dental veneers

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THE ESTHETIC OPTION OF VENEERS

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THE ESTHETIC OPTION OF

VENEERS

WHAT IS MEANT BY DENTAL VENEERS?

Dental veneers are custom made shells made from tooth colored materials that facilitate covering the front surface of the tooth and these are alternately known as dental laminates.

Dental veneers are normally classified under cosmetic dentistry

TYPES A composite veneer

can be build up in the mouth by directly placing it can be fabricated in a dental laboratory

A porcelain veneer made out of cannot be built in mouth and hence fabricated

outside and fitted later.

INDICATIONS OF VENEERS

Esthetically compromised anterior teeth

Poorly shaped or crooked teeth Stained teeth (intrinsic/extrinsic) Closure of diastemas Enamel hypoplasia Fractured teeth Anatomically malformed teeth Tooth wear

CONTRAINDICATIONS OF PORCELAIN VENEERS

Crowded or misaligned teeth Teeth with inadequate enamel present Patient with habitual clenching and

grinding Non-ideal occlusion Periodontal disease Teeth weakened by existing large

restorations

ADVANTAGES OF PORCELAIN VENEERS

Esthetic stability Stain resistant Stronger and durable Gum tissue tolerates porcelain well The color of a porcelain veneer can be selected such

that it makes dark teeth appear whiter. Veneers offer a conservative approach to changing a

tooth's color and shape.

DISADVANTAGES OF PORCELAIN VENEERS

The process is irreversible More costly than composite veneers Not suitable for patients with clenching or

grinding habits Not repairable should they chip or crack Tooth may become more sensitive to hot and cold

foods and beverages They can dislodge and fall off Technique sensitive

ADVANTAGES OF COMPOSITE VENEERS

One visit procedure Less expensive Repair potential Chair-side control of the anatomy Minimal irreversible loss of tooth

structure

DISADVANTAGES OF COMPOSITE VENEERS

Tend to discolor Wear out quickly Marginal staining Shade matching difficulty Often require repair and replacement

WHAT MAKES AN ESTHETIC SMILE?

Lips should be symmetrical

A pleasing smile should ideally show canine to canine or premolar to premolar

Symmetrical gingiva

75 to 80% of max incisors showing, women show more of their maxillary incisors whereas men typically show more mandibular teeth

COMMON PROBLEMS WITH GINGIVA

Excessive root surface exposure Loss of papilla between teeth Excessive gingival display Uneven gingival contour

How to deal with these problems: For root surface exposure/loss of papillae

Crown lengthening and root grafting For excessive gingival display

Excision of excessive gingiva For uneven gingival contours

Excision of excess gingiva when needed

SHADE SELECTION Understanding tooth light interaction rather

than selecting a shade Hue, Chroma, Value Age consideration Natural color progression of dentition

Maxillary central incisor- dominates smile, color, shape and position

Lateral- similar hue to central Canine- appear darker due to intense Chroma Premolars- similar to lateral

Different shade system Increased translucency

At interproximal surface At incisal edge

Different areas of teeth Cervical area Incisal

PATIENT EXAMINATION AND TREATMENT PLANNING

Comprehensive clinical examination may reveal failing restorations, recurrent decay, marginal leakage, and staining.

A full series of intra- and extraoral images are taken for treatment planning, marketing, and case documentation. These images are studied—along with clinical examination notes—prior to treatment so that a basic plan could be formulated.

Patient’s preferences must be kept in mind while deciding a treatment plan including his/her financial status.

DIRECT COMPOSITE

VENEER

Anesthetization and tooth isolation Shades of composite are tried on Assessment on a central incisor Any existing composite resin or decay is removed Tooth is roughened and a slight finish line is created Contoured anatomical matrix is placed and wedged loosely Tooth is then etched and a dentin bonding agent is applied Composite is placed and cured and shaped with a

composite roller

TECHNIQUE

Basic shape is formed with a finishing diamond bur

Embrasures are shaped and refined with three levels of finishing disks

Interproximal areas are shaped with abrasive strips

Additional polishing and shaping are completed three days later

CASE PRESENTATION

CASE # 1

• Bio data: A 25 year old female presented with an unaesthetic smile.

• Chief complaint: “Discoloration of my front teeth since childhood”.

• Treatment plan: As clinical examination revealed fluorosis of the entire dentition so composite veneers were suggested and carried out on only the anteriors as per the patients demand.

After placing composite veneers

CASE # 2

• Bio data: 35 year old male.

• Chief complaint: “Unhappy with the space, shape and color of my front teeth”.

• Treatment plan: Suggested porcelain veneer as the optimal treatment but based on cost decided to use composite veneer.

Etching Bonding

Finished composite veneers

PORCELAIN VENEER

TECHNIQUEFirst Appointment (VENEER PREPARATION PROCEDURE) Shade Selection-

Clean teeth with pumice and water Select a tentative shade with your patient

participating

Tooth preparation- A uniform 0.5mm intraenamel reduction is

sufficient Preparations are extended to the gingival crest

and into the interproximals without breaking contact

Three ways to manage incisal edge coverageNo incisal edge coverageCover incisal edgeWrap around incisal edge

Impression- The retraction cord should be left in place if

possible during the impression Use a polysiloxane or polyether material for the

impression

Temporary Veneers- They are placed when necessary or desired Hand sculptured using composite, kept

supragingival and attached by spot etching

Second Appointment (VENEER CEMENTATION PROCEDURE)

Remove temporary- Care must be taken not to damage margin areas

of preparations

Clinical try-in- Contacts need to be carefully assessed Proximal contacts can be adjusted

CEMENTATION

Steps Try-in paste allow you to mask any underlying color

abnormalities and select cement shade. Apply saline solution to the internal aspect of the

veneer. Etch, rinse, dry but do not dessicate. Apply primer/adhesive to the tooth and lightly air

dry. Apply cement to the internal aspect of the veneer,

seat the veneer, clean off excess cement, light cure. Floss contacts and adjust occlusion.

CASE PRESENTATION

CASE # 1

Biodata: 66 year old female.

Chief complaint: “I hate the spots on my front teeth”.

Previous medical history: German measles during tooth development resulted in hypoplastic enamel.

Previous dental history: Areas of pitting restored multiple times with composite.

Treatment plan: Full porcelain crowns on 11, 21 and 23.

After placing porcelain veneer

CONCLUSION This procedure is becoming more common in dental

offices because everyone wants a great smile

It is a great way to change a smile that shows yellowed, stained teeth into one that makes you look fantastic.

But remember veneers are not for everyone, and if your teeth are not strong enough you will not be recommended to have the dental veneers applied

THANK YOU