porcelain laminate veneers/ dentistry course in india

Porcelain laminate veneers.
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.comwww.indiandentalacademy.com

Table of contents.
Introduction.
Definitions.
History.
Review of literature.
Indications.
Contraindications.
Case selection for PLV.
www.indiandentalacademy.com

All ceramic systems used for laminate
veneers.
Tooth preparation.
Impression making.
Shade selection.
Provisional restoration.

Lab communication.
Lab Fabrication.
Try- in considerations.
Luting of porcelain laminate
veneers.
Finishing and polishing
Summary.
Conclusion
References.www.indiandentalacademy.com

Introduction.
The restoration of the unaesthetic
anterior teeth has always been a
problem, involving large amounts of
sound tooth substance, with adverse
effects on the pulp and gingiva. The
establishment of clear parameters for
effective, reliable etching to dental
enamel and the development of high
quality , microfine composite cements
led to introduction of composite
veneers for masking discoloration.

Unfortunately composites show
polymerisation shrinkage staining
andpoor wear resistance. The acrylic
laminate veneers was an attempt to
overcome some of these problems,
but the long term results were
clinically unacceptable.

Porcelain as a material for veneering
was first reported by Horn , using
commercially available porcelain built
up in layers on a platinum foil matrix
adapted to the model of the tooth.
Further Calamia described a
modified technique using high
temperature investments.

Porcelain is readily etched and the
application of the silane couplers to
the surface overcame the problem of
poor bonding found in acrylic veneer.

Definitions.
Veneer: 1. a thin sheet of material usually
used as a finish.
2. A protective or ornamental facing.
3.Suferficial or attractive display in multiple
layers, frequently termed as laminate
veneers.
(GPT 8)

Porcelain laminate veneers: a thin
bonded ceramic restoration that
restores the facial surfaces and part
of the proximal surfaces of the teeth
requiring esthetic restorations.
(GPT 8)

History.
1937: Pincus attached thin labial porcelain
veneers temporarily with denture adhesive
powder to enhance the appearance of
Hollywood stars for close-up photographs.
1955: Buonocore introduced the acid etch
technique to increase the adhesion of
acrylic filling material to enamel.

1958: Bowen developed silica-resin
direct filling material.
1975: Rochette mentioned the use of
a silane coupling agent with porcelain
laminate veneers for repairing
fractured incisors.

1976: Faunce and Myers used
acrylic resins for preformed laminate
veneers.
1983: HORN introduced platinium foil
technique.
1983: Calamia introduced refractory
die technique.

1983-1984: Calamia demonstrated
good bond strengths for hydrofluoric
acid etched porcelain, and that the
use of silane coupling agent could
further increase the bond strength of
resin composite to etched porcelain.

Review of literature.

Ron Highton etal.,
A photoelastic study of stresses on
porcelain laminate veneers. (JPD
1987;58(2):157-161).
A photoelastic study of four designs
for the tooth preperation for porcelain
laminate veneers revealed that
incisal, labial, proximal and gingival
reduction is recommended for
patients with class I, division I
occlusions. www.indiandentalacademy.com

Although modifications for variant
tooth conditions may be necessary,
gingival tooth preparation is
necessary to control stress
distribution and provide the best
potential for periodontal health.

Friedman M.(JADA 1987 Dec).
stated that the etch porcelain veneer
can provide a restoration that looks
natural with minimum tooth
preparation. Periodontal response to
the veneers , when properly placed
has been excellent.

Herbert Victor.
Predictability of color matching and
the possibilities for enhancement of
ceramic laminate veneers. (JPD
1991;65:619-22).

This study investigated the
predictability of color on three
illustrated surfaces of the ceramic
veneers and the extent to which the
laminates may be shade adapted by
the use of tints opaquers on the fitting
surface.

Conclusion: significance
discrepancies were found in the final
color match. The dentist should opt
for a lighter, more translucent shade,
which can be modified before final
cementation.

Robert E. Rada.
Porcelain laminate veneer
provisionalization using visible light curing
resin (QI 1991;22:291-293).

Placement of PLV has become
relatively common procedure.
Occasionally it is necessary to
fabricate provisional restorations.
For these situations, the use of self
cure acrylic or composite resin has
been described in the literature.

Extensive trimming and finishing
procedures are often necessary and
due to their inherent fragility they are
prone to breakage.
To improve the technique , visible
light cure acrylic resins are used for
fabrication of direct provisional
restorations.

J.J. Linden etal.,
Photoactivation of resin cements through
porcelain veneers.( J. Res. Dent
1991;70(2):154-157.

The purpose of the study was to
evaluate the effect of porcelain
opacity on the curing of composite
when porcelain shade and thickness
were held constant.
Microhardness testing (KNH) was
used to test the degree of cure of
each material at various intervels.

Concluded that porcelain opacity did
not significantly affect hardness. But
the chemical catalyst and prolonged
curing times might be essential for
clinical success.

Sumiya Hobo
Porcelain laminate veneers with
three dimensional shade
reproduction. (int dent J;1992:42:189-
198.

A new system for creating porcelain
veneers with three dimensional shade
option is described.
The development of new porcelain
consisting of an intense color which
provides natural tooth esthetics in
layers of only 0.5mm has made this
system possible

In addition a masking porcelain may
be used over the discolored tooth.
This system claim to supersede the
esthetic shade created with other
laminate systems, as well as
enhancing the marginal integrity of
the veneer.

J. G. Wall etal.,
Cement luting thickness beneath
porcelain veneers made on platinum foil.
(JPD1992;68:448-50).

The purpose of this investigation was
to measure the luting space under
porcelain laminate veneers that were
fabricated on platinum foils cemented
on mandibular incisors.

The study demonstrated that
required folds in the platinum folds
substantially increases marginal
discrepancies around the luted
veneers.
These discrepancies were apparently
smaller than that created with
refractory die technique.

S. M. Dunne etal.,
A longitudinal study of the clinical
performance of porcelain veneers.
(BDJ 1993;175:317-21).

In this study a total of 315 porcelain
labial veneers were fitted in 96
patients and were evaluated after a
period upto 63 months.
During the evaluation period 17%
restorations in 32% of the patients
presented with a problem at review.

Increased problem and failure
rates were associated with veneers
placed on existing restorations,
where tooth surface loss occurred
prior to the treatment and where
inappropriate luting cements were
used.

Age , gender, fabrication technique , use
of rubber dam were not significant factors.

M. Peumans etal.,
Five year clinical performance of porcelain
veneers. (QI1998;29:211-221).
The objective to evaluate overall clinical
performance of porcelain veneers
evaluated at 5yrs.

Results:
93% were satisfactory.
7% presented recurrent caries,
porcelain fracture, clinical
microleakage and pulpal reaction.
100% retention rate.
14% presented excellent marginal
adaptation. www.indiandentalacademy.com

P. A. Brunton.
Tooth preparation techniques for
porcelain laminate veneers (BDJ
2000;189: 260-62).
The objective of the study was to
determine the effect that two guides
(silicone index, depth preparation bur)
had on operators ability to
appropriately and consistently
prepare the teeth for PLV.www.indiandentalacademy.com

Concluded that considerations
should be given to the use of a
silicone index or depth gauge bur
when teeth are prepared for PLV.

David G Wildgoose.
Dimensional change of refractory
materials used for ceramic veneers. (Eur.
J. Prosthodont. Rest. Dent 2001;9:101-
105).

The current literature considers a
number of clinical factors which affect
the fit of PLV. However , little
consideration has been given to the
refractory die material and the lab
techniques used.

This study found a wide range of
dimensional change occurred during
setting and firing cycles for 7
refractories recommended for
construction of PLV.

It is there fore important that the
clinician should consider the
suitability of the materials offered by
the laboratory, in order to obtain
optimum marginal integrity.

Bo-Kyoung Kim
The influence of ceramic surface treatments
on the tensile bond strength of composite
resin to all-ceramic materials (J Prosthet
Dent 2005;94:357-62.)

The purpose of this study was to
evaluate the tensile bond strength of
composite resin to 3 different all-
ceramic coping materials with various
surface treatments.

Alumina and zirconia ceramic
specimens treated with a silica
coating technique, and lithium
disilicate ceramic specimens treated
with airborne-particle abrasion and
acid etching yielded the highest
tensile bond strength values to a
composite resin for the materials
tested. www.indiandentalacademy.com

Christian F.J. Stappert.
Longevity and failure load of ceramic
veneers with different preparation designs
after exposure to masticatory simulation
(J Prosthet Dent 2005;94:132-9.)

This study evaluated the influence of
preparation design on longevity and
failure load of ceramic veneers
bonded to human maxillary central
incisors after cyclic loading and
thermal cycling in a dual-axis
masticatory simulator.

Within the limits of this in vitro
investigation, the use of adhesively
luted IPS Empress veneers prepared
according to the 3 different preparation
designs demonstrated adequate
stabilization of residual tooth structure.

Crack pattern analysis showed a
higher risk of subcritical crack
development when the indenter
impact was located on the palatal
ceramic surface.

Therefore, the palatal contact point
position of the antagonist should
remain on the natural tooth structure
after preparation. In particular, this is
important for complete veneer
preparations.

George P. Cherukara, Graham R. Davis
etal.,
Dentin exposure in tooth preparations for
porcelain veneers: A pilot study
(J Prosthet Dent 2005;94:414-20.)

The purpose of this pilot study was to
assess the effectiveness of 3 clinical
techniques, namely, dimple, depth
groove, and freehand, in producing an
intraenamel preparation.
 The relation between overpreparation
beyond the commonly accepted depth of
preparation of 0.5 mm and dentin
exposure was also examined.www.indiandentalacademy.com

Within the limitations of this pilot
study, it was demonstrated that a
labial reduction of 0.4 to 0.6 mm
resulted in an intraenamel
preparation, other than in the cervical
region. Even with the use of depth-
limiting techniques, a quarter of the
prepared labial surface was exposed
dentin. www.indiandentalacademy.com

Fernando Zarone
Dynamometric assessment of the
mechanical resistance of porcelain
veneers related to tooth preparation: A
comparison between two techniques.
(J Prosthet Dent 2006;95:354-63.)

The purpose of this study was to
detect the stress in maxillary anterior
teeth restored with porcelain veneers
and compare the resistance to
fracture of porcelain veneers
prepared using different preparation
designs.

Conclusion: The chamfer preparation
is recommended for central incisors,
whereas the window preparation
showed better results for canines.
Both preparations can be adopted in
the restoration of lateral incisors.

Seok-Hwan Cho,
Effect of die spacer thickness on shear
bond strength of porcelain laminate
veneers.
(J Prosthet Dent 2006;95:201-8.)

The application of die spacer may affect the
shear bond strength (SBS) of porcelain
laminate veneer. However, there is no
standard for the amount of die spacer
necessary for the fabrication of PLV
restorations.

The purpose of this study was to
evaluate the SBS differences
between enamel and a feldspathic
PLV as a function of die spacer
thickness.

Within the limitations of this study it was
found that the appropriate application of
die spacer exerts a favorable influence on
the SBS of composite-bonded PLV.
The 2-coat application of die spacer
provides suitable space to accommodate
the cement thickness.

Indications of PLV12,3
1. used in patients who wish to have their
anterior dental aesthetic problems
corrected in terms of tooth shade,
morphology and alignment.

2. if there is sufficient tooth substance for
bonding and support, veneers can be used
for correcting:
- Tetracycline stains.
- Stained non-vital teeth.
- unattractive restorations.
-enamel fluorosis.
- Enamel hypoplasia.
- Chipped or slightly worn anterior teeth.
- Microdontia.
- Minor tooth malalignment.
- Closure of midline diastema.

-modifying anterior guidance.
-providing undercut zones for
removable prostheses.
In adverse clinical situations like
lingual erosion.
As substitute for porcelain metals
and crowns, especially in mandibular
teeth. www.indiandentalacademy.com

Contraindications.12,3
If there is insufficient amount of
enamel for bonding such as in
extensive caries and tooth fractures,
heavily restored teeth, severe enamel
hypoplasia and short clinical crowns.
If excessive forces are acting on the
teeth as with active bruxism, and
object biting habits.

Darkly stained teeth.
Malocclusions.
Extensive periodontal bone loss
Large diastemas.

Case selection for PLV.
(QI 1995;26:311-315)
Static and dynamic Occlusal
relationship.
The usual mode of failure is fracture of the
corners, frequently happens at the incisal
edges.
The margins should be placed so that they
do not contact the opposing dentition
during the rest position.

Occlusal interferences and Para
functional habits are contraindications
for PLV because they result in crack
formation.

Periodontal and oral health status:
A healthy periodontium forms a strong
foundation on which all the restorative
work rests.
It is therefore important to assess the
patient's periodontal and oral health
before the procedure is begun.

Healthy periodontium.

Mouth breathers who have poor
gingival health are poor candidates
for porcelain veneers.

Condition of the tooth.
Degree of
discoloration:
If the tooth is grossly
discolored it may be
necessary to bleach
the tooth before the
veneer is placed.

The discoloration of the tetracycline staining
becomes more severe as the enamel
reduces.

Extent of caries:
 if little or no enamel is present after
caries removal placement of veneers is
contraindicated.
The veneer –tooth complex is
weakened when the surface area of the
enamel available for bonding is
decreased by 50%.

Extent of restorations:
A restoration if present , should be
small enough that the area for
bonding with enamel is not
compromised.

Quality of the tooth.
Structural defects like amelogenesis
imperfecta, dentinogenesis
imperfecta are contraindicated.
Large areas of exposed dentin are
also unsuitable.

Amelogenesis imperfecta.

Dentinogenesis imperfecte

Large areas of exposed dentin.

Patient’s motivation to maintain.
The patient’s attitude towards the
dental health care should be
assessed before porcelain veneers
are attempted.

Patients expectations.
The patient’s expectations should be
realistic.

Oral habits.
Nail or pencil biting is contraindication for
veneers because shearing stress may be
too great for the ceramics to withstand.

All ceramic systems used for PLV.13,11,1
Conventional (powder- slurry) ceramics.
Castable ceramics.
Machinable ceramics.
Pressable ceramics.
Infiltrated ceramics.

Conventional powder slurry ceramics.
These products are supplied as
powders to which the technician adds
modulator liquid to produce a slurry,
which is built up in layers on the die
material to form the contours of the
restoration.

The powders are available in various
shades and translucencies and are
supplied with characterizing stains
and glazes.

Optec HSP:
Has greater strength than
conventional feldspathic porcelain as
a result of an increased amount of
Lucite.
Because of its increase strength it
does not require a core when used to
fabricate all ceramic restorations.

The body and the incisal porcelains
are pigmented to provide desired
shade and translucency.

Advantages.
They fit accurately.
Does not require special processing
unit.

Disadvantages.
Increased content of Lucite
contributes to high wear of opposing
teeth.

Duceram LFC.
Is referred to as “hydrothermal low-fusing
ceramic”.
Composed as an amorphous glass
containing hydroxyl ions.
Greater density.
High flexural strength.
Greater fracture resistance.
Cause less abrasion against tooth
structure. www.indiandentalacademy.com

Restoration is made in two layers:
1. Base layer: is a Duceram metal ceramic .
Placed on a refractory die using powder
slurry technique and then baked at
930degree C.

2. Second layer: over the base layer ,
Duceram LFC is applied using powder-
slurry technique and baked relatively at
660 degree C.
Material is supplied in different shades .
No special lab technique or equipment.

Castable ceramic systems.
Dicor:
Polycrystalline glass ceramic material.
The fabrication uses lost wax technique
and centrifugal casting techniques similar
to those used to fabricate alloy castings.

To achieve appropriate shade , the
colorant shades are baked on the surface
of the glass-ceramic material.
It is less abrasive to the opposing teeth.

Dentsply introduced Dicor Plus.
Which is shaded feldspathic
porcelain veneer applied to the dicor
substrate.

Machinable ceramics.
The ceramic ingots used in CAD-
CAM restorations donot require
further high temperature processing.
They are placed in the machining
appartus to produce desired contours.

The different types of systems are:
1. Cerec system (Sirona dental systems,
Germany.)
This system uses Vita Mark II (Vivdent),
Dicor (Dentsply Int), Procad (Ivoclar North
America).

2. Procera AllCeram system (Nobel
Biocare).
The procera system involves an industrial
CAD-CAM system.

Celay system: in this system the
pattern is fabricated directly on the
prepared tooth or on the master die,
then the pattern is used to mill
porcelain restorations.

The restorations produced by these
systems produce considerable wide
gap between the restoration and the
tooth structure.

Pressable ceramics.
 1. IPS EMPRESS(IVOCLAR , N.
AMERICA)
 2.OPTEC PRESSABLE CERAMIC
(JENERIC /PENTRON)
 3.CERGO-DENTSPLY
 4. VITA PRESS-VIDENT

Veneering porcelain
IPS Empress- Empress
IPS Empress 2 Empress 2, Eris
Optec- optec
Cergo- Ducera Gold
Vita Press- Vita Omega

These ceramics offer greater flexural
strength when the veneer thickness is
not less than 0.5mm.

Infiltrated ceramics.
Composed of an infiltrated core veneered
with feldspathic porcelain.
Core is initially extremely porous, and is
composed of either Aluminiun oxide or
spinel( a composition containing Al2O3
and MgO).
This porous sub structure is subsequently
infiltrated with molten gas.
Veneering porcelain-Vitadur alpha

Extremely high flexural strength
Strongest of all ceramic dental
restorations

Disadvantages-
core of Al2O3 or spinel is so strong
that traditional internal surface
etching is not possible
because of opaque Alumina core ,
the translucency of the final
restoration may not be as life like as
with other systems

Stratification method.4
Stratification is a process of
forming in layers.
A porcelain veneer that is
bonded to the tooth with a resin
cement is an example of
stratification.

The layers are :
The inner layer – the tooth.
The middle layer – the resin cement.
The outer layer- the porcelain
veneer.

Various principles are involved in
enhancing the color of the porcelain
veneers.
The dynamic application of these
principles to complex area of
porcelain veneer coloration is called
stratification method.

Tooth preparation:
Without graded tooth preparation,
color control is inconsistent, and over
contoured veneers are the rule.

Two levels of graded tooth
preparation are necessary to create
space.
One level -----> moderate color
change (universal preparation).
Another level -----> profound colorwww.indiandentalacademy.com

 For Moderate color change , two
color change or less, a two plane
facial reduction of 0.3 mm in the
cervical one third and 0.5 mm in the
incisal two thirds is indicated.

For profound color change, three
shades or more, all teeth except
mandibular incisors, atleast 0.4mm in
the cervical area and 0.6mm in the
incisal area is indicated.

Resin interface space:
The relationship between light
reflection and vitality of the porcelain
veneer.
Veneer formed by opaque porcelain
----- masks tooth color ----- limited
vitality -------- due to surface light
reflection. www.indiandentalacademy.com

Translucent porcelain ------ light
transmission and reflection ------
enhances vitality ------ difficult to mask
tooth color.

How can porcelain veneers
simulate natural teeth?

Using grade resin interface
space , to allow resin to dilute
tooth discoloration.

Can de accomplished by the use of die spacer.
Two shade change or less

Moderate color change.

THREE SHADE CHANGE OR MORE

Profound color change.

Porcelain veneer formulation.
For a given cast the ceramist should
formulate a porcelain veneer that will
contain graded opacity appropriate to
the desired color change.

Moderate color change ------ translucent
porcelain.

Profound color change ------- more
opaque porcelain.
For polychromatic color gradation
veneers are highly characterized.

Porcelain laminate veneers.
Compiled by Dr. Venkat
Yenepoya Dental College(2004-07)

All ceramic systems used for
laminate veneers.
Tooth preparation.
Impression making.
Shade selection.
Provisional restoration.
Lab communication.

Lab Fabrication.
Try- in considerations.
Luting of porcelain laminate
veneers.
Finishing and polishing
Summary.
Conclusion
References.

Mastique veneer system (L.D Caulk
Company) 19
A kit containing several shades of composite
resin, laminates.
A large assortment of shapes and sizes of
the laminates.

The clear , shell like laminates (0.4mm in
thickness) are made of synthetic resin by
a pressure and heat cured process.

Veneer primer
cleaner

Cerestore system: (Johnson and
Johnson dental products)7
Shrink free ceramic crown.

This system uses a transfer molding
technique to fabricate ceramic crowns
directly on the master die with the
excellent marginal fit.

Ceramic is flowable at 160deg c and then
transferred into the plaster mold by
pressure.

Why the ceramic donot shrink?
Oxidation of silicone.
The silicone resin used as a binder
during transfer molding compensates for
the shrinkage of the core material by
conversion of siO to siO2 during firing
from 160 degree C to 800 degree C.

Composition:
Al oxide.
MgO
Glass frit.
Kaolin clay.
Silicone resin. (thermosetting, thermoplastic)

Difference between Castable and
Pressable ceramics.18,4
Castable ceramics (Dicor)
contains tetrasilicafluoroamina
crystals.

After the glass casting core is recovered ,
the glass is sandblasted and the sprues
are cut away.
The glass is covered by a protective
embedment material and heat treated to
cause microscopic plate like crystals
(mica) to grow within the glass matrix.
This is known as ceramming.(1350 deg
C for 10hrs)

Creamming 1350 deg c for 10hrs.

Ceramming process results in:
Increased strenght and
toughness
Resistance to abrasion and
thermal shock.
The material is less abrasive.

Whereas Pressable ceramics contain
higher concentration of Lucite crystals
that increase the resistance to crack
propagation.

Castable Pressable Infiltrated. Machinable
.
Margin
quality
Good. Good-
excellent
Fair- good fair
appearanc
e.
translucent Slightly
translucent
Opaque. Slightly
translucent
strenght Weak. Moderately
strong
Moderate-
very strong
Moderately
strong
Acid
etchable
Etchable. Etchable. Not
indicated
Etchable.

Tooth preparation.1,3,4,5
 Objectives of tooth preparation:
1. To provide adequate space for the PLV
buildup to prevent over contouring.
2. To allow efficient bonding with less acid-
resistant enamel.
3. To create a definite finish line for the
technician to fabricate restorations with
superior marginal fitting.

4. To provide adequate thickness for
porcelian strenght.
5. To allow operator to adapt the veneers
more easily to their correct positions.

 Usually tooth preparation can be divided
into four parts:
1. Labial reduction
2. Interproximal extension.
3. Cervical margin placement.
4. Incisal preparation.

Labial reduction.
The labial reduction of the maxillary teeth should be
in the range of 0.3- 0.7mm.

Crispin & Hewlett

Careful depth control is necessary when
an even thickness of the enamel is to be
removed.
Needed for natural convexities of the
labial surfaces.

Nixon porcelain veneer kit II, Brasseler
GmbH.

LVS , Brasseler GmbH

Lasco, Chatsworth, CA.

Interproximal extension.
To conceal the finish, the preparation
should extend laterally to finish facial to
the interproximal contact areas.
If preparation extends on to the lingual
side of the contact areas , then undercut
zones are created in the cervical areas.

Sorensen etal.,(JPD 1992;67:16-22).
 found that the mesial and distal
proximal cervical margins of the
porcelain veneers have more
marginal discrepancies when
compared with those of labial surface.

Margin placement.
A well defined chamfer is usually
recommended.

Subgingival margin.

Incisal reduction.
GILMOUR AND J.S. GLYDE
(BDJ 1988;9-14)
CLASSIFIED THE
PREPARATION INTO 4 TYPES

Window or intra enamel preparation with
intact incisal enamel.

Feathered incisal preparation labially

Incisal edge preparation to form butt joint
lingually.

Incisal edge preparation overlapping
lingual surface.

HIGHTON R. etal
JPD 1987:58;157-161
Did a photoelastic analysis-
showed that incisal overlapping
reduce stress in the veneer most
effectively.

Graber etal suggested
placement of palatal
chamfer-results in increased
veneer strength

Tooth preparation in special situations 4
Diastema closure.

Correct proximal preparation

Deficient proximal preparation.

Malpositioned teeth.

Facially tipped teeth.
Desired contour.
Facially tipped.

enameloplasty
Desired contour
Lingual deficiency

Original contour
Space for veneer
Lingual finish line

Post-operative view.

Gingival retraction.3

Impression making.4,5
Materials
 Rubber base impression materials such
as addition silicones or polyether.

Trays:
 Custom made or stock full arch impression
trays are used.

Embrasure blockout

Inteproximal tear through margin.

Embrasure blockout.

Intact interproximal extension.

Shade selection.4,5,6
Because ceramic veneers are thin, color
from the underlying tooth may alter the
final veneer shade.
Without prescribing the background of the
tooth to be veneered it is difficult to select
the shade of the veneer.

Shade of the prepared tooth.

Shade of the veneers

Provisional restorations.3
Usually not necessary.
In several clinical situations,
provisionalization may be required.

If excessive reduction is done to align the
tooth.
To prevent supraeruption of the prepared
tooth.
If isolated teeth are prepared.
High esthetic expectations.

Materials that can be used for provisional
restorations:
Acrylics.(SNAP (PARKEL), TEMPLUS (ELLMAN) ,JET
(LANG) , DURCALAY (RELIANCE)
Composites.( Revotec, Protemp Grant,
Unifast L C)

Techniques :
Direct technique.( acrylic, composites)
Indirect technique. (acrylic, composites)

Direct technique ( acrylic
resin). JPD 1989;2;4;139

BONDING OF PROVISIONAL
RESTORATION
Composites.
Provisional Non- eugenol cements.

D.A.ELLEDGE etal (JPD 1989;62;139-142)

Direct method using composites:
JADA 1995;126:653-656.

Indirect method:(composites) 4

Vacumm Formed provisional coverage4

Position stabilisation using composite
resin.4

THINGS NEEDED FOR GOOD
COMMUNICATION ARE.4
Laboratory prescription.
Pretreatment models.
Photographs of the teeth.
Accurate impressions.

Lab prescription.
A complete lab prescription consists of the
following:
1. shade of the prepared teeth.
2. shade of the veneer: cervical, body,
incisal.
3. appropriate interface space in die
spacer coats.
4. veneer length, contacts, incisal shape.

Shade of the
prepared tooth:

Shade gradation of the veneer:

Die spacer:
0.1 mm die spacer for two- shade shift.
0.2mm for profoundly stained teeth.

Translucency and opacity levels:
Use of highly opaque porcelain gives
non-vital look.
Trend is to use translucent and
highly characterized porcelain
combined with increased die spacing.

Length, contacts and incisal shape:
Veneer length relative to the prepared
tooth.
Contact zone (long or short)
Tooth shape( tapered, square)
Incisal shape (round, square, variable).

Communication with desired contour and
tooth shape.

Lab fabrication.4,5
Platinum foil technique.
Refractory die technique.

Platinum foil technique.
Fabricate and use standard stone
removable dies.
Platinum foil can be quickly adapted to the
die and fabrication started.
Easy to measure the thickness of the
veneer during fabrication.

Veneers can be tried on the prepared
tooth prior to final glazing.

Disadvantages.
Foil distortion possible.
Difficult to assess actual color.
Cost of foil.

Stone working model seperating dies

Die spacer

Platinum foil adapted on the die

APPLY GINGIVAL CERAMICS

Apply dentine porcelain.

Cutting back mesial and distal
surfaces for enamel porcelain

Application of enamel porcelain.

Blue stain for mesial and distal
borders

Yellow stains on the incisal edges

Completed veneer

The veneers should be colored and
glazed prior to foil removal.

Refractory die technique.
 Advantages:
1. Overall accuracy and fit is generally
better.
2. Easier technique.

Disadvantages:
1.Requires duplication of stone dies.
2.Divestment is required.
3.Fit must be verified on stone dies.
4.More difficult to control veneer
thickness.

Refractory cast trimmed with stone base.

Dies are placed in the ceramic oven.

Cooled to room temperature and soaked
in distilled water.

Application of the opaque layer.

Full contour ceramic buildup.

Contouring the veneers on the dies.

Disc used to cut the veneer away from
the die.

Excess is removed from the stone.

Air abraded.

Porcelain etching4,5
Hydrofluoric acid is applied to the fitting
surface of the veneer.
Provides good bonding strength by partly
dissolving the glassy matrix of the
porcelain.

Apply wax to the areas
not etched

Internal bonding surface etched with
hydrofluoric acid.

Properly etched-
foggy appearance

Under etched-
shiny appearance

Over etched

Swift B et al., (BDJ 1995; 179: 203-20)
Do not place the etched veneers back on
the master cast because it will
contaminate their fitting surfaces and
adversely affect bonding strength.

Trade names.
Porcelain bonding kit (KHS polymer
technologies). 6% HF.
Porcelain etch (Cosmodent) 9.5% HF.
Porcelain etchant (Bisco Inc) 4% HF.

Veneer try-in. 4,5,3

Initial veneer inspection.

Veneer color.
Veneer placed on white towel.

Chair side try- in.
Three steps:
1.Dry try-in of individual veneer for marginal
fit.
2.Wet try-in of all veneers collectively with a
clear liquid medium, for proximal fit.
3.Resin cement try-in.

Dry try-in for marginal fit.
Place the gingival retraction cord
subgingivally to prevent sulcular moisture
or bleeding from contaminating the
surface.
Try each veneer individually in dry to
determine marginal accuracy.

Each veneer is placed dry on the
prepared tooth to check marginal fit.

Wet try-in for proximal fit.
Fill the internal etched surface with water
soluble glycerin to minimize dislodgement
if a vertical position is assumed.
Try veneers on appropriate teeth in
sequential manner.
If the veneer resists seating remove the
veneer and carefully reduce using
microfine diamond bur.

All veneers are seated to check the
marginal fit.

Veneer try-in for color and color
modifications.

TRADE NAMES OF RESIN CEMENTS.
NEXUS (KERR)
PVS PORCELAIN BONDING
 KIT(JELENKO)
INSURE (COSMODENT)
COMPOLUTE (ESPE)
VIRIOLINK (VIVADENT)

VENEER LUTING AGENT (BISCO)
RECOVER(TELEDYNE GETZ )
MIRAGE FLC(CHAMELEON)
RELY X VENEER CEMENT(3 M
ESPE)

For color evaluation veneers must be
placed with the material that optically
connects the veneer to tooth for correct
color evaluation.
Clear water soluble gel is used.

If the color is acceptable
cementation using a clear acrylic is
initiated.

If the try-in is lighter than a intended
shade.
Use resin cement that is darker or
approximately same degree.

If it is darker than the intended shade
Mix one part of light opaque resin cement
with ten parts of light translucent resin
cement.

If generalised polychromatic
shade modification needed
only for a portion of veneer .

High chroma composite tint on inner
gingival surface.

Grey tint on the inner incisal third.

Veneer seated with right and left rocking
motion to extrude cement laterally

Seating veneer from incisal to gingival
forces all tints gingivally

TRANSLUCENT
VENEER
OPAQUE
VENEER
GINGIVAL TINT PLACED

Cementation and finishing. 4,5,3,1
Good moisture control is necessary.

Gingival retraction. 4
Gingival cords:
•Retraction cord is of great help to
prevent contamination from gingival
crevice

Gingval cords come
in different sizes:
Ultrapak plain and
ultrapak E
(epinephrine
impregnated)
Knitted.
# 00,#0,#1,#2.

Fischer’s Ultrapack packers
- Small
- Regular
- Large.

GingiBraid:
They are available in both plain and
impregnated types.
They are impregnated with 10% pottasium
aluminium sulphate.
They are braided.

Available in different
sizes:
0(n)
0(a)
1(n)
1(a)

Chemical used: Al chloride, Al sulphate,
ferric sulphate, epinephrine.

Gingival retraction
instrument is
Retracta-Gard.
Bin angle, 0.5mm
thick, 3mm wide, light
and slender polished
shank.

Inserting the
retraction cord:

Gingigel.

Veneer preparation.
Ultrasonically
clean the veneer in
acetone for 5 mins

Dry thoroughly and apply silane coupling
agent

Apply a thin film of light cured dentin –
enamel adhesive liner to the etched
surface of the veneer.
Donot light cure.
Place veneers in light protected area.

Tooth preparation.

CLEAN TOOTH WITH PUMICE

Check interproximal contacts of the teeth
using metal strips(0.0005’’)

PASSING OF ULTRA THIN DIAMOND
COATED METAL STRIP TO LIGHTEN
THE CONACTS

METAL STRIP PLACED

LOADING VENEER WITH RESIN
CEMENT

SEATING THE VENEER

VENEER CARRYING STICKS
(GRAB IT-CHAMELEON
DENTAL PRODUCTS)3

EXCESS CEMENT

REMOVING EXCESS RESIN

REMOVING EXCESS
CEMENT FROM
LINGUAL MARGIN

VENEER TACKED BY LIGHT
CURING A SMALL SEGMENT

2-3mm tip

METAL STRIP DRAWN LINGUALLY

REMOVE ANY EXCESS LEFT

CURED RESIN CEMENT EXCESS
REMOVE
LONG POINTED 30
FLUTED CARBIDE BUR
SCALER OR CURETTE

FINISHING STRIPS-
REMOVE INTERPROXIMAL
EXCESS

ADJUST OCCLUSAL CONTACTS

POLISH USING CERAMIC
POLISHING RUBBER CUPS

Maintenance of porcelain veneers

Maintenance of porcelain veneers
consists of periodic reexamination of the
veneers as well as contiguous hard and
soft tissue.
Patient receptivity to oral hygiene
instructions and post-treatment monitoring
is optimal.

It is beneficial to contact patient within 30
days of initial placement.

The soft tissue should be examined.
If the veneer margin has a porcelain
ledge, the veneer is over contoured,
porcelain surface has been roughened, or
extraneous cement flash is still present, a
localized gingivitis may persist.

The causative factors for any such
gingivitis should be diagnosed and
eliminated at this follow- up appointment
by recontouring or polishing the porcelain.
The patient should continue to be followed
up at 2 weeks interval until gingival tissue
is healthy.

If the repeated attempts to resolve a
localized gingivitis fail , then the veneer
should be removed and replaced.

All the veneer margins should be checked
with a sharp explorer along the gingival,
proximal and incisal margins.
If any catch occurs a micro fine diamond bur
and a 30 fluted carbide bur , following by
porcelain polishing paste is used to
eradicate it.

If any marginal void is detected , a small
diamond bur should be used to make
penetration into the void.
The enamel surrounding the void is etched for
30 sec , and a polishable resin which matches
the veneer is placed to repair the void.
This resin patch should be highly polished.

Any Occlusal prematurities should be
detected and adjusted.
If any interferences present, they should
be removed , and the veneer should be
polished.

Dental hygienist should not polish the porcelain
veneers with any form of pumice to avoid
altering surface glaze and roughening the
porcelain.
If polishing is required , a silicon polishing
wheel followed by a porcelain polishing paste
should be used with the surface kept moist.

Scaling around the veneer should be
performed as with the natural tooth.

The dental hygienist should not use
acidulate fluoride solutions on any
porcelain surface.
This will effect the glaze and surface is
roughened.

Repair of veneers.
Porcelain fractures will occur ranging from
minor cracks to bulk losses of the
material.
For minor cracks, the occlusion should be
checked, adjustments made as required.

Minor intra porcelain cohesive failures
may require recontouring and polishing of
the damaged area.

Larger looses of porcelain , together with
adhesive failures, will require repair of
veneer with fine particle hybrid resin
composite restoration, or its replacement.

Summary.

Conclusion.

refereneces
1.CONTEMPORARY FIXED
PROSTHODONTICS-:STEPHEN F.
ROSENSTEIL(3 Edt.)
2.THE SCIENCE AND ART OF DENTAL
CERAMICS:JOHN W. McLEAN(VOL.I
AND II)
3.PORCELAIN LAMINATE VENEERS FOR
DENTISTS AND TECHNICIANS:ROGER
J. SMALES www.indiandentalacademy.com

4.FUNDAMENTALS OF ESTHETICS:CLAUDE R.
RUFENACHT
5.CONTEMPORARY ESTHETIC
DENTISTRY:BRUCE J. CRISPIN
6.PORCELAIN LAMINATE VENEERS:A
PRELIMINARY REVIEW(BDJ 1988:9:9-14)

6.A PROVISIONAL RESTORATION
TECHNIQUE FOR LAMINATE VENEER
PREPARATIONS:(JPD 1989:62:139-142)
7.ADVANTAGES AND LIMITATIONS OF
PLV:(JPD:1990:64:406-411)
8.PREDICTABILITY OF COLOUR
MATCHING :(JPD 1991:65:619-22

9.THE SCIENCE AND ART OF DENTAL
CERAMICS:J.W.MCLEAN:
(J.OPERATIVE
DENTISTRY:1991:16:149-156)
10.REMOVAL OF PARTIAL OR FULLY
POLYMERISED RESIN FROM
PORCELAIN VENEERSJPD
1993:69:443-444)

11.COMPARISON OF FIT OF
PORCELAIN VENEERS
FABRICATED USING DIFFERENT
TECHNIQUES:IJP 1993:6:36-42
12.CASE SELECTION FOR
PLV:QUINT INT;1995;26;311-315

13.A REVIEW OF ALL CERAMIC
RESTORATIONS:JADA 1997:128:297-307
14.FIVE YEAR CLINICAL PERFORMANCE OF
PORCELAIN VENEERS:QUINT INT :
1998:29:211-221)
15.VITAPAN 3D-MASTER:THEORY AND
PRACTICE:QDT:1999;43-53

16.FIVE YEAR CLINICAL
PERFORMANCE OF PORCELAIN
VENEERS:QUINT INT 2002:33:185-
189
17.CROWNS AND OTHER EXTRA-
CORONALRESTORATIONS:
PORCELAIN LAMINATE
VENEERS:BDJ 2002:193:73-82

18. Science of dental materials- Anusavice.
19. Art and science of dentistry- Sturdvent.

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