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

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.

13.  YOUNG TEETH AND OLD TEETH
 ANATOMICAL FEATURES

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

21. Lengthening of tooth
Incisal defect
Facilitates seating of veneer
Lower anteriors not veneered

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

41. Modeling MB5 Contour Guide

42.  Unesthetic facial portion of metal
restoration
 No.2 carbide bur
 Mechanical retention in no.1/4
bur- 0.25mm
 4-META

43. Always place centrals,
then laterals, and so on

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