Many applications for ceramic veneers are related to esthetics, such as diastema closure, changing color and forms. Traditional approach for creating the veneers is to prepare teeth in order to give enough space for the ceramist to do his( her) work, even with interdental preparation in case of diastemas, but in some cases where the color is good and there is only the need to change the form and the shape, tooth reduction can be avoided in order to not to harm the sound tissues of teeth but only to bond on tooth surface.
Fig.1
A 34 year old female patient presented complaining of the diastemata in her lower front teeth, and asking to have her teeth aesthetically corrected without orthodontic treatment. She has healthy teeth with no caries or periodontal disease.
No functional problems.
Fig.2
A mock-up was done on a waxed-up model, and then transferred and evaluated in the patient’s mouth, for both dentist and dental technician to decide:
1) if a no-prep approach was a viable option for veneers in this case
2) if this approach would satisfy the patient’s aesthetic expectations
Fig.3
With a no-prep technique, taking the impression is easy, we just needed the first retraction cord (Ultrapak #000, Ultradent).
Fig.4
Then the second retraction cord Ultrapak #0. All cords were placed only in interdental areas.
Fig.5
Our dental technician fabricated the Geller model.
Fig.6
Veneers were fabricated using the platinum foil technique.
Fig.7
The most difficult part is to bond the veneers, because they are ultra thin, to the extent of a 0.1-0.2 mm thickness in some areas. Both dentist and dental technician should be very careful not to break the veneers.
Fig.8
After isolating properly, the teeth were etched.
Fig.9
The first veneer was bonded on tooth 42.
Video
With the micro brash and the flowable composite is easier to handle the ultrathin veneers. If the inter proximal contact is too tight and does not allow the veneer to fully seat we can use the Sof-Lex Finishing Strips 3M to make the contact less tight.
Fig.10
The veneer on tooth 41 in place.
Fig.11
We did the same whit teeth 31 and 32.
Fig.12
Immediately after the bonding of the veneers.
Fig.13
Incisal view.
Fig.14
Lingual view of the veneers and proximal contacts.
Fig.15
Two years follow-up picture demonstrates no marginal staining and stable functional and aesthetic result.
Fig.16
Before and After.
Conclusions
The no-prep technique described in this case report has some advantages and disadvantages. The advantages of the partial additional veneers (no-prep veneers) is, obviously, that teeth are not prepared, and the adhesion is performed fully on enamel. Patients acceptance is higher Vs traditional veneers, as the dentist will not “drill” teeth.
The disadvantage is that this is not an easy procedure and it requires strong attention both by the ceramist, for the lab procedures, and by the dentist during try-in and cementation, causing some stress.
Esthetics is not so “perfect” as full-prep veneers, as the margins are not hidden and could be seen, but usually, on a macro view picture and not in daily social life.
Aknowledgement:
Thank to DT Oliver Krieger for the outstanding craftwork.
Bibliography
1. Hein S, Geller W. The Platinum Foil Technique: History, Indication, Fabrication, and Adaptation. QDT 2011.
3. Kahng L. Using platinum foil techniques to create natural tooth colour. Pract Proced Aesthet Dent 2008;20:479–481.
5. Suh PS, Johnson R, White SN. Fit of veneers made by CADCAM and platinum foil methods. Oper Dent 1997;22:121–127.
7. Wall JG, Reisbick MH, Espeleta KG. Cement luting thickness beneath porcelain veneers made on platinum foil. J Prosthet Dent 1992;68:448–450.
9. Williams T. Porcelain veneer fabrication. Platinum foil and refractory model techniques. Ont Dent 1994;71:38, 40–42.
