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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

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Page 1: 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

Page 2: CEREC Veneers

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

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

Page 3: CEREC Veneers

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

Veneer Procedure

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

Page 4: CEREC Veneers

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

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………….

Page 5: CEREC Veneers

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

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

Page 6: CEREC Veneers

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

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.

Page 7: CEREC Veneers

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

BENEFITS OF CEREC VENEERS

Fast

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)

Page 8: CEREC Veneers

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

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

Page 9: CEREC Veneers

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

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

Page 10: CEREC Veneers

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

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

Page 11: CEREC Veneers

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

PREPARATION INDICATIONS

Normal porcelain veneer requirements

Thicker if there are shade changes (more tooth reduction)

Go into the interproximal areas

Finish on enamel

Page 12: CEREC Veneers

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

Page 13: CEREC Veneers

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

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

Page 14: CEREC Veneers

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

Page 15: CEREC Veneers

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

Page 16: CEREC Veneers

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

Page 17: CEREC Veneers

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

Incisal Edge

The problem is poor palatal margin fit.

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

Page 18: CEREC Veneers

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

The Camera Problem

Page 19: CEREC Veneers

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

Conventional Incisal Wrap Prep

Page 20: CEREC Veneers

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

Why this happens

Page 21: CEREC Veneers

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

Try this…..

Page 22: CEREC Veneers

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

Makes it easier for the Camera

Page 23: CEREC Veneers

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

You get this

Page 24: CEREC Veneers

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

Instead of this

Page 25: CEREC Veneers

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

Also Try this

Page 26: CEREC Veneers

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

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

Page 27: CEREC Veneers

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

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

Page 28: CEREC Veneers

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

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 ?

Page 29: CEREC Veneers

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

This is easy…

Page 30: CEREC Veneers

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

This is still easy with database

Page 31: CEREC Veneers

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

Even this can be done!!! With Veneer !

Page 32: CEREC Veneers

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

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

Page 33: CEREC Veneers

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

Page 34: CEREC Veneers

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

CORRELATION VENEER ENDOCROWN

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

Page 35: CEREC Veneers

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

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

Page 36: CEREC Veneers

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

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 !

Page 37: CEREC Veneers

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

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

Page 38: CEREC Veneers

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

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

Page 39: CEREC Veneers

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

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)

Page 40: CEREC Veneers

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

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

Page 41: CEREC Veneers

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

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

Page 42: CEREC Veneers

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

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.