Veneer success through temporization

A clinical case by our Community member Dr Edward Li

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.

The ability to efficiently create aesthetic temporaries is crucial for successful porcelain veneer procedures. This involves careful planning, smile design, and material selection, whether using composite resin or porcelain. Utilizing a digital or analogue wax-up is essential for modern smile transformations, providing a visual reference for both the patient and clinician and allowing for patient feedback and observations.
Temporization is often viewed simply as a guide for tooth preparation and as temporary restorations for the patient. However, dedicating a separate appointment to trial the design in the patient’s smile builds trust, confidence, and facilitates meaningful communication about the desired outcome.
Performing cosmetic treatments like veneers comes with responsibilities and potential risks. Bridging the gap between conceptualization and tangible results reduces risks and strengthens the rapport between patient and clinician.
My preferred combination for 2-stage PVS impressions and trial smiles is DMG Honigum Pro Putty Soft Fast (purple) with Honigum Pro Light Fast (orange). A 2-stage impression technique allows for sharper indexes, resulting in more realistic embrasures and contact points, leading to higher aesthetic outcomes with less chair time required for refinement. The snap-set timeframe of Honigum Pro in the Fast range offers sufficient working time for well-rehearsed workflows and precise trimming of impressions.
Luxatemp Star is a well-known and reliable choice for temporary restorations, offering predictable snap-set properties, high aesthetics, and good strength for durable temporaries between appointments. My preferred Luxatemp Star BL shade closely resembles BL3 with slightly more translucency than e.max MT, providing valuable visual feedback during smile trials or temporary placement to achieve the desired aesthetic outcome.

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style italiano styleitaliano initial situation before veneers restoration

Fig.1
The patient sought to achieve more symmetry and buccal presence to fill the corners of their full smile. They observe the maxillary cant with the right-hand side appearing more elevated. Alignment of the teeth with a slightly brighter value was also desired without stepping into the territory of artificiality.

styleitaliano style italiano Basic guidelines indirect veneer restoration porcelain veneers DMG

Fig.2
Using some basic guidelines to compare the maxillary cant to the patient’s eye level. The varying lines are to compare key landmarks such as incisal lengths and zeniths of the gingivae. This is the first step to inform the smile design and the analogue wax-up to come.

styleitaliano style italiano wax-up indirect veneer restoration porcelain veneers DMG

Fig.3
My own analogue wax-up is painstakingly built-up and crafted, as in some instances, the artful touch by hand is my preferred approach instead of using a library in a digital workflow. This is an additive wax-up with no cutback on the teeth and helps me identify the possibility to align the buccal arch without excessive bulk. Note the translucency seen in the wax where the teeth are shining through. This immediately highlights areas I know the preparation thickness will be crucial, especially if the substrate requires any masking. These details are lost on a screen when designing digitally that can be overcome, but not yet instinctive.

styleitaliano style italiano PSV index indirect veneer restoration porcelain veneers DMG

Fig.4
A 2-stage PVS index using DMG Honigum Pro Putty Soft Fast (purple) with Honigum Pro Light Fast (orange) with channel cut-outs to direct the flow of excess. Note the centre line channel as it helps locate the mid-line when transporting the index intra-orally. For trial smile indexes, the palatal only needs to cover the incisal third so the rest can be cut away to allow even easier retrieval of excess and reduction in the trapping of the resin in the interproximal spaces (especially fixed retainers). Keep vertical reference points by allowing some occlusal coverage on premolars/molars. Luxatemp Star BL used and excess lifted in 1 uniform piece during the ‘gel’ phase whilst keeping finger pressure on the index for the entire time.

styleitaliano style italiano provisionals indirect veneer restoration porcelain veneers DMG

Fig.5
Sharp index, purposeful seating and undisrupted setting allows the DMG Luxatemp Star to really show its potential. No burs or polishing used here, just a Sickle Scaler used to remove flakes of excess. This is the first opportunity for the patient to visualize it in their smile and see the vision you have in mind.

styleitaliano style italiano extra-oral view of the trial smile indirect veneer restoration porcelain veneers DMG

Fig.6
An extra-oral view of the trial smile allows the clinician to analyze and incorporate patient feedback. Upon initial assessment, it is evident that the right-hand side could be further elongated to better mask the maxillary cant, all while maintaining control over the functional envelope and lateral guidance on that side.

styleitaliano style italiano way for preparation indirect veneer restoration porcelain veneers DMG

Fig.7
On the day of the preparation, the same index is used to apply the Luxatemp Star on the teeth as the prep-guide.

styleitaliano style italiano outline of the margins indirect veneer restoration porcelain veneers DMG

Fig.8
Using a Round Diamond Bur with a size between 0.8mm-1mm provides an effective method for outlining the required margins. This initial depth cut allows for adjustments based on the final material, such as Lithium Disilicate. It is important to note that the bur should be used on two teeth simultaneously, focusing on their contact points and sharing the width of the bur.

styleitaliano style italiano additional depth grooves indirect veneer restoration porcelain veneers DMG

Fig.9
Additional depth grooves are created, particularly deeper ones toward the incisal region if a greater degree of porcelain layering and internal textures are desired beyond the minimum thickness.

styleitaliano style italiano aligned buccal form indirect veneer restoration porcelain veneers DMG

Fig.10
With the aim to broaden the arch and achieve an aligned buccal form, the removal of the prep guide on the right-hand side reveal an almost untouched surface.

styleitaliano style italiano aligned buccal form indirect veneer restoration porcelain veneers DMG

Fig.11
This continues onto the left-hand side.

styleitaliano style italiano retraction cord placement indirect veneer restoration porcelain veneers DMG

Fig.12
00 Retraction Cord is placed 5-5 in 1 uncut strand to aid the definition of the 2-stage PVS to come. Surfaces are refined for more definitive seating and better path of insertion. With no interproximal restorations and no black triangles to address, all contact points are kept intact and all surfaces kept to enamel for optimal bonding.

styleitaliano style italiano impression indirect veneer restoration porcelain veneers DMG

Fig.13
2-Stage PVS with the recipe of DMG Honigum Pro Putty Soft Fast (purple) with Honigum Pro Light Fast (orange). The best demonstration of the definition and tear resistance are the interproximal arches of silicone encircling the contact points.

styleitaliano style italiano temporization indirect veneer restoration porcelain veneers DMG

Fig.14
Now it is time for the actual temporization and the initial assessment of uniform reduction, which can be observed through the consistency in color. Enamel spot etching is applied to the tips, ensuring that all temporary veneers are bonded as a single unit with sharp definition to appear separate and easily cleanable with interdental brushes. Temporary cements are not used; instead, retention is primarily achieved through macro-mechanical means, with some assistance from micro-mechanical retention on the incisal edges exposed to biting forces. Luxatemp Star BL is utilized for this purpose.

styleitaliano style italiano veneers on model indirect veneer restoration porcelain veneers DMG

Fig.15
Lithium Disilicate in shade MT BL3 was utilized, with additional layering applied to the incisal third. The restoration was predominantly monolithic, given the thinness required and the intention to visually integrate the natural tooth characteristics through the veneers, enhancing its natural chroma without the need for masking.

styleitaliano style italiano bonding procedure indirect veneer restoration porcelain veneers DMG

Fig.16
The bonding process involved the use of DMG Vitique BL, applied with an ergonomic broad nozzle to facilitate application and reduce reliance on microbrushes, minimizing the risk of introducing air bubbles or contaminants. Prior to bonding, the porcelain surfaces underwent sandblasting, etching, and silanation. Subsequently, DMG ecosite universal bonding agent was applied to the teeth and allowed to air-dry. Etching and application of the bonding agent were performed simultaneously for all teeth, followed by meticulous cleanup of contact points. The bond was left uncured to aid in the seating of the veneers. All veneers were then seated simultaneously, starting from the mid-line and progressing backward to ensure precise control of positioning.

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styleitaliano style italiano pre-operative occlusal view indirect veneer restoration porcelain veneers DMG

Fig.17
Pre-operative occlusal view to observe the mild rotations, smaller arch from due to the extracted first premolars and 180 reversed UL5 with an existing veneer.

styleitaliano style italiano post-operative occlusal view indirect veneer restoration porcelain veneers DMG

Fig.18
Post-operative occlusal view to observe the finishing line and blend. New buccal silhouette and alignment achieved with the broadened buccal corridor.

styleitaliano style italiano retracted anterior contrastor view indirect veneer restoration porcelain veneers DMG

Fig.19
Retracted anterior contrastor view. Lithium Disilicate in MT BL3 at mostly minimum thicknesses and some layering on the incisal thirds where space allows.

styleitaliano style italiano final situation indirect veneer restoration porcelain veneers DMG

Fig.20
Successfully filling the buccal corridor and camouflaging the maxillary cant. A well integrated and harmonious smile achieved through what was learned with the Luxatemp Star trial smile.

styleitaliano style italiano before and after indirect veneer restoration porcelain veneers DMG

Fig.21
More views to compare how the broadened arches appear under the soft tissues. The ‘V’ shape appearance of the upper arch is no longer present with the additive buccal volume brought into the smile from the veneers.

Conclusions

When a successful and informative trial smile is achieved early in the appointment sequence, the remaining journey becomes more enjoyable to both patient and clinician as we are all on-board to achieve the same vision.

To predictably trial and later temporize with DMG Luxatemp Star with high aesthetics, true colour representation and good strength builds great confidence from the patient to continue to place the trust in the clinical work required ahead of the final result. All of this is underpinned with my choice in silicone where the DMG Honigum Pro range does the heavy lifting to support the efficient workflows as the handling, predictable working time and performance of the set silicone results in perfect impressions, indexes and templates first try.

Bibliography

  1. Chalifoux PR, Darvish M. Porcelain veneers: concept, preparation, temporization, laboratory, and placement. Practical Periodontics and Aesthetic Dentistry: PPAD. 1993 May 1;5(4):11-7.
  2. Hammond BD, Machowski M, Londono J, Pannu D. Fabrication of Porcelain Veneer Provisional Restorations: A Critical Review. Dentistry Review. 2022 Jun 1;2(2):100004.

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