Veneers and Bleaching

Question 1

indications for veneers

Answer 1

aesthetic improvement
change tooth shape/colour
correct peg laterals
space and diastema closure
align labial surfaces of teeth

Question 2

basic principles of veneers

Answer 2

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

Question 3

types of veneers, and options for materials

Answer 3

palatal
- porcelain
- lithium disilicate
- composite
- zirconia
- gold
- nickel-chromium

buccal
- porcelain
- lithium distillate
- composite
- zirconia

Question 4

palatal veneers - uses

Answer 4

tooth wear
- erosion
increasing OVD
Dahl approach

Question 5

buccal/labial veneer contraindications

Answer 5

uncontrolled caries and periodontal disease
poor oral hygiene
excessive spacing
severe malocclusions
- malpositioned teeth
bruxism
insufficient enamel
severe discolouration

Question 6

labial/buccal veneers - cases to take additional care with

Answer 6

lower incisors
gingival recession
root exposure
high smile lines
heavy occlusal contacts previous failed veneers

Question 7

veneers - planning and consent

Answer 7

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

Question 8

indications for external bleaching

Answer 8

age related darkening/discolouration
mild fluorosis
post smoking cessation
tetracycline staining

Question 9

bleaching - warnings for patient

Answer 9

sensitivity
relapse and retreatment
restoration colour
allergy
might not work or only work partially
compliance with regime

Question 10

internal non-vital bleaching indications

Answer 10

non vital tooth
adequate RCT
no apical pathology

Question 11

internal bleaching contraindications

Answer 11

heavily restored tooth
better with crown or veneer
staining due to amalgam

Question 12

combination bleaching for non vital teeth (inside out bleaching) - outline steps

Answer 12

make bleaching tray with a palatal reservoir
bleach placed in access cavity and in tray
replaced frequently over about a week

Question 13

combination bleaching - downsides

Answer 13

difficulty for patient
- tray must be worn the whole time

Question 14

bleaching medico-legal issues

Answer 14

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