cerec veneers

Dr Brad Wright BDSc (Qld) LLB( Hons) FFDACLM ISCD CEREC Trainer CEREC Veneers Atlanta Cerec Day October 26 2002

Cerec Veneers

How, when & why

www.cerecsolutions.com

This presentationThis was part of a presentation given at Dr Kennedy’s Atlanta CEREC day on 10/26/2002.

This is given freely in good faith.

The only condition that applies to its receipt is that where any part of it is used, acknowledgement of the source must be given, and there must be no charge for the provision of the presentation and any images within it.

Hey I can’t help it – I am a lawyer as well !

Brad Wright Gympie Qld Australia

www.cerecsolutions.com

Veneer Procedure

• Case Selection• Preparation• Design• Shading• Naturalise / Glaze• Cementing• Finishing

Why would you do a CEREC Veneer ?

Veneers are almost always done to improve aesthetics.

We consider CEREC Veneers because of a balance of clinical indications and practicalities.

We would only consider CEREC if it is easier better or faster, or some other practicality………….

Characteristics Of Cerec Veneers

VERY Translucent

Ultimate Shade Control by operator

Characterisation is excellent

Can be time consuming for multiples

Not great for VERY big Value changes

Not great for a smile that is manufactured

Inexpensive to construct

Can be stressful

Characteristics of Laboratory veneers

Not time consuming

Very Good for multiples

Can be expensive

Can create tension with Technicians where expectations are not met

Little Shade Control by the dentist

Remakes expensive and time consuming

Can accommodate large value changes because of opacity built into ceramic.

BENEFITS OF CEREC VENEERS

No temporary

Have them today

Great Translucency

Great Ability to Individualise

Great Control

Remake is quick

Because you don’t need temporaries, you can prep dentin without concerns about sensitivity (Dr. M. Hodish)

DISADVANTAGES OF CEREC VENEERS

Translucent – must block out

Time Consuming

Individualising can be difficult

Preparations may need to be less conservative

No temporaries means you have to get them RIGHT

INDICATIONS For CEREC

Not too great a shade change

Where you have room to block out

Single and double cases

Where tooth symmetry and shape are not at issue

CONTRAINDICATIONS

Large shade and Chroma changes

Multiples, “Chiclet” style

VERY Fussy patients who will take a lot of time

Where there are issues of Symmetry and Shape

Where you have a lot of teeth showing and not a lot of time

PREPARATION INDICATIONS

Normal porcelain veneer requirements

Thicker if there are shade changes (more tooth reduction)

Go into the interproximal areas

Finish on enamel

PREPARATION RULESButt Joints interproximally

Labial Inciso Chamfer

Flat and smooth as possible

Gingival can be a chamfer also

Think about colour change

Think about labial and proximal emergence profile

Incisal Edge

The problem is poor palatal margin fit.

This may not be new, but a vary small inciso-labial chamfer will help

The Camera Problem

Conventional Incisal Wrap Prep

Why this happens

Try this…..

Makes it easier for the Camera

You get this

Instead of this

Also Try this

TECHNIQUESYou can do crowns with the veneer programme, you just MUST be able to visualise all margins from the labial.

Camera angle is what influences success with all CEREC, no less with Veneers

Crown vs Veneer – What is the difference ?

Veneer – where occlusion is not absolutely critical

Crown where occlusion is more of an issue, and where the dentine enamel walls externally are all gone

Veneer is quick simple but needs adjusting

Crown is fast complex but needs adjusting

DATABASE VENEERSimplest Programme to use

Fast Effective

Gives plenty of Ceramic to remove

Must obey certain prep rules

Where you have a freestyle tooth to work on ( so not when you are doing a row of chiclets)

How much tooth can you add, and when does a veneer become a crown ?

This is easy…

This is still easy with database

Even this can be done!!! With Veneer !

CORRELATION VENEERIdeal where you send the patient home with a mock up veneer

Allows you to copy the labial contour and emergence profiles as well as the embrasures

Ideal for cases where a copy is required

Can still do large incisal additions, but can need adjustments

CORRELATION VENEER ENDOCROWN

Variation on Correlation veneer where endo crown programme and milling characteristics ensure a well fitting veneer

SHADING

The biggest problem with CEREC veneers, are that the shading work done by our technicians must be done by the dentist.

We have to be as good as technicians are at shading.

This can be done internally, or externally

INTERNAL

Most commonly with dark teeth, some extra dentin must be removed so that an opaque layer can be added.

This is really pre-shading prior to imaging so that the baseline characteristics of the tooth are such that a translucent Cerec Veneer can be constructed over it.

This includes the cement !

EXTERNALNaturalise and glaze with Vita Akzent and Atmomat Furnace or similar

This adds the lab feel to a veneer

It can add 15-20 minutes onto the procedure

TRY INAdjust to seat.

Bond (no etch on Ceramic or tooth) with flowable

Adjust shape

Polish

Cement before Etch with your cement and set

Check Colour again

CEMENTATION

Do a try in with your cement of choice – cured but not bonded. MOST cements give a significant value shift ( darker) on light curing !!

As per normal CEREC

Use light or dual cure (I prefer dual cure)

Miscellaneous

Perhaps make a resin provisional where you are to make a significant shape or length change at the consultation

If you have to temporise, some flowable is fine if it is not bonded to the veneer or tooth structure

To conclude..

Be Prepared to give veneers a try – its fun

It is the most underused (except perhaps Function) of the suite of programmes.

Is very cost effective

Can make a veneer with Cerec and add porcelain or have your technician chraracterise them

Thanks

I would like to sincerely thank Dr Jim Kennedy Decatur GA, for the opportunity to speak at his weekend.

I would like to acknowledge Dr Sam Barr Oneida NY for his help in this presentation. If it wasn’t for selfless distribution of material on Cerec, many of us would not being enjoying the success we are.

I would like to thank Mr Geoff Staples of Halas in Brisbane Qld Australia and Mr Roddy McLeod of Shalfoon in Auckland NZ for their assistance and encouragement.

cerec veneers

dr kennedys atlanta

benefits of cerec veneersfast

great control remake

time consuming individualising

little shade control

contraindicationslarge

chroma changes multiples

large value changes

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