lower incisors isolated with rubber dam

Diastema closure with no-prep partial porcelain veneers

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.

diastema between lower incisors

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.

mock-up on lower incisors

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

retraction cord inside sulcus

Fig.3

With a no-prep technique, taking the impression is easy, we just needed the first retraction cord (Ultrapak #000, Ultradent).

second retraction cord inside gingival sulcus

Fig.4

Then the second retraction cord Ultrapak #0. All cords were placed only in interdental areas.

geller working model

Fig.5

Our dental technician fabricated the Geller model.

platinum foil coated model

Fig.6

Veneers were fabricated using the platinum foil technique.

no prep technique partial ceramic veneers

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.

lower incisors under rubber dam isolation

Fig.8

After isolating properly, the teeth were etched.

bonding veneers on lower incisors

Fig.9

The first veneer was bonded on tooth 42.

Video 1

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.

ceramic veneers cemented on lower incisors

Fig.10

The veneer on tooth 41 in place.

isolation with rubber dam and teflon and transparent strip

Fig.11

We did the same whit teeth 31 and 32.

partial veneers on lower incisors

Fig.12

Immediately after the bonding of the veneers.

bonded no prep veneers

Fig.13

Incisal view.

lingual view of proximal veneers

Fig.14

Lingual view of the veneers and proximal contacts.

seamless ceramic partial no prep veneers

Fig.15

Two years follow-up picture demonstrates no marginal staining and stable functional and aesthetic result.

before and after lower incisor veneers

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

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