No-prep Additive 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 order to follow these techniques is necessary to follow some precise steps and know some basic concepts.
Requirements
· Teeth must have some kind of deficit in thickness, so an adding material can be placed without over-contouring 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 intra-oral 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 than half of the success of the treatment.

Fig.1

Initial case, look the recession on the 21 tooth, diastema and mild misalignment. Patient is not satisfied with the smile.

Fig.2

Detail of the smile.

Fig.3

Diagnostic wax-up where the thickness on tooth 12 is evidenced, being near 0.1 mm.

Fig.4

Transparent silicone index, with hard consistency for the mock-up and to build a preview in the mouth.

Fig.5

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

Fig.6

Composite pressing with strong pressure in order to avoid overhangs.

Fig.7

Close-up of the margins where the scarce thickness is obvious.

Fig.8

Preview of the mock-up in the mouth.

Fig.9

Interaction of the mock-up with the lips.

Fig.10

Close-up of the mock-up.

Fig.11

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

Fig.12

Detail of the impression.

Fig.13

Ceramics layering in the laboratory showing a delicate and accurate stratification technique over refractory dyes.

Fig.14

The four veneers ready to be cemented.

Fig.15

Cementation session 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

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 11 after teeth are dehydrated, this composite will be sandblasted before cementation.

Fig.17

Orthophosphoric acid conditioning of the tooth, and Teflon tape protection of the neighbor teeth.

Fig.18

Detail of the etched enamel.

Fig.19

In this kind of cases is important to leave the cement self-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

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

Fig.21

Final aspect of the case.

Fig.22

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