Micro preps for ceramic veneers

A clinical case by our Community member Dr. Francisca Micola

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Preparing teeth through the optic microscope, the quantity of dental structure removed was minimum and this can assure a perfect control. Making minimally invasive veneers means conserving as much as possible of dental structure. Porcelain veneers are more resistant than direct composite veneers, they have better chromatic stability and they represent an alternative to composites.

styleitaliano style italiano old composite incisor restorations

Fig.1
A 24-year old female’s smile, came to the office complaining the aspect of her old composite veneers. We found out that she had suffered an accident on the playground during her childhood, leading to fracture of teeth 11 and 21 in the incisal edge. The teeth were directly restored with composite many times, but she still wasn’t happy about the shape and general aspect of the other teeth. After informing the patient about the advisability of an orthodontic treatment, she explained she wanted a result in a shorter time span, so we decided to go for lithium disilicate veneers for all the 6 frontal teeth. This option allowed for a slight correction of her misalignment, shape correction, and color improvement.

styleitaliano style italiano intraoral picture showing old composite restorations

Fig.2
Frontal view with the retracted lips. You can notice the misaligned teeth, the old restorations, and the diastema between 21 and 22.

styleitaliano style italiano models mounted for occlusion study

Fig.3
The models mounted in an semi-adaptive articulator Artex CR (Amann Girrbach) in a centric relation.

styleitaliano style italiano bite check of articulated models

Fig.4
After examining protrusion and laterality movements, we could highlight a few interferences.

styleitaliano style italiano wax up and mock up

Fig.5
The diagnostic wax-up was followed by the mock-up. In order to correct the misalignment, some enamel needed to be removed from teeth 13, 11 and 21.

styleitaliano style italiano preparation through mock up

Fig.6
Preparation through the mock-up with a preset bur of 0.5 mm was the most conservative way to start. The whole preparation was made under magnification.

styleitaliano style italiano magnified view of precision impression

Fig.7
Impressions were taken with a polyether (Impregum Penta Soft – Medium Bodied Consistency, Garant LDuo Soft – Light Bodied Consistency, 3M) and checked under the microscope for possible interferences like air-bubbles.

styleitaliano style italiano lithium disilicate veneers

Fig.8
The six E-Max veneers.

styleitaliano style italiano incisor veneers

Fig.9
Veneers of 11 and 21. In the cervical area the thickness of the veneers was 0.3 mm.

styleitaliano style italiano etching veneers with hydrofluoric acid

Fig.10
The veneers were etched with 9% hydrofluoric acid for 20 seconds and then rinsed.

styleitaliano style italiano etching veneers with phosphoric acid

Fig.11
To achieve a clean surface of the veneers and for residue removal, additional etching was performed with 37% phosphoric acid for one minute. After this, the veneers were cleaned for one minute with running water, dried with air and skimmed with alcohol 90%.

styleitaliano style italiano silane application on veneers

Fig.12
The silane was applied with a brush and air dried to help the alcohol evaporate.

styleitaliano style italiano detail of veneer preparation

Fig.13
The rubber dam was applied in order to achieve perfect isolation. With a spatula and dental floss, the rubber dam was inverted into the gingival sulcus.

styleitaliano style italiano steps of veneer cementation

Fig.14
Steps from the cementation process. Teflon tape was applied to the neighboring teeth in order to protect them from over-etching. Each tooth was etched for 30 seconds, then rinsed and dried. After the etching process, all the following steps were made under the UV filter from the microscope. The Variolink Esthetic kit (Ivoclar Vivadent) for veneer cementation was used. Bonding was applied in a thin layer and air-blown for a few seconds. Each veener was loaded with the light-curing cement (Light shade was chosen from the kit) and fit into place. The excess material was removed with a brush, and double checked for a perfect fit. The polymerization was made for 40 seconds on each side.

styleitaliano style italiano cemented veneers before rubber dam removal

Fig.15
After placing the veneers.

styleitaliano style italiano smile after veneer cementation

Fig.16
At check-up.

styleitaliano style italiano smile before veneer treatment

Fig.17
The initial situation.

styleitaliano style italiano smile after veneer treatment

Fig.18
Two years post-op. The veneers are fully integrated and no inflammation of the gingiva was found. The patient was truly delighted with the result and she periodically comes for the recommended check-up.

Conclusions

The concept of minimally invasive dentistry means the use of optic microscope and it’s really helpful to conserve better the healthy dental tissue and that is the key of long-term success restorations. Magnification is important when trying to be minimally invasive, especially when the cervical area is involved. When preparing this area, magnification helps reduce the risk of hurting the gingiva, bleeding at the marginal sulcus, and also allows for a perfect finish to the preparation. The final cementation was performed using rubber dam and magnification for maximum precision, durability and excess removal.

A special mention goes to Conf. Dr. Leretter Marius, under whose coordination this case was performed.

Bibliography

1. Marshall SJ, Bayne SC, Baier R, Tomsia AP, Marshall GW. A review of adhesion science. Dental Mat 2010; 26(2);11–16.
2. Mangani F, Cerutti A, Putignano A, Bollero R, Madini L. Clinical approach to anterior adhesive restorations using resin composite veneers. Eur J Esthet Dent. 2007;2:188–209.
3. Coachman C, Gurel G, Calamita M. The influence of tooth color on preparation design for laminate veneers from a minimally invasive perspective: case report. Int J Periodontics Restorative Dent. 2014 JulAug;34(4):453-9.
4. Giordano, R. and McLaren, E.A. Ceramics Overview: Classification by Microstructure and Processing Methods. Compendium of Continuing Education in Dentistry. 2010;31:682-684.

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