Ceramic Veneers Flashcards
What to consider/ask if the pt does not like the appearance of their teeth?
What do you not like How long have you had this problem Why has it occurred Has it improved or worsened How would you like your appearance altered Look and listen to your pt
Why listen to your pt?
Assessment of the type of pt to understand how the appearance is affecting their life
Cause may be preventible - avoiding extensive tx
Explanation of the cause leads to the reassurance of pt and increased confidence in dentist
What to consider before veneers?
Alternative treatments
- Ortho, crowns, implants, surgery
Pre-tx - bleaching, crown lengthening, restoration replacement
Which veneer prep
What is a veneer?
Layer of tooth coloured material applied to a tooth to restore localised or generalised defects and intrinsic discolourations
Improves shape, colour, position
Thin facing fabricated either by ceramic or composite material - hence bleaching may be needed as it’s very thin
Most conservative and aesthetically pleasing direct or indirect restoration
Indications for veneers?
Colour defects or abnormalities - amelogenesis imperfecta, medication, fluorosis, age, trauma
Abnormalities of shape - microdontia, atypical tooth shape, malformed incisor
Abnormal structure or texture - dysplasia, erosion, coronal fracture
Malpositioning - rotated teeth
Diastema
Missing teeth - lateral with canine in lateral position
Lingual laminate veneers - correct anterior guidance, create canine guidance, palatal erosion
Lengthening - proportions
Venner contraindications?
Insufficient surface enamel
Pulpless teeth, fragile teeth
Unsuitable occlusion - pronounced overbite
Parafunction - nail biting, bruxism
Unsuitable anatomical morphology e..g crown too small
Single laminate veneers difficult to match with neighbouring teeth (esp if discoloured)
Heavily restored dentition - caries and fillings with poor OH
What to consider in the exam/assessment for veneers?
The problem The pt OH Teeth in question Quality and quality of enamel Occlusion
What can the causative factors of aesthetic problems be?
Hereditary
Systemic
Traumatic - TSL
Parafunction
What to consider with tx planning for veneers?
OHI, caries, failed restorations
Perio status
Endodontic status
Smile analysis
Occlusal analysis - centric, protrusive, lateral
Must not coincide with veneer margins
Placement of margins on occlusal marks will cause resin to wear and unsupported ceramic to fracture and chip
Diagnostic wax up Direct placement of composite resin - NO etch/bond Temp composite resin restorations Diagnostic wax up + matrix + protemp Resin composite shell or overlay on diagnostic cast - place intraorally Computer imaging Demonstration models Photography
What to analyse with the face for veneers?
Shape of face, lips, maxillary and mandibular lip lines
Skin colour - veneers that look bright and high in value against tanned skin will look more yellow and lower in value in lighter skin
What to analyse with the smile?
View from front and sides
Shape of face
Size of lips
Visible coronal and gingival levels - at rest, talking, broad smile
Harmony and proportion of cervical line, of line of incisal edges and of lip line
Tooth colour - hue, value, chroma, translucency, texture and luster
Tooth shape - size, incisal edges, contour, assessing triangular tooth shape
Analysis of static and dynamic occlusion - centric (intercuspal), protrusive, left and right excursions
Spatial arrangement of teeth
What must occlusal movements (articulating paper) NOT coincide with? Why?
Occlusal movements must not coincide with veneer margins
Can cause resin to wear and the unsupported ceramic to chip and break
What to discuss with the pt regarding all the possible tx options?
Advantages and disadvantages
Maintenance
Informed consent - post op sensitivity, marginal discolouration, fracture, debonding
Short and long term maintenance
Financial implications
Do not make decision at first appointment
