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Fixed Pros > Veneers > Flashcards

Veneers Flashcards

1
Q

What burs are used for veneers?

A

Depth cutting burs (e.g. Komet 834)

Technik 856

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2
Q

What are the steps in prepping a veneer?

A
  1. Use Komet 834 depth cut bur to reduce labial surface by 0.5mm (thickness of cement + veneer generally add to 0.5mm) (0.3mm burs also available)
  2. Reduce incisal surface by 1.5mm using technik 856 (may do 1-1.3mm initially to allow for polishing), nb: thickness of end of bur is about 1mm
  3. Use technik 856 to reduce labial surface in two planes, extend to near proximal area and follow gingival contour (nb: in clinical situation would take margin JUST under gingival tissue, but no deeper (2mm is too far subgingival and cause permanent inflammation))
  4. Extend the gingival margin further interpoximally so that when looking at tooth distally + mesially while it is in the arch should see finishing margin not a triangle of unprepped tooth structure towards the gingiva)
  5. Define the margin with the intermediate speed technik 856 (creating 0.5mm chamfer) and use komet 8877 to take prep to the contact point (basically similar princinple to breaking through contact with L10 BUT not going all the way through this time, only reach contact area)

*DO not bevel joint between incisal and palatal, leave it as a butt finish to allow for thickness of material

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3
Q

What is a shell crown?

A

-Basically a relatively conservative crown on anterior teeth made of ceramic (basically a ceramic veneer extending around the entire tooth)

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4
Q

How do you do a shell crown prep?

A
  1. Prepare the labial the same way as preparing a veneer
  2. Open the contacts with an L10 bur
  3. Create 0.5mm fine chamfer margin interproximally with 8877
  4. Create 0.5mm fine chamfer margin on the lingual cingulum area (gingival 1/3) with 8877
  5. Take 0.5mm off concave area on the lingual (incisal 2/3) with high speed F40 and Horicon 239
  6. Smooth over preparation with technik 856 and round all angles (including the butt finish from the veneer prep)

*NB: can not have sharp edges with ceramic preps

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5
Q

How can preps be rounded?

A

Angle bur 45 degrees to the sharp edge and reduce slightly

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6
Q

How do you cement a veneer or shell crown?

A

Acid etch enamel
Bonding resin
Resin cement
Veneer

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7
Q

What are veneer failures associated with?

A

Aesthetics
Mechanical complications (increased by parafunction)
Periodontal support
Loss of retention (increased when bonded to retained restorations, not bonded to enamel)
Caries
Tooth fracture

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8
Q

What material is used in veneers/

A

Feldspathic glass, may have leucite filler

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9
Q

What are the factors that determine successful treatment?

A
  • Good case selection
  • Thorough treatment plan
  • Communication, verification of pt satsifaction
  • Properties and limitations of materials
  • Good clinical technique (tooth prep/impressions, cementation)
  • Good lab technique
  • Recall and maintenance
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10
Q

What are the indications for veneers?

A
  • Diastema closure
  • Alter tooth shape, colour, contour, position of tooth
  • Mask tooth surface anomalies (e.g. tetracycline, hypo/hyperplasia)
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11
Q

What are the advantages of veneers?

A
  • Excellent aesthetics
  • Alloy free
  • Good clinical record especially with porcelain veneers
  • Conservative restoration
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12
Q

What are some limitations of veneers?

A
  • Covering dark stains
  • Correcting severe malpositions/angulations
  • Fragile
  • Post insertion sensitivity
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13
Q

What are the rules to follow when preparing a veneer prep?

A
  • Keep in enamel
  • Margin must be at gingival crest or subgingival
  • Proximal extensions must be present
  • Do the correct reductions
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14
Q

What should you do if you hit dentine while doing a veneer prep?

A

-Convert it to a crown

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15
Q

What impression technique should be used?

A
  • Apply adhesive to tray
  • Extrude light body around tooth
  • Extrude heavy body into tray
  • Insert tray and allow to set
  • Remove tray
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16
Q

What are some things to consider when temporising veneers?

A
  • Tend to debond
  • Tooth sensitivity could be an issue
  • Use resin based or eugenol free cement
17
Q

What are some common causes for marginal leakage under temporary veneers?

A
  • Poorly fitting temporaries
  • INadequate cement seal
  • Long term temporisation
  • Smoking, coffee, tea, food
18
Q

What temporary cement should be used to cement temp veneers and why?

A

Tempbond clear: colour does not show up beneath veneer (note difficult to remove excess)

19
Q

What cement should be used to cement permanent veneers?

A
  • Nexus III

- RelyX Veneer

20
Q

What are the steps to cementing a permanent veneer?

A
  • Ask patient about tooth sensitivity
  • Check veneer for chipping and fit on master die
  • Clean tooth surface
  • Seat veneer and check contact, contour, shape and shade of veneer and fit as well; check patient satisfaction
  • Prepare veneer and tooth surface for bonding and cement with resin cement as per manufacturer instruction

*Can suggest patient bring someone else at consult to help assess veneer

21
Q

How should the tooth surface be prepared to bond with veneer?

How should Sinfony veneers be prepared prior to bonding?

How should porcelain veneers be prepared prior to bonding?

A 
Tooth
Etch 15 seconds
Wash
Gently dry
Optibond Solo Plus for 15 seconds and air dry for 3 seconds
Light cure 20 seconds

Sinfony (resin):
Sandblast with rocatec soft
Apply silane
Gently air dry

Porcelain

  • Etch with 9.5% HF acid
  • Rinse with water
  • Apply silane
  • Gently air dry
22
Q

How is the veneer cemented after preparation is done?

A

-Apply cement to veneer
-Seat
-Light cure 40 seconds
(Varies e.g. light cure time according to the different type of cement, but more or less follows these steps)

23
Q

How should the final veneer be polished after cementation?

A
  • Diamond polishing paste

- Applied with rubber cup in slow speed

24
Q

What are some possible veneer failures? What can cause them?

A

Incisal chipping

  • Trauma
  • Parafunction
  • Fabrication defect
  • Insufficient reduction
  • Binding of veneer during cementation

Fracture:

  • Fabrication defect
  • Insufficient tooth reduction
  • Trauma
  • Parafunction
  • Binding of veneer during cementation
  • Incorrect handling
  • Binding of veneer during trial fitting

Attachment loss

  • Trauma
  • Parafunction
  • Poor enamel quality
  • Cementation flaw (incorrect mixing, premature setting, incorrect tooth conditioning)

Marginal leakage

  • Poor marginal fit
  • Incorrect cementation
  • Marginal contaimination
  • No enamel margin
  • Poor oral care/cervical plaque deposit

Periodontal problems

  • Poor oral care
  • Encroach biological width
  • Overcontoured cervical margin
  • Cement overhang
  • Marginal opening

Gingival recession

  • Overeruption
  • Encroach biological width
  • Cervical fracture/incisal wear
  • Fabrication defect
  • INsufficeint reduction
  • Trauma
  • Parafunction
  • Poor adhesion
  • Binding of veneer during cementation
25
Q

How do you repair a veneer?

A
  • Isolate with RD
  • Bevel margin with HS diamond

Etch stage

  • Etch porcelain with 10% HF acid
  • Wash carefully and dry
  • Etch enamel and dentine
  • Wash and dry

Adhesive stage

  • Apply silane primer to porcelain + chip
  • Wait 60 seconds
  • Apply Optibond Solo Plus to tooth and porcelain margin and LC

Cement stage

  • Apply cement to fractured piece and seat and LC
  • Recontour and polish
26
Q

What is the survival rate of porcelain (feldspathic) veneers according to Layton’s paper?

A 
96% +/- 1% at 5 to 6 years
93% +/- 2% at 10 to 11 years
91% +/- 3% at 12 to 13 years
73% +/- 16% at 15 to 16 years 
(Note that 15 to 16 years results may have been skewed due to small sample size and death of 5 patients who otherwise had a high chance of success but were discounted)
(+/- is the standard error)
27
Q

What were the main reasons for failure of veneers according to Layton’s paper?

A 
Aesthetics (31%)
Mechanical complications (31%)
Periodontal support (12.5%)
Loss of retention (12.5%)
Caries (6%)
Tooth fracture (6%)
28
Q

What differences need to be made in preps between feldspathic and leucite reinforced feldspathic veneers?

A
  • Feldapathic can be formed into thinner sections (0.3-0.5mm)
  • Leucite reinforced requires more reduction (0.6-0.8mm)
29
Q

What features should you consider for a veneer to be appropriate?

A
  • Not lost more than 1/3 of incisal edge
  • Sufficient enamel substructure
  • Not have a high parafunctional risk
30
Q

Should a retraction cord be used during the cementation procedure and why?

A
  • No

- It results in etched and uncovered cementum beyond the CEJ==>tooth sensitivity

Fixed Pros (20 decks)

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