No-prep Additive Veneers

Indirect anteriors
10 Dec 2012

No prep veneers, an article by Angelo Putignano and Vincenzo Musella

Less invasiveness and more aesthetics, we think is not only what dentists want but more and more is the patient demand.
In ordert o follow these techniques is necesary to follow some precise steps and know some basic concepts.
· Teeth must have some kind of deficit in thickness, so an adding material can be placed without overcontouring much.
· Misalingment of teeth should not compromise the space of the veneers
· Enamel existence at the cervical area is highly advised
· Diagnostic wax-up and intraoral mock-up are the main guides in a therapy of no-prep veneers
· retentions must be removed
· Wax-up must be additive without touching the plaster.
· A highly skilled technician means more thah half of the succes of the treatment.

Fig. 1

1) Initial case, look the recession on the 2.1 tooth, diastema and mild misalignment. Patient is not satisfied with the smile.

Fig. 2

2) detail of the smile

Fig. 3

3) diagnostic wax-up where the thickness in the 1.2 is evidenced, being near 0.1mm

Fig. 4

4) Trasnparent silicone stent, with hard consistency for the mock-up and to build a preview in the mouth.

Fig. 5

5) A3 flowable composite in the margins and A2 in the body.

Fig. 6

6) composite pressing with strong preassure in order to avoid overhangs.

Fig. 7

7) Close-up of the margins where the scarce thickness is evident.

Fig. 8

8) preview of the mock-up in the mouth.

Fig. 9

9) interaction of the mock-up with the lips.

Fig. 10

10) Close-up of the mock-up.

Fig. 11

11) Retraction cords insertion to make visible the CEJ (cementum-enamel-junction)

Fig. 12

12) Detail of the impression

Fig. 13

13) Ceramics procedure in the laboratory showing a delicate and accurate stratification technique over refractory dyes

Fig. 14

14) the four veneers ready to deliver.

Fig. 15

15) Cement try-in, an extremely important step given the fact that the veneers thickness allow the cement to modify the final outcome of the restorations.

Fig. 16

16) All the anterior teeth under rubber dam isolation, cervical clamps for the rubber dam are avoided in order to avoid undesired excess. Note the restoration on the 1.1 after teeth are dehydrated, this composite will be sandblasted before cementation.

Fig. 17

17) Ortophosphoric acid conditioning of the tooth, and Teflon tape protection of the neighbor teeth

Fig. 18

18) detail of the etched enamel

Fig. 19

19) in these kind of cases is important to leave the cement auto-curing for 4 minutes, and only after that time, photo-polymerize, that way reducing the stress that can break the extremely thin veneers.

Fig. 20

20) A small amount of glycerin is applied, and an extra polymerization is carried on, in order to eliminate the oxygen inhibited layer.

Fig. 21

21) Final aspect of the case

Fig. 22

22) 6 months post-op control, evidences the integration and the spontaneous healing of the recession on the 2.2 because of the new cervical anatomy.