Veneers and Bleaching Flashcards
indications for veneers
aesthetic improvement
change tooth shape/colour
correct peg laterals
space and diastema closure
align labial surfaces of teeth
basic principles of veneers
caries removal
keep as much sound tooth tissue as possible
maintain pulpal and periodontal health
restore form and function
longevity
aesthetics
occlusal stability
must be cleanable
types of veneers, and options for materials
palatal
- porcelain
- lithium disilicate
- composite
- zirconia
- gold
- nickel-chromium
buccal
- porcelain
- lithium distillate
- composite
- zirconia
palatal veneers - uses
tooth wear
- erosion
increasing OVD
Dahl approach
buccal/labial veneer contraindications
uncontrolled caries and periodontal disease
poor oral hygiene
excessive spacing
severe malocclusions
- malpositioned teeth
bruxism
insufficient enamel
severe discolouration
buccal veneers advantages
satisfies most people’s aesthetic demands
minimally invasive
downsides of buccal/labial veneers
higher failure rate if involves dentine or other restorations
lute and leakage
cyclical replacement
technique sensitive
labial/buccal veneers - cases to take additional care with
lower incisors
gingival recession
root exposure
high smile lines
heavy occlusal contacts previous failed veneers
veneers - planning and consent
provide information on risks
- consider mock up in pro temp or composite
- consider diagnostic wax ups
- alternatives - no treatment, bleaching, micro abrasion, crows, direct composite etc
- expectations
- smile lines
- consider the daughter test
tooth prep options for buccal porcelain venner
indications for external bleaching
age related darkening/discolouration
mild fluorosis
post smoking cessation
tetracycline staining
bleaching - warnings for patient
sensitivity
relapse and retreatment
restoration colour
allergy
might not work or only work partially
compliance with regime
internal non-vital bleaching indications
non vital tooth
adequate RCT
no apical pathology
internal bleaching contraindications
heavily restored tooth
better with crown or veneer
staining due to amalgam
internal non vital bleaching limitations
doesn’t always work, or may only partially work
internal non-vital bleaching advantages
conserves tooth tissue
patient satisfaction
internal non vital bleaching potential complications
external cervical resorption
combination bleaching for non vital teeth (inside out bleaching) - outline steps
make bleaching tray with a palatal reservoir
bleach placed in access cavity and in tray
replaced frequently over about a week
combination bleaching - downsides
difficulty for patient
- tray must be worn the whole time
bleaching medico-legal issues
whitening products can only be sold by dental practitioners
1st cycle of treatment must be supervised
concentrations exceeding 6% hydrogen peroxide (10% carbamide peroxide) are prohibited
- unless wholly for the purpose or prevention of disease
