Ceramic Veneers Preparation

Dental Ceramics

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types of materials Leucite Reinforced Porcelain Made by heat pressure and CAD/CAM:IPS e.max (lithium disilicate)Advantages of Ceramic Laminatescolor bond strength periodontal health resistance to abrasion strength resistance to fluid absorption estheticsAdvantages of Ceramic Laminates colorthe ceramic veneer offers inherent color control and natural appearance as well as the ongoing stability of bothAdvantages of Ceramic Laminates bond strengththe bond of the etched veneer to the enamel surface is stronger than any other veneering systemAdvantages of Ceramic Laminates periodontal healththis highly glazed porcelain surface provides less of a depository area for plaque accumulation -Minimal tissue responseAdvantages of Ceramic Laminates resistance to abrasionthe wear and abrasion is high compared to composite resinAdvantages of Ceramic Laminates strengthonce bonded, they integrate with the tooth structure and become durableAdvantages of Ceramic Laminates resistance to fluid absorptionporcelain absorbs fluids to a lesser degree than any other veneering materialAdvantages of Ceramic Laminates estheticsconsiderably better than any other veneering material can be stained both internally and superficially, and has a natural fluorescenceAdvantages of Ceramic Laminates esthetics: considerably better than any other veneering material because of the ability tocontrol color and surface texture with ceramicConsiderations (disadvantages) for Ceramic Laminates :time repair color tooth preparation fragility temporization costConsiderations for Ceramic Laminates : timethe placing of the veneer is technique sensitive and therefore time consuming. requires two patient visits, making of impressions, and laboratory feesConsiderations for Ceramic Laminates : repaircannot be easily repaired once they are luted to the enamelConsiderations for Ceramic Laminates : fragilitythe veneers are fragile and need experience to manipulateConsiderations for Ceramic Laminates : colorit is difficult to modify color once the veneers are luted in position on the enamel surfaceConsiderations for Ceramic Laminates : tooth preparationsome tooth prep is required to prevent potential problems associated with over contouringConsiderations for Ceramic Laminates : temporizationChallenging to temporize prepared teethConsiderations for Ceramic Laminates : costshould depend on difficulty of patient problem, the time, level of skill, artistic requirements, planning and lab costs involvedIndications of Ceramic Laminates:discoloration correction of developmental abnormalities diastema malpositioned teeth consider orthodonticsIndications of Ceramic Laminates: discolorationtetracycline staining intrinsic staining fluorosis and even teeth darkened with age can benefit by the processIndications of Ceramic Laminates: correction of developmental abnormalitieshypoplasia amelogenesis imperfecta malformations (peg laterals, microdontia)Indications of Ceramic Laminates: diastemagaps and other multiple spaces can be closedIndications of Ceramic Laminates: malpositioned teethdeveloping the esthetic illusion of straight teeth where teeth are actually rotatedContraindications of Porcelain Laminates :available enamel ability to etch enamel oral habits occlusal interference darkly stained teeth periodontally involved teethContraindications of Porcelain Laminates : available enamelthere should be enamel around the periphery of the laminate, not only for adhesion but also to seal the veneer to the tooth surfaceContraindications of Porcelain Laminates : ability to etch enameldeciduous teeth and teeth that have been excessively fluoridated may not etch effectivelyContraindications of Porcelain Laminates : oral habitsbruxism or tooth-to-foreign-object habits may not be candidates for veneers. The shearing stress may be too great for the ceramic to withstandContraindications of Porcelain Laminates : occlusal interferenceedge to edge relationships, crossbiteLevels of Tooth Reduction1. Minimal or no tooth preparation 2. Slight or moderate enamel reduction 3. Tooth reduction through enamel to dentinLevels of Tooth Reduction 1. Minimal or no tooth preparationSmall teeth Lingually tilted teeth Adequate tooth size, unfavorable colorLevels of Tooth Reduction 2. Slight or moderate enamel reductionModerate discolorationLevels of Tooth Reduction 3. Tooth reduction through enamel to dentinEasier for doctors or lab technician Used for severe discoloration In some situations, deeply-cut veneers are not as predictable as full-coverage crownsTreatment Visits1-treatment planning 2-preparation 3-insertion 4-final finishTreatment Visits 1-treatment planningimpressions for study models (full arch alginate) bite registration record mounted study models shade selection diagnostic wax-up radiographs photographsTreatment Visits shade selectionShade selection-indicated modifications noted. Determine the position, contour, size, and amount of tooth preparation involvedTreatment Visits 3-insertiontry-in cementation gloss finishRationale for enamel preparationto provide adequate space to remove convex lines and create a path of insertion to provide adequate seat during veneer placement to prepare a receptive enamel surface to facilitate sulcular margin placementRationale for enamel preparation to provide adequate space forthe veneer for opaquing and for the composite resin cementRationale for enamel preparation to prepare a receptive enamel surface foretching and bondingveneer preparation Enamel Reduction:1- Labial Reduction 2- Interproximal Extension 3- Sulcular Extension 4- Incisal Modification 5- Lingual Reductionenamel reduction 1- Labial ReductionDepth guide Remove the remaining enamel to the depth of the original groove to reduce the tooth to the exact amountenamel reduction 1- Labial Reduction depth guideto create horizontal striations or depth-cut grooves on the labial aspect of the tooth.enamel reduction 1- Labial Reduction how much reduction should be adequate for most situations?0.5mm1- Labial Reduction depth cutters functionControl depth of the facial tooth preparation.1- Labial Reduction depth cutters when the color changes are 2 shades or less, which depth cutters are used?0.3mm and 0.5mm1- Labial Reduction Preparing the incisal 1/3rd The preparation must reproduce the ______ of a maxillary central incisor and caninenatural convexity1- Labial Reduction Preparing the incisal 1/3rd Minimum reduction thickness at the junction of the middle and incisal thirds0.7mm1- Labial Reduction Preparing the incisal 1/3rd common errorincisal 1/3 too far labially1- Labial Reduction include incisor 1/3 or not??? A retrospective study shows that there is ______no difference between 2 preparation designs and the longevity.1- Labial Reduction include incisor 1/3 or not??? incisal reduction advantageshelps seat veneer increase mechanical resistance of veneer2- Interproximal Extension : the marginshould generally be hidden within the embrasure area (beyond the mesiobuccal and distobuccal line angles-visible area)2- Interproximal Extension : contact areashould be preserved2- Interproximal Extension : provide extra reduction in this area so as tofacilitate the addition of ceramic bulk in this region and the strengthening of the laminate around the periphery2- Interproximal Extension : When to include the contact?closing a diastema changing the shape or position of a group of teeth the existence of caries defects or pre-existing composites2- Interproximal Extension : When to include the contact? closing a diastemayou may extend the prep to lingual3- Sulcular Extension:margins should be located subgingival retraction cord is advised3- Sulcular Extension: margins that are ______ provide the best resultfully exposed and cleansable3- Sulcular Extension: subgingival margins should be placed about....half of the width of the crevice depth (0.5mm subgingival)3- Sulcular Extension: retraction cord is advised to ensure....access for the diamond, less gingival trauma, and direct vision of the margin during all procedures3- Sulcular Extension: finish line configurationchamfer (conservative thickness +/- 0.25 mm)3- Sulcular Extension: mean enamel thickness in gingival area0.4mm - 0.3mm4- Incisal Reduction2 ways of finishing: no incisal overlap vs incisal overlap4- Incisal Reduction no relation between ______ due to incisal prep designsurvival rate due to4- Incisal Reduction incisal overlapincreases the mechanical resistance of the porcelain veneer4- Incisal Reduction no overlapping veneerhas more resistance to axial stress, more conservative4- Incisal Reduction smile line and incisal length: if the laminate overlap the incisal edge, the restoration will have....a positive stop during seating4- Incisal Reduction smile line and incisal length: if added length is desirable, the prep of the incisal edge should be....at least 1 mm with rounded buccal and lingual line anglesRegistration or ImpressionUse Retraction Cord -PVS impression -Polyether impression -Optical ScanInterim Restoration typesFacial template from the wax up and a flowable composite Hybrid composite No temporization Conventional resin provisional using TempBond Clear or non eugenol cementTemporary cementnon-eugenol temporary cement use spot bond bonding agenttemporary cement non-eugenol temporary cement typesTempBond (Kerr) UltraTemp (Ultradent) Polycarboxylate TempBond ClearTempBond ClearNote: No opacity is showing through the interim restorations because clear cement was usedUse spot-bond flowable compositeprepare tooth spot etch with phosphoric acid only add bonding agent to those spots slide temporary over with temp bond clear or just use bonding agent and light cureVisit 3, Try-inpay attention to prep surface use pumice isolate and dry teeth moisten the laminate veneers clean the veneer with alcohol or acetone etch, rinse, and dryVisit 3, Try-in use pumice toclean prep surfaces and wash thoroughly (if temporary cement remnant, laminate veneer may not seat all the way)Visit 3, Try-in moisten the laminate veneers withwater or try-in paste to check for fit and shade

Ceramic Veneers Preparation

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