16/06/2023

Jordan University of Science and Technology

Second semester 2022/2023

Veneers I&II: Considerations

and step-by-step technique
Abdelrahman Badarneh BDS, DClinDent (Pros),
MRACDS (Pros)
Specialist Prosthodontist
Department of Prosthodontics/ Faculty of
Dentistry

Indications
• Restore lost tooth structure
• To change the shape of the teeth
• To close diastemata
• To improve the colour of the teeth
• To improve the position of the teeth??

Considerations
• Enamel ➔ Bonding ➔ Key for successful
treatment
• Non-crowded teeth ➔ Path of insertion
• Mild to moderate discolouration!!!
• Occlusion ➔ Posterior support, overbite,
occlusal interferences and para-function
• Gingival contour ➔ You can’t change the
gingival contour using veneers
• Low caries experience/risk patient

1
 16/06/2023

Approach
• History and examination
• Understand what the patient wants
• Assess if it is possible
• Plan the treatment
• Urgent/Emergent care
• Stabilisation
• Rehabilitation
• Additive
• Subtractive
• Combined
• Treatment plan execution

For details please refer to smile design and analysis lecture

and History, Examination and Treatment planning lecture

Examination
• Micro and micro elements of the
smile
• Smile line and Lip support!
• Occlusal plane orientation ➔
Facebow record!

Diagnostic wax-up
• Try-out possible teeth
modifications
• Assess the feasibility of the
treatment
• Communicate with the patient
and technician
• Follows the principles of
functional-aesthetic smile

2
 16/06/2023

Silicon putty templates

• Reduction guide (index)
• Produced from the diagnostic
wax-up
• Allow visualization of the final
incisal edge position and an
understanding of the final tooth
form
• Reduce the amount of tooth
structure removal ➔ Reveal the
areas that need and don’t need
reduction
• Incisal reduction guide
• Labial reduction guide

Silicon putty templates

• Template for intra-oral mock-up
and provisionals

Putty + Light body

For details please refer to Fundamentals of colour and shade lecture

Shade taking
• No later than at the beginning of
the tooth preparation session
• Agreed on with the patient
• Oral hygiene and bleaching
procedures should have been
completed at this point

3
 16/06/2023

Resin mock-up
• Visualize the final outcome
• Verify
• Reduce the amount of tooth
structure removal➔ How?

10

Teeth preparation
• Axial reduction
• Gingival third➔ Reduction of 0.3 mm
(feldspathic porcelain) to 0.6 mm
(leucite and lithium disilicate material).
The enamel thickness at the gingival
third is 0.3–0.5 mm ➔ What if we have
a discoloured tooth ➔ Need more
reduction
• Middle third➔ 0.5mm
• Incisal third➔ 0.7mm
• Incisal reduction ➔ 1.0 to 1.5 mm

11

Classification (LeSage
Classification)
• The most modern classification considers the
amount of enamel available, and the amount of
dentin exposed:
• Class I – without preparation or minimum
preparation with the maintenance of
approximately 95% of the enamel
• Class II – minimally invasive preparation with a
reduction of up to 0.5 mm and the maintenance
of approximately 80% enamel
• Class III – conservative preparation with tooth
reduction between 0.5 to 1.0 mm and the
maintenance of approximately 50% to 80%
enamel
• Class IV – conventional preparation with more
than 50% enamel reduction

12

4
 16/06/2023

Teeth preparation
• Creating the finish line/veneer
outline
• Round bur
➔ 1mm diameter ➔ Goes
half-way into the tooth
➔Handpiece can be angled
more freely as the centre of
the bur will not be altered
➔Can also be used to
create depth orientation
duvets on the labial surface

13

Teeth preparation
• Axial reduction:
• Self-limiting depth reduction bur
➔Also known as triple
wheel
➔Cutting wheel and non -
cutting shank of 0.6 or
1mm diameter
➔ Used to create depth
orientation grooves on the
labial surface
➔Three planes of reduction

14

Teeth preparation
• Axial reduction is completed
using a chamfer bur
• Three-plane reduction

15

5
 16/06/2023

Teeth preparation
• Incisal reduction
• Completed first or last, and why?
• Bur/handpiece inclination?

16

Teeth preparation
• Incisal edge
rounding ➔ Why?
• Using diamond
finishing discs

17

Teeth preparation
• Incisal edge design

18

6
 16/06/2023

Teeth preparation
• Contact area
• Break the contact ➔ Why and
how?

19

Teeth preparation
• Contact area
• Break the contact ➔ Why and
how?

20

Teeth preparation
• Contact area preparation
• Where should I place the margin?
• Visibility
• Black triangles
• Restorations

21

7
 16/06/2023

Teeth preparation
• Contact area preparation
• Where should I place the margin?
• Visibility
• Black triangles
• Restorations

22

Stump shade
• Especially for dark teeth
• Maximise shade matching
accuracy

23

Impressions and bite record

• Retraction cords labially
• Addition silicon light and regular
or medium body ➔ one stage
• Custom tray!!!! ➔ U-shaped,
Two trays
• Bite record vs hand articulation

24

8
 16/06/2023

Provisionalisation
• Apply separating medium on the
teeth➔ Water soluble
• Fill in the template with the resin
material
• Trim excess around the gingival
margin and the interproximal
areas to facilitate removal

25

Provisionalisation
• Trim the excess material extra
orally
• Open the embrasures
• Polish the restoration

26

Provisionalisation
• Spot etch and bond
• Mechanical retention➔
Composite without etching and
bonding
• Temporary cement ➔ light cured
resin

27

9
 16/06/2023

Veneer try in
• Try in paste ➔ Clear or coloured
• Check:
• Shade
• Marginal adaptation
• Sequence of insertion!
• Protect the veneer (adhesive
tips) and the patient’s airway➔
Gauze
• Don’t mix the veneers!

28

Bonding
• Rubber dam isolation
• Teflon isolation and acid
etching (Ph)
• Veneer acid etching (HF)
• Veneer cleaning ➔ Special
solutions (IvoClean) or Ph
acid then in ultrasonic bath
• Silane coupling agent
application ➔ Universal
adhesives?

29

Bonding
• Application of the adhesive
on the tooth structure
• Application of the adhesive
on the veneer
• Application of the bonding
cement on the veneer
• Seat the veneer➔ Labial
and incisal pressure
• Tack curing or cure from the
lingual surface
• Remove excess material
• Full cure

30

10
 16/06/2023

Colour modifications
• Using bonding cement ➔ Comes
indifferent shades and opacities
➔Importance of the try-in
cement
• Staining by the dental technician
to change the shade from bright
to dark
• It is nearly impossible to use
staining to brighten a shade that
is too dark

31

Material selection

32

Success and survival of veneers

• The survival rate of porcelain veneers has been shown in the
literature to be very high
• Friedman, in a review of 3500 veneers over 15 years:
• Survival rate of 93%
• 7% complications rate in clinical service (fractures accounted for 67% of total
failures, leakage 22% and debonding 11%
• Fradeani et al., in a review of 182 veneers:
• Survival rate of 94.4% at 12 years, with a low clinical failure rate
(approximately 5.6%)

33

11
 16/06/2023

Additive
• Diastemata closure case
• Diagnostic wax-up
• Silicon putty indices

34

Additive
• Intraoral mock-up
• Create depth orientation grooves
into the mock-up
• Mark the grooves with a pencil
• Remove the resin material
• Prepare until the marks
disappear
• Sometimes all you need to do is
creating a finish line and
eliminating undercuts

35

Additive

36

12
 16/06/2023

Additive
• Finish preparation
• Impressions
• Lab can use the silicon templates
to build up the ceramic veneers
• Veneers insertion

37

Final result

• Natural!

38

Crowding
• Moderate crowding can often be
successfully treated be a
combination of removing tooth
material (1-1.5 mm) and adding
restorative material on the mesial
and distal surfaces (additive
subtractive)
• How to plan and assess the
changes?
• Radiographs➔ Assess pulp size and
proximity
• Study casts➔ Remove➔ Wax-up
➔ Mock-up

39

13
 16/06/2023

Combined
• Moderate crowding case
• Planning and executing teeth
modifications on the diagnostic
cast
• Wax-up to ideal contours

40

Combined
• Transferring tooth modifications
from the cast to the patient’s
mouth

41

Combined
• Complete teeth preparation
according to the reduction guide
• Insertion and final outcome

42

14
 16/06/2023

Take home messages

• The amount of enamel available for bonding increases the
predictability of the treatment ➔ Preserve it!
• Diagnostic wax-up on mounted study casts is important for planning
and executing the treatment
• Preparation on the resin mock-up and using reduction indices
preserve tooth structure and provide sufficient space for the
restorative material

43

Thank you for listening.

Any question?

44

15