Ceramic Veneers and Root Coverage
The ideal situation for a clinician to bond bonding ceramic veneers is to bond them all on enamel. This, however, is not always the case and one often comes across Class V lesions or dentinal areas that need to be covered or bonded onto. This could be necessary for reasons of aesthetics, function, preservation of the tooth or a combination of these.
3 cases are here presented to suggest different modalities that one can employ to facilitate such coverage.
The author would like to thank MDT Lamberto Villani for the ceramic work in these cases.
A 52 year old male came complaining of some old crowns on upper incisors and upper right second premolar and also wanted to enhance aesthetics. Diagnosis and treatment planning led to the choice of a multiple restorations protocol. Home bleaching for 2 weeks was given to the patient.
TIP#1: once the Class V restorations are done the final curing cycle should be carried out with a water soluble oxygen blocking gel that eliminates the oxygen inhibition layer. This will otherwise interfere in the polymerization of the silicone impression material.
TIP#2: when temporary veneers are being cemented in such cases, usually using flowable composite, apply a thin layer of vaseline to these areas which have been restored to ensure that the composite layers do not bond to each other making it difficult to remove the temporary veneers on a later date.
A 50 year female with a fair bit of recession and multiple class V lesions, all of which were not restored. The patient wanted to improve the health of her teeth and her smile.
TIP#4: After placing the first thinner cord it is suggested not to prepare any more then the level of the gum tissue at this point even if the second cord suggests a further retraction.
A 42 year old female had existing veneers but was unhappy about the esthetics. She had a history of periodontal surgery a few years before, after which a clinician placed veneers for her. The central incisors were over 14mm long and tooth number 23 even longer.
TIP#5: texture is the most important element that make the restoration blend in with its surroundings and make restorations look lifer like. It was thereby decided to change the reflective index of the pink in the veneers using ceramic polishing rubbers (Shofu Co.)
The aim in contemporary dentistry is to be able to enhance aesthetics, conserve tooth tissue and also to improve function but by minimally compromise on healthy tooth tissue.
In the earlier times it was considered that one do a full coverage restoration if there was a fair bit of dentine exposed in any part of the tooth.
Now with bonding protocols and the understanding of tooth bonding improving it can be confidently suggested to seal the dentine with composite when it is being prepared and later bond on to it using the protocols suggested.
The author would like to thanks that team at The Dental Studio and MDT Lamberto Villani for their contribution.
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