Veneers Flashcards
Understand the aesthetic considerations and restrictions of different cases Understand the process of aesthetic treatment planning Learn about the different types of laminate veneers Learn about the different fabrication techniques and materials
What is a veneer?
Purpose of veneer
Layer of tooth coloured material fabricated by ceramic or composite material
Restore localised or generalised defects and intrinsic discolouration
Improve shape, colour and position
Indications for veneers
Colour defects/abnormalities e.g AI
Abnormalities of shape or structure
Malpositioning
Diastema
Missing teeth e.g masking canine as lateral
Lingual laminate veneers to correct guidance
Lengthening
Contraindications for veneers
Insufficient surface enamel for etching and bonding Pulpless/fragile teeth - may change colour Unsuitable occlusion Parafunction Unsuitable anatomy Single veneers - very hard to match Heavily restored dentition Poor OH
Examination and assessment criteria
Problem Patient's opinion OH Teeth involved Quality and quantity of enamel Occlusion?
Tx planning
Full history Determine causative factors e.g hereditary AI OHI Caries PD status Endodontic status
Facial assessment
Shape of face, lips, maxillary, mandibular lip lines
Skin colour - changes
Smile analysis
View from front and sides
Size of lips
Visible coronal and gingival levels
Tooth colour - things to consider
Hue Value Chroma Translucency Texture and lustre
tooth shape
Size - height : width
Incisal edge
Contour of buccal surface
Assess triangular tooth shape
Occlusion
Placement of margins on occlusal marks will cause resin to wear and chip away
Demonstrate the proposed aesthetic changes before and after
Wax up Direct placement w'out etch/bond Temp composite resin restorations Wax up and matrix and protemp Resin composite shell/overlay on diagnostic cast CAD Demo models Photography
Evaluate and discuss
Adv and Disadv of each option
Informed consent - post op sensitivity, marginal discolouration, fracture, debonding
Short and long term maintenance
Financial issues
Veneer prep depends on
Method of fabrication Occlusion Desired aesthetics Parafunction Presence of enamel
Veneer can be made of
Resin
Porcelain ceramic
Resin/Direct composite veneer - indications
Extensive damage to incisal/buccal surface
Defective restoration
Discolouration
Malaligned or mishapen teeth
Lack of taime or finances
Where indirect would require excessive prep
Contrindications to direct composite veneer
Inability to obtain correct shades Inability to achieve correct contour Inability to achieve correct surface characteristics Inability to isolate Time consuming if multiple teeth
Advantages of direct CV
Little/no tooth prep
Many wear similar to natural tooth - no iatrogenic wear of opposing teeth
Chairside repairs
Can be altered
Disadvantages of direct
Colour stability - take on stains
Result not as long lasting as porcelain alternative
Not as strong as ceramic
Wears more compared to ceramic
Technique for direct
made chairside
Uses colour modifiers
Resin composites/microfilled/hybrid
Consider minor preparation if build up will change lip line
Longevity of Composite veneers
Fx survival 100%
Overall survival rate 84.6% after 5 years
Indirect technique of COMPOSITE
Minimal prep
0.25-0.5mm tooth reduction if needed
Resin cement
Bonding procedure similar to porcelain veneers
Advantages of indirect over direct
Less polymerisation shrinkage
Less leakage and staining and sensitivity
Physical properties of composite found to improve with more curing
Better control over contacts and contours
Less technique sensitive
Porcelain veneers - 4 components - ESSENTIAL
Porcelain veneer
Acid-etched enamel surface
Silane coupling agent
Resin cement
Advantages of porcelain veneer
Aesthetics Durability Strength Marginal integrity Soft tissue compatibility Minimal tooth reduction
Disadvantages of porcelain veneers
Time consuming Fragile Difficult to repair Colour matching can be a challenge Irreversible Inability to trial cement the restoration
Porcelain glass ceramics
Disilicate
Glass reinforced
Veneer considerations
If not prepping?
To prep?
If not prepping - reversible, painless, overcontoured, bulky, hygiene, inflammation?
Advantages of prep
Stress concentration is less
Prep removes aprismatic and hypermineralised enamel which is more resistant to etch
Aim for prep to be completely in enamel to maximise bond strength
Tooth prep measurements
Minimal 0.3 - 0.5 mm mini chamfer 0.6-0.8 incisal buccal reduction Facial reduction in 2 planes Special bur kits
Types of prep - how to accomodate for occlusive force
More prep so provide more ceramic bulk
Preparation types
Window prep - short of incisal edge
Long bevel - thin incisal edge
Complete coverage
Extension of prep over incisal edge
- increases strength
Temporisation - important factors
Aesthetics
Reduced sensitivity
Types of temp
Direct composite with spot etching
Chairside - diagnostic wax up
Cementation - fx
Shared part of applied loading stresses
Luting agent for light cured composite
Try in stage - purpose - using what
Resin luting agent
Assess fit and aesthetics
Try in paste
Preparing veneer
Trreat surface with HP
Clean and remove
Veneer cementation
Must be held in two planes
Resin spaces are caused by
Incorrect luting
Incorrect seating
Failures
Fracture due to occlusion, PF, bonding to existing restoration
Microleakage/marginal staining
Debonding
3 types of veneer fracture
Static
Cohesive
Adhesive
Static fracture
and cause
Segment of veneer fragments but remains in place
XS load –> loss of fragment
Cohesive fracture
and cause
Within body of porcelain
Tensile loads from XS functional loading
Results in fracture
Adhesive fracture
and cause
Failing of bonding interface
Due to weak bond or severe occlusal loading
Debonded veneer
Determine which interface has failed
If luting agent is still present on TOOTH - etching was inadequate
If luting agent still present on VENEER - problem with bonding/placement/bonding substrate
