porcelain laminate veneers taylor

8/7/2019 Porcelain Laminate Veneers Taylor

http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 1/41

Porcelain Laminate Veneers Porcelain Laminate Veneers

Peter A. Taylor BSc, DDS, Oakville, Ontario



¶A captivating smile showing an even row of natural,

gleaming white teeth is a major factor in achievingthat elusive dominant characteristic known aspersonality.·

Dr. Charles Pincus, 1938

Historical Perspective



Fea tur es of PLV·s

Advant agesAdvant ages

ColourBond StrengthPeriodontal HealthResistance to AbrasionInherent StrengthResistance to Fluid

AbsorptionEsthetics

Di sadvan t agesDi sadvan t ages

TimeRepairTechnique-sensitiveColourTooth PreparationFragility

Cost



Diastema Closure

Malpositioned Teeth



Malocclusion

Worn Restorations



Aging

Wear Patterns



Agenesis of the Lateral Incisor



Porcelain Materials for Veneers

Pressable CeramicsPressable Ceramics

eg. Empress 2high equipment costshigh strength

many indications

Feldspathic PorcelainFeldspathic Porcelain

highly estheticconservative preparation0.3 mm thickness possible



PRINCIPLE

The long-term preservation of the tooth²restorationcomplex.- requires the achievement of a sufficient ceramicthickness to provide the restoration with some intrinsicmechanical resistance.

-recommended thickness:

cervical < 0.3-0.5mmmiddle & incisal thirds 0.7mmincisal coverage 1.5mm

Pascal et al. 2004



ToothTooth--Preparation StrategiesPreparation Strategies

1. Driven by the existing tooth surface.



2. Driven by the final volume of the preparation



1. Preparation Driven by Existing Tooth Surface1. Preparation Driven by Existing Tooth Surface

- goal is to remove a uniform layer of the toothstructure

- using burs with calibrated diamond rings- reduced diagnostic steps- intrinsic principle is the reproduction of the initialsituation( form and function)- can lead to dentin exposure- cases are rare and typically involve patients withdiscolored teeth



Existing Tooth SurfaceExisting Tooth Surface



2. Preparation Driven by Final Volume of Restoration2. Preparation Driven by Final Volume of Restoration

-diagnostic approach that requires a high level of

communication with the dental laboratory- aim is to restore the original volume of the tooth- cases include patients with thin enamel or alteredtooth shape- diagnostic wax-up mandatory- saves hard tooth structure as well as the criticaldentin- enamel junction- key: well-adapted horizontally sectioned siliconeindex from an additive wax-up



Final Volume of RestorationFinal Volume of Restoration

Step 1- Preliminary restorative goal



Step 2- Fabrication of corresponding acrylic template inthe patients mouth using self-curing resin( Lang DentalManufacturing, Wheeling, ILL) molded to the existingtooth surfaces with the silicone matrix.



Step 3- Conformity with the lower lip contour is ofparamount importance in esthetic evaluation in 1 or 2

weeks



Step 4- Critical step of facial reduction is assisted by

two round diamond burs

2.5mm 2.9mm



-DC 0.7 shaft is placed against the incisal third of thefacial surface- a single horizontal groove is obtained and marked witha pencil



-DC 0.5 shaft is placed against the junction of thecervical and middle third of the facial surface andscalloped

- mark with pencil



Step 5 - Remaining part of mock-up is removed followedby the use of traditional burs until the pencil marks arecompletely removed

- Round-ended, slightly tapered burs at rightangle to the initial reduction grooves



Step 6- A horizontally sectioned silicone index is used toevaluate facial clearance; a palatal index is used toassess the 1.5mm incisal clearance



Step 7- Finishing procedures include a slight proximalseparation with disks, round transition line angles withfinishing diamonds, and lastly seal dentin with

adhesive(eg. Clearfil LB2, Clinical Research, London, Ont).



Step 7- Fi nal impr ess io ns are made with appropriatesoft-tissue protocol using desired impression material.Tem poriz atio n may be completed intra-orally with thesame principles used for the mock-up with self-curingresin.

- Alt erna ti vely, a clear impression( ClearlyAffinity, Clinicians Choice, New Milford, Conn) is made ofthe wax-up.



- Spot etch if less than four preps. Lubricate lingual andsoft-tissue with a thin film of pet role um jelly. Syringef lowable c omposit e( INTRO, Clinical Research, London,Ont) directly into the facial/internal aspect of the matrixbeginning with the incisal.



- Gently place the matrix over the prepared teeth.Light-cure each preparation from the facial aspect 5seconds and remove matrix.



- Excess may be easily removed with a bladed instrument.Li ght-cu re again for 20 seconds facial and inciso-lingualareas. Polish with Enhance cups(Dentsply, 624055X) anddisks followed by Green r ubber cups(Vivadent, Size C,D).



Insertion ProtocolInsertion Protocol1. Remove temporary and thoroughly cleanse the teeth.2. Check for individual fit (passively). Microfine

diamond bur at undercuts and contact points.3. Collective fit try-in.4. Assessment of contour and colour. Initially wet only,

then using water soluble shade modifiers if required.5. Veneer placement procedure(with rubber dam):i) T issue management - lightly place #00 cord

ii) Seating sequence - central incisors individuallyfirst, laterals, and so on.iii) C hemical treatment - veneer:etch 37%phosphoric acid, rinse then silanate to enhanceadhesion for 30 sec; prep: etch, prime andcure(20sec), bond resin(uncured) air thinned.



iv) Lig ht or dual-cured cement - gently pulsate veneerwith luting cement into position with dead-soft matrixstrips separating contact points; wipe excess with abrush; spot cure for 3-5 sec on facial and remove grossexcess with sharp carving instrument.



v) F inis hing - only once all veneers are in place and havebeen cured 40 sec each surface. Carbide finishingburs(ET6014, H379M018 Brasseler) gently placed atthe gingival and lingual margins), Enhance cup, porcelainpolishing cups(K000010, Brassseler) and metal finishingstrips(Compo-strips 100UF/F, Premier) are all used tocomplete the seating.



Esthetic ConsiderationsEsthetic Considerations1. MidlineMidline- located in the center of the face, perpendicular

to the interpupillary line.



2. Incisal LengthIncisal Length- maxillary central incisors are the mostimportant determinant in the creation of a smile;maximum length is 70% of the distance between theupper and lower lips.



3. Gingival EmbrasuresGingival Embrasures- reduce in volume in a posteriordirection.



4. Gingival ContoursGingival Contours- nicely scalloped with the lateralcrest inferior to central and cuspid.



5. Incisal EmbrasuresIncisal Embrasures- become larger and widerposteriorly.



6. MaxillaryMaxillary Incisal Edge ContourIncisal Edge Contour- follows the curvatureof the lower lip.



Fi nal C onsi dera ti onsFi nal C onsi dera ti ons

- ti me: 2u/veneer(minimum 2 veneers) at prep & insertappt.- longev it y: 5-15 yrs depending on O.H., maintenance, andhabits.- spli nt t hera py: highly recommended.- ex per ti se : 2-3 yrs.

- f ees : 90-95% of full coverage equivalent.



Thank-You

Peter A. Taylor DDS, Oakville, [email protected]

porcelain laminate veneers taylor

Documents