6. Porcelain laminate veneers Flashcards
What is a laminate veneer?
Extracoronal partial-coverage single-tooth restoration made of porcelain
Characteristic of laminate veneers? (3)
- Highly esthetic
- highly conservative
- low geometrical retention
Why are laminate veneers highly esthetic?
- high translucency
- takes advantage of optical properties of the underlying dentin
Why are laminate veneers highly conservative? (4)
- Minimal preparation.
- Into enamel whenever possible.
- 0.3 – 0.5 mm thick.
- Excellent bond to enamel.
Laminate veneers: low geometrical retention?
- very low friction
- adhesive bond
When should we choose a laminate veneer?
When you need a maximal long-term esthetic results
What is needed to have laminate veneers? (2)
- healthy tooth structure
- minor color, shape or position alterations
What teeth will we use laminate veneers on?
Anterior teeth and premolars
What are the different materials you can use for laminate veneers? (3)
- Feldspatic porcelain
- e.max + veneering
- Monolithic e.max
When do you use feldspathic porcelin for laminate veneers? (4)
- max 2 shades of color alteration
- slight differences with color of the substrate
- no more than 2mm of lengthening of incisal border
- low mechanical load
When do you use E.max+veneering for laminate veneers? (4)
- 3 color shades modification or more
- non-homogenous color of the substrate
- more than 2mm lengthening of the incisal border
- bruxism, overbite, high mechanical load
When do you use monolithic e.max for laminate veneers?
When the mechanical needs are higher than esthetic ones
Indications of laminate veneers? (4)
- Color alterations
- shape and size alterations
- Position alterations
- to restore anterior guidance
What color alterations are an indication for laminate veneers? (4)
- Tetracycline stains.
- Dental fluorosis.
- Hypoplasia stains.
- Tooth resistant to bleaching.
What shape/size alterations are an indication for laminate veneers? (5)
- Microdontia / conoid teeth.
- Primary teeth.
- Tooth fractures.
- Broad cervical embrasures.
- Dental erosion
What position alterations are an indication for laminate veneers? (3)
- Diastemata
- Mild crowding
- Minor malpositions (e.g: rotations)
What are the tooth classifications for laminate veneers?
- Type I, II, III
What is a type I tooth for laminate veneers?
Whitening resistant teeth
What are the different types of type I tooth for laminate veneers?
A: grade II and IV discoloration from tetracycline
B: lack of response to external or internal bleaching
What are the different types of type II tooth for laminate veneers? (3)
A: conoid shape
B: Closing diasthemas and interdental triangles
C: Increasing length and incisal prominence
What is a type II tooth for laminate veneers?
Important morphological changes
What is a type III tooth for laminate veneers?
Extensive restorations (adults)
What are the different types of type III tooth for laminate veneers? (3)
A: Extensive coronal fractures
B: Extensive loss of enamel due to erosion and wear
C: Acquired and generalized malformations
What are the contraindications of laminate veneers? (6)
- Inadequate occlusion or position
- multiple restorations
- inadequate anatomy
- caries/bad hygiene
- untreated periodontal disease
- angle’s class II
Laminate veneer contraindication: what is included in inadequate occlusion or position ? (3)
- deep overbite
- parafunctional habits (bruxism)
- severe crowding
Laminate veneer contraindication: what is included in inadequate anatomy? (4)
- short clinical crown
- thin incisal portion of tooth
- highly triangular crowns
- little quantity of enamel
What is type I preparation for laminate veneers?
Only buccal
What is type II preparation for laminate veneers?
Buccal and incisal preparation
What is type III preparation for laminate veneers?
Buccal, incisal and lingual/palatal preparation
Characteristics of type I preparation? (4)
- The most conservative.
- Requires thick incisal edge.
- Allows less shape change.
- Less toughness -> more fractures.
Characteristics of type II preparation? (4)
- Thicker at the incisal edge.
- Tougher.
- Allow greater shape changes.
- same toughness as type III.
Characteristics of type III preparation? (4)
- Increases support of incisal porcelain.
- Tougher under horizontal forces.
- Increased retention and stability.
- Increases adhesion surface.
Which preparation type for laminate veneers considered more adequate?
II
Which preparation type for laminate veneers is advised against?
III
What material is used for palatal veneers?
LDS
Thickness of palatal LDS laminate veneers?
0.8-1mm thickness
Con’s of palatal LDS laminate veneers?
erosion or attrition
When do you use palatal LDS laminate veneers? (2)
- When avoiding placing a full coverage crown
- Re-establish occlusal schemes
General characteristics of preparation of laminate veneers? (3)
• Over enamel whenever possible, especially at the margin—
Better adhesion and less marginal leakage.
• Always conditioned by the diagnostic wax-up.
What is the reduction for a laminate veneer? (2)
- 2/3 incisally: 0.5m
- 1/3 gingivally: 0.8mm
What is the guiding grooves size for laminate veneers?
Special bur with 1.6-2mm depth
How do you prepare laminate veneers buccally?
- 856 bur
- deep chamfer, chamfer or rounded shoulder
- finish line 0.3mm deep
What should the height of the finish line be for buccal laminate veneer prep?
- yuxtagingival
- slightly gingival
Proximal preparation of laminate veneers ?
FL should end far from visible areas
Incisal preparation of laminate veneers?
1.5-2mm
high stress area
In which tooth will a type III prep for laminate veneers sometimes be needed?
lower incisors
Lingual prep of laminate veneers? (4)
- Round tapered bur
- Thickness of 0.5mm
- Located in the Incisal third
- Continuity with the interproximal preparation.
How is the finish of the prep for laminate veneers? (2)
- Remove edges/angles.
* Open contact points with polishing strips
What is the required volume for E max LDS monolithic pressed laminate veneers?
0.3mm
What is the required volume for E max LDS monolithic milled laminate veneers?
0.4mm
What is the required volume for E max LDS veneered over press / CAD laminate veneers?
0.7mm
What is important to remember about the thickness of Emax LDS laminate veneers?
Thickness of the veneered ceramic cannot exceed the
thickness of the core
What situations do you vary from the standard preparation of laminate veneers? (4)
- Dark tooth color
- Malpositioned teeth
- premolars
- diastema
How do you prepare a laminate veneer for a dark tooth color? (2)
- 0.4-0.5mm gingival 1/3
- 0.6-0.7 mm preparation incisal 2/3
What is the purpose of the wax up for laminate veneers? (3)
- Mock up
- Silicone guides
- Direct provisional
What does a silicone guide do for laminate veneers?
Helps measure and visualize the amount of tooth structure we need to remove
Uses of silicone guides in laminate veneers? (3)
- mock up
- preparation guide
- prep of temp veneers
How are the margins cut for preparation silicone guides in laminate veneers?
With a blade to create the key that will be used for the temporary veneers to
help the material flow or for the mock-up
What is the first generation way of guiding the tooth preparation?
Fissure guiding burs
What is the second generation way of guiding the tooth preparation?
Silicon key guide
What is the third generation way of guiding the tooth preparation?
Aesthetic Pre-evaluative
Temporary (APT)
Technique
What is the fourth generation way of guiding the tooth preparation?
First Fit
Digital guides for
the preparation
and cementation
Do we need a retraction cord for laminate veneer impressions?
Yes, double retraction cord
How do we use the double retraction cord? (2)
- second cord removed right before taking the impression
- first chord stays in gingival sulcus
Why do we use a double retraction cord?
Create a better access and
reproduction of the FL
How do you do the single step impression for laminate veneers?
Taken with PVS: light body : putty silicone in one step
What is PVS?
an addition silicone
How do you take the two step impression for laminate veneers?
- putty silicone impression
2. light body silicon impression over the previous impression
Why are provisionals for laminate veneers complicated? (2)
- low retention of provisional
- low adjustment
Why are provisionals not always necessary in laminate veneers?
- preparations are over enamel
- asethetics are unaffected
What are the types of provisionals for laminate veneers? (3)
- Resin composite direct provisional.
- Acrylic resin direct provisional.
- Acrylic resin indirect provisional.
Lab procedure of laminate veneers: cast? (2)
- Master cast is duplicated with investment material.
* Individualization of dies.
Lab procedure of laminate veneers: porcelain layering?
- from inside to outside
- different opacities to cover underlying color
- 2-3 firings and glazings
Lab procedure of laminate veneers: IPS e.max veneers ?
- Lost-wax or CAD/CAM.
- Lithium disilicate copings.
- Allows acid etching.
- Feldspathic veneering porcelain.
Laminate veneers: verification? (5)
- Individual fit.
- Collective fit (contact points).
- Color verification (modification if needed).
- Use Try-in pastes or Glycerine.
- General appearance.
What are the types of materials you can use for laminate veneers? (3)
- Feldspathic
- High leucite
- Lithium disilicate
What does the final shade of laminate veneers depend on?
Cement
List the surfaces from tooth to veneer in laminate veneers (6)
- etched enamel surface
- dentin-enamel adhesive
- composite luting agent
- dentin-enamel adhesive
- silane coupling agent
- etched porcelain veneer
Laminate veneer post operative instructions: 24-72 hours (4)
- avoid alcohol
- avoid hard food
- avoid foods that can stain
- careful mastication
When should check ups be for laminate veneers?
Every 6 months
Maintenance for laminate veneers? (4)
- Avoid flour-rich substances.
- Avoid parafunctional habits.
- Mouthguard for sporty people.
- Night mouthguard
What is considered a failure of a laminate veneer? (4)
- Fractures.
- Marginal leakage.
- Loss of cementation.
- Gingivitis.
