darkened from
age.
• Repair chipped or fractured teeth.
• Closing of diastemas between teeth.
• Ability to lengthen anterior teeth.
• Improve the appearance of rotated or misaligned teeth
4. Contraindication
• If little or no enamel is present, full crown should be
considered.
• Certain tooth-to-tooth habits like bruxing or
clenching, or other para-functional habits such as pencil
chewing or ice crushing.
• Teeth that exhibit severe crowding.
• Certain types of occlusal problems such as Class III &
end-to-end bites.
5. There are three types of veneers
(1) Conventional Porcelain Veneers.
(2) Lumineers.
(3) Composite Resin Veneers.
6. A conventional porcelain veneer is a thin piece of
porcelain that is bonded to the front of a tooth.
Porcelain is a durable, translucent, strong, natural-
looking, and beautiful material.
In most cases, Conventional Porcelain Veneers
will create the most beautiful results, and are
thus the most common type of veneer used.
(1) Conventional Porcelain Veneers.
7. It is done either in one appointment by using
the prefabricated porcelain(ready made)
veneer or in two appointments by using
porcelain veneer fabricated in the lab.
8. Tooth preparation
We have four aspects of tooth preparation
1-Labial reduction
2-Interproximal reduction
3-Incisal modification
4-Cervical definition
First Appointment (VENEER PREPARATION PROCEDURE)
9. -Paralleling the entire gingival margin, prepare a definitive
chamfer finish line.
-Continue the definitive chamfer finish line with diamond bur
from the papilla tip toward the incisal edge on both the
mesial and distal proximal surfaces.
-Place a horizontal facial depth cut, it is usually 0,3 mm from
proximal line angle to proximal line angle. Make this depth
cut at the junction of the cervical and middle one-third of the
facial surface of the tooth.*
10. -The facial depth cuts are removed with the diamond bur,
and the long axis of the diamond bur is “rolled” into the
proximal chamfer area to eliminate any sharp line angles.
Bad prepGood prep
11. How to handle incisal edge ?
Path of Insertion
Unrestricted
Restricted
Most
common
Less
common
12. -There are three ways to manage incisal edge
coverage.
no incisal edge coverage- easiest to manage, requires
provisionalization less because there is less dramatic
change in appearance.
cover incisal edge – less stress on internal aspect of
veneer if rounded, less chance of die abrasion, I use on
centrals and laterals most for unworn teeth
wrap around incisal edge- this technique used more
when significant wear already exists and B-L width is
thick. Also provides some mechanical retention for
longer extensions (>1.5mm)
13. Impression
The retraction cord should be left in place if
possible during the impression.. It is best to use
a polysiloxane or polyethermaterial for the
impression since multiple pours are often
needed for the laboratory procedures. Placing
soft wax in the lingual embrasures prior to
taking the impression will minimize tearing of
the impression in these areas
Temporary Veneers
If they are necessary or desired, they are hand sculptured using
composite, kept supragingival, out of heavy occlusion, and attached by
spot etching the enamel in the center of the tooth away from any
margins. Other methods can be used which include acrylic type indirect
methods.
16. Second Appointment (VENEER CEMENTATION PROCEDURE)
Remove temporary
Clinical try-in.
Evaluate fit and esthetics
All veneers should be placed without bonding medium on teeth to assess the fit.
17. Preparing the restoration for cementation.
-Clean the restorations with acetone or Cavilax if you
have tried it in with resin based systems. If you have
used only water soluble medium (glycerin, K-Y jelly, Try-in
pastes) you need only to rinse. It is a good idea to clean
with enamel etchant (35% phosphoric acid) to help clean
any salivary contaminants that may have come in contact
with the bonding surface.
-Etch. etch with porcelain etchant (porcelain
conditioners- 10% HF acid). The time of etch depends
on the ceramic materials used. (Porcelain > 3min Empress
< 1 min).
18. -Apply Porcelain Primer or Silane Coupling
Agent.
Set prepared veneer in a lightproof box until
ready for cementation
use a prehydrolized silane which means you
do not have to mix two components (usually
contained in cementation kit (Nexus, Kerr) It
is applied with a brush. The coupling agent
acts to wet the surface of the porcelain. The
silane coupling agent is allowed to set on the
surface (usually for at least 60 sec but some
are shorter periods). It can be dried with a
gentle stream of air. Do Not Rinse.
19. Prepare tooth for bonding.
Isolation. Rubber damn isolation is usually not
practical for multiple anterior cementation
techniques. Cotton roll isolation and an assistant
are usually sufficient for cementation.
Clean all tooth surfaces with rubber cup and
pumice/water mixture or chlorohexidine
soap/pumice mixture and rinse thoroughly.
Place clear Mylar strip between involved adjacent teeth to
minimize etching and placement of adhesive and cement on the
adjacent unbonded teeth . Do two veneers at a time. The
sequence I usually use is: both centrals first, then lateral and
cuspid on one side and finally the lateral and cuspid on the
opposite side.
20. Adhesive is applied to the surfaces of the
preparation. In the Nexus system this layer is
air thinned and cured prior to cementation.
In other systems this layer may be left
to cure during the cementation.
Etch the preparation. The enamel is etched for 15-30
seconds with 35% phosphoric acid. Gel etches are easier
to control. Rinse the tooth thoroughly to make
sure no etchant remains and air dry with air syringe
or high evacuation.
21. Apply the cement (Nexus, Kerr) to the
preparation and the surface of the veneer
with a brush or plastic instrument. Light
cured materials are used for
cementation since the veneers are
extremely thin and transmit enough
light. Most cementation kits now contain
two viscosities of cement.
Seat the restoration with firm finger
pressure and hold in place while the excess
cement is removed with a sable brush
Light cure veneer from the facial
surface for at least 60 seconds. You
cannot overcure these restorations. Cure
from lingual surface if the incisal edge is
included in the restoration.
22. Finishing and polishing procedures.
Remove excess set bonding material with sharp carvers.
Keep instruments stable against restoration and tooth
surface to minimize soft tissue damage. Recontouring and
occlusal adjustments of the porcelain are done with a
fine diamond and high speed using water coolant. Any
surface which has been modified with a finishing diamond
needs to be polished. If no marginal discrepancies were
present between the tooth and ceramic, finishing can be
initiated with finishing carbides, discs and rubber points
23. What is the difference between Lumineers and standard
porcelain veneers?
The main difference is that Lumineers are made from a
special patented cerinate porcelain that is very strong
but much thinner than traditional laboratory-fabricated
veneers. Their thickness is comparable to contact lenses.
(2) Lumineer
24. • Lumineers can be placed on the teeth without removal
of the tooth structure.
• Patients can receive their veneers quickly, usually within
two weeks from the date that the impressions are made.
• Lumineers bond directly to the tooth, making the bond
very strong. They are also very long-lasting- up to twenty
years or longer.
• Lumineers are a reversible procedure.
Advantages
25. Although Lumineers are the most advantageous
option, there are certain limitations to be considered:
• Lumineers can only be placed on teeth that are in good
structural condition. The teeth must be free of decay. Any
existing fillings must also be in good condition, along with
the surrounding gum in the area where the Lumineers will
be placed..
• The patient must have good oral hygiene, with no
receding gums or signs of gum disease. Bleeding of the
gums will interfere with the bonding process.
• Because there is very little or no tooth preparation, a
small bump is likely to develop between the veneers and
the gum.. The bump may create an irritation to the
gum, and may increase the chances for staining and tooth
decay.
26. The LUMINEERS
No-Prep Technique
allows LUMINEERS to be placed over the existing teeth without
the removal of any form of tooth structure.
Therefore, anesthesia and temporaries are also not required.
requires slight modification of the enamel but never touches dentin
during LUMINEERS placement. Only .3 mm-.5 mm enamel is
removed, causing no sensitivity for the patient and therefore no need
for any anesthesia.
The LUMINEERS Minimal
Contouring Technique
27. PREPARATION OF LUMINEERS
Clean the teeth with Porcelain Laminate
Polishing Paste and rinse.
Perform minimal enamelplasty with a
prep diamond bur, using light pressure.
–Use the whole length of the bur,
keeping contact with the teeth.
1. Polishing
2. Refresh the Enamel
28. Isolate the teeth receiving
LUMINEERS from the teeth not
receiving LUMINEERS by applying
Paint-On Dental Dam or placing
metal interdental strips in order to
prevent etchant from contacting
adjacent teeth.
1. Etch the teeth with Etch ‘N’ Seal®
for 20 seconds.
2. Rinse thoroughly with water, then dry.
3. Interdental Strips
4. Etching
29. 5. Bonding Application
1. Add 5 coats of Tenure® A+B.
2. Add 1 coat of Tenure S to the
teeth.
Note: Tooth surfaces must be shiny.
30. 6. Prime-Bonding on
LUMINEE RS
1. Add 1 coat of Tenure A+B on the
inner side of the LUMINEERS.
2. Add 1 coat of Tenure S on the
inner side of the LUMINEERS.
7. Ultra-Bond® Plus on LUMINEE RS
Add an even layer of Ultra-Bond® Plus
resin cement to the inner side of the
LUMINEERS. Work upwards from
incisal edge of the LUMINEERS to
gingival edge and keep light contact
with the LUMINEERS
31. 8. Insert the LUMITray
1. Remove the Paint-On Dental Dam or
interdental strips.
2. Center the LUMITray (midline).
3. Insert the tray in one smooth movement.
Apply light and continuous buccal pressure.
Take your time for the placement.
4. Remove excess Ultra-Bond Plus resin
cement from the gingiva with a microbrush.
32. 9. Cure LUMINEE RS Through
LUMITray
1. Tack-cure each tooth using a sweeping
movement.Set Light for 3 seconds.
2. Remove more excess cement with a
probe.
3. Light-cure each tooth for 3 seconds
through the tray.
33. 10. Clean-Up and Open
Interdental Spaces
1. Remove Ultra-Bond Plus cement from
interproximal spaces.Maintain complete control
over the
instrument. If difficult, postpone to follow-up visit.
2. Remove excess cement using the finishing
bur kit.
34. 11. Light-Cure the LUMINEE RS
Light-cure each LUMINEERS individually
for a second time, on both the lingual and
buccal sides, for 5 seconds with
Sapphire Light.
12. Check Occlusion and Polish
1. Check and finish the occlusion.
2. Polish the LUMINEERS with Porcelain
Laminate Polishing Paste.
