LAMINATE

VENEERS
CONTENTS
• Introduction
• History
• Definition
• Porcelain laminate veneer
Indication
Contraindications
Rationale for enamel preparation
Armamentarium
Tooth preparation
Facial reduction
Proximal reduction
Incisal reduction
Lingual reduction
Advantages
Disadvantages
 CONTENTS

• Composite Veneer
Tooth preparation
Direct
Indirect
• Direct vs. indirect composite veneer
• Porcelain vs. Indirect composite
veneers
• Conclusion
• References
INTRODUCTION;

One of the greatest assets a person can

have is a smile, that shows beautiful natural
teeth. When teeth are discoloured,
malformed or crooked, they are often
conscious and make efforts to avoid smiling
or causes a hand to cover the mouth or
manipulation of the lips in an unnatural
manner to make up for the defect.
INTRODUCTION;

The restoration of a smile is one of the

most appreciated and gratifying services a
dentist can render. The veneer is a
conservative alternative to full coverage
for improving the appearance of an anterior
tooth. Veneers have evolved over the lost
several decades to become one of esthetic
dentistry’s most popular restoration.
HISTORY

1938 – Dr Charles Pincus used thin

porcelain veneers to improve the
esthetics of movie stars……but it
lacked permanent bonding
HISTORY

1955 – Buonocore… research of acid

etch technique combined with Bowen’s
later use of filled resins provided
direct bonding
1968 - McCulloch …first described
the use of castable glass-ceramic
facing..
HISTORY
Horn and Calamia… reported first
porcelain facing technique.
1970 PREFORMED PLASTIC LAMINATES a
dental cosmetic technique using
preformed factory processed plastic
laminates
HISTORY
Matching preformed plastic laminates
to the teeth to be veneered and then
of modifying them until close
adaptation was achieved.
HISTORY
HISTORY

1972, Dr. Alain Rochette

published a paper detailing
an innovative combination of
acid-etched bonding of enamel
with a porcelain restoration.
 DEFINITION:
Veneer is a layer of tooth colored
material that is applied to a tooth to
restore a localized or generalized
defect and intrinsic discoloration
Sturdvent

Two types of veneers exist

Partial veneers- localised defects or
areas of intrinsic discoloration
Full veneers-generalised defects or
intrinsic staining involving most of
facial surfaces of tooth
TYPES:

Direct veneers
a.Direct partial veneers
b.Direct full veneers
Indirect veneers
a.Etched porcelain veneers
b.Processed composite veneers
c.Castable ceramics
Veneers for metal restorations
PORCELAIN LAMINATE
VENEER
PORCELAIN LAMINATE VENEER

Porcelain laminates are thin facings of

ceramic porcelain affixed directly to
teeth using a composite resin as
bonding cement.
ADVANTAGES
Less invasive
Color and surface texture of the restoration
can be matched to natural color effectively.
Good biocompatibility with gingival tissues at
the margin of the restoration
Good bond strength
Eliminate metal collars
Resistance to wear and abrasion
Resistant to solvents
Surface luster retention
DISADVANTAGES
No alterations are possible once
veneers are ready.
Technique sensitive.
Procedure is time consuming.
Are fragile…may fracture during try-in
or cementation.
Difficult to repair .
Susceptibility to pitting by certain
topical fluoride treatments
Cost
 Chipped teeth Diastema
Hypo-calcification

Peg lateral
Tooth brush abrasion Rotated teeth

Stained restorations Lingual position

CONTRAINDICATIONS
• Teeth with defective enamel formation
• Teeth having insufficient crown
material
• Teeth exhibiting severe occlusal wear
patterns, due to Para-functional habits
• Severe periodontal involvement and
severe crowding
• Poor oral hygiene
• Young permanent tooth
Insufficient fusible substrate Poor oral hygiene

Labial version
 ENAMEL REDUCTION

TO PREPARE OR NOT TO PREPARE

?
Regardless of which bonding or laminating
system is chosen, it is important to decide
whether or not to remove enamel, and if so
then how much should be removed?
RATIONALE FOR ENAMEL PREPARATION

1.To provide for an adequate dimension of

available space for porcelain material.
2.To remove convexities and provide a path for
insertion.
3.To provide space for adequate opaquing where
necessary and for the composite resin luting
agent.
4.To provide definite seat to help position
laminate during placement.
5.To prepare a receptive enamel surface for
etching and bonding the laminate.
6.To facilitate sulcular margin placement in
severely discolored teeth.
CARDINAL RULES:

The preparation should be as conservative

as possible
It should allow for a covering of
approximately 0.5mm of porcelain without
giving any overly thick appearance for the
tooth
Cleansable gingival margin
Should not penetrate the dentin if at all
possible
CARDINAL RULES:

Should not include any sharp internal angles

where stresses will be more
It should allow for free path of insertion
without any undercuts
Enough clearance must be present
interproximally.
Any area of tooth which is visually
accessible must be covered by porcelain
ARMAMENTARIUM

Veneer preparation kit

Two grit diamond burs

Depth cutters
LVS 1-.3MM
LVS 2- .5MM
TOOTH PREPARATION
• Enamel reduction should be considered
from five distinct aspects….
– Facial reduction
– Proximal reduction
– Sulcular extention
– Incisal reduction
– Lingual reduction
LABIAL REDUCTION:

The preparation should remain within enamel

whenever possible and most certainly at all
peripheral marginal areas
There are several methods to guage the amount of
enamel removed most effective being LVS system or
use a no.1 round bur
Hold the bur at a slight angle so that indentations
can be made into enamel to the depth limited by the
base of the shank
LABIAL REDUCTION:
Position the depth cutter on the labial aspect of
tooth to be prepared

Oblique view showing 0.5mm striations cut into the

enamel by the depth cutter
LABIAL REDUCTION:
LABIAL REDUCTION:
LABIAL REDUCTION:
Place the two grit diamond into position and
prepare the interspersed enamel down to the
depth of the striations

The discolored incisor is painted green to help

guide the depth cuts.
LABIAL REDUCTION:
• The special three-tier extra-coarse diamond depth
cutter comes in 0.5-mm (LVS-1) and 0.3-mm (LVS-
2) thicknesses and is so efficient that usually one
sweep across the labial surface completes the
depth cut. Since the veneer will be
approximately0.6 mm in thickness (up to 0.8 mm in
darkly stained teeth), the 0.5-mm bur will generally
be the depth cutter of choice unless over-building
is desired.
 LABIAL REDUCTION:
• After completing the depth cut the remainder of the
preparation is completed with the two grit diamond.
The body of the diamond contains extra-coarse grit,
which leaves a rough finish on the preparation to
maximize
LABIAL REDUCTION:
The distal aspect of the tooth has been reduced to
the depth of the depth cut striations. The mesial half
of the tooth still has the grooves and remaining
enamel present.
INTERPROXIMAL REDUCTION:
The margin of the porcelain laminate should generally
hidden within the embrasure area
This is achieved with LVS two grit bur moving the
margin into this embrasure area and just lingual to the
buccal surface of interproximal papillae
This also facilitates the addition of porcelain bulk into
this region
Step preparation should be avoided at the gingival end
as it could create an unsighty dark shadow when the
veneer is placed.
The reduction should extend into the contact area,
but it should stop just short of breaking the contact .
INTERPROXIMAL REDUCTION:
Use two grit diamond to enhance the reduction in the
interproximal areas and increase the potential
thickness of porcelain
INTERPROXIMAL REDUCTION:
Use the abrasive strip to demarcate the contact
areas by reducing the lingual areas by reducing the
lingual aspect of the interproximal point and the
abrasive side will reshape the contact areas rather
than separate them
 INTERPROXIMAL EXTENSION:
• Reprox diamond strips are rapid cutting because they
contain diamond grit on both sides. They are good for
modifying interproximal area
INTERPROXIMAL EXTENSION:

When multiple adjacent teeth are prepared, contacts

should be opened to facilitate separation of dies without
damaging the inter-proximal finish line.
TOOTH PREPARATION
Static area of visibility Vs Dynamic area
of visibility:
Static area--Entire labial tooth surface,
gingival area, labial to contact area with
adjacent tooth is visible if the available light
and perspective of the viewer is optimal
Dynamic area—labial embrasure is partially a
function of viewing perspective..influenced by
shadows from the surrounding structures- lip,
adjacent tooth contour & position, gingival
contour, shade, position of tooth under
observation.
TOOTH PREPARATION
Proximal contact area:
When the shade difference between
the tooth & final restoration is minimal,
proximal chamfer finish lines are placed
labial 0.2mm to contact area
Advantage:
Ease in evaluvating marginal fit
Access for perfoming & evaluvating finishing
procedures
Access for home care
Ease in evaluvating marginal integrity during
following maintanance visits
TOOTH PREPARATION
Entire embrasure visible-finishing line must placed into the
contact area
Partially visible-margins within nonvisible area
Majority not visible-margins need not to placed as deeply into
interproximal area
TOOTH PREPARATION
Proximal contact area:
Disadvantage:
Eventual staining of tooth restoration
interface
TOOTH PREPARATION
PROXIMAL SUBCONTACT AREA:
Interproximal tooth structure immediately
gingival to the contact area with the
adjacent tooth
 INTERPROXIMAL EXTENSION:
Proximal finish lines:
Chamfer finish lines is preferred except for
diastema cases
Diastema cases-feather edged finish line
SULCULAR MARGINAL PLACEMENT:
Preparation right at the gingival margin however it is
desirable to place within the sulcus
No need to go any more than 0.05 – 1mm into the
sulcus even to remain supragingival if dramatic color
change is not high priority
ADVANTAGES OF RETRACTION CORD:
Access for the diamond
Less gingival trauma
Direct vision of the margin during all procedures
SULCULAR MARGINAL PLACEMENT:

Place a thin braided retraction cord lightly into the

sulcus
SULCULAR MARGINAL PLACEMENT:
• With the tissue displaced, the gingival margin can now
be placed just into the gingival sulcus.
SULCULAR MARGINAL PLACEMENT:
The modified chamfer developed by the two grit
diamond seems to be the preparation of choice
BENEFITS:
Increased bulk of porcelain at the margin hence
increased strength
A definite stop to aid in seating
Increased accurate fit
Correct enamel preparation exposing correctly aligned
enamel rods for increased bond strength at the
cervical margin
INCISAL OR LINGUAL REDUCTION:

In general never end the incisal edge where

excursive movements of the mandible will cause
shearing stresses across the junction of porcelain
laminate and tooth
J.S. Clyde and A.Gilmour(Porcelain
Veneers : A Preliminary Review BDJ 1988; 164:9, 9-
14)There are 4 techniques for incisal preparation
In the first: the prepared facial surface is
terminated at the incisal edge. (feathered incisal
edge)
There is no incisal reduction or preparation of the
lingual surface.
INCISAL OR LINGUAL REDUCTION:

In the second: the incisal edge is slightly

reduced and the porcelain overlaps the
incisal edge, terminating on the lingual
surface(overlapped incisal edge)
INCISAL OR LINGUAL REDUCTION:
In third :the incisal edge is reduced and a
bevel is given at the expense of labial
surface and incisal edge to a depth of 0.5-
1.0mm (incisal bevel preparation)
In fourth: there is an intra enamel window
preparation design .This is given to
protect the veneer
INCISAL OR LINGUAL REDUCTION:
Use two grit diamond to enhance the
reduction at the incisal edge to facilitate
increased porcelain thickness at the
peripheral area
INCISAL OR LINGUAL REDUCTION:
Incisal depth cuts using a round tapered
fissure bur
Facio-lingual thickness of the tooth, the
need for esthetic lengthening, and occlusal
considerations will help to determine the
design of the incisal edge.
For most of the patients coverage of the
incisal edge is preferred as it provides a
vertical stop that aids in
proper seating of the
veneer.
INCISAL OR LINGUAL REDUCTION:
The tooth structure between the grooves is
removed with a round tapered diamond bur
Create the lingual finish line using a round
end tapered diamond bur.
It should be 1/4th the way down the lingual
surface, preferably 1.0mm from the centric
contact, and connecting two proximal finish
lines.
INCISAL OR LINGUAL REDUCTION:
Placement of the lingual finish line for
laminate veneer will depend on…
– Thickness of tooth
– patient’s occlusion
– When ever possible , the finish line
should be placed on the lingual surface.
The final step in the preparation is
the production of a smooth enamel
surface, achieved with fine diamond
bur carried across the enamel with a
light sweeping motion, followed by
polishing with small diameter,
waterproof, flexible discs.
12 fluted tungsten carbide bur
30- micron round end tapered finishing bur
¾-inch fine garnet disc
Completed preparation
IMPRESSION

• Vinyl polysiloxane ,is an excellent material

for a final impression.

• the bite registration material should be a

putty or silicone type
TEMPORIZATION:

Mostly not necessary---- when?

May necessary-----?
Four basic techniques:
Direct composite resin veneer
Direct composite resin veneer utilizing
vacuform matrix
Direct acrylic veneer
Indirect composite resin/ acrylic resin
veneer
DIRECT COMPOSITE RESIN VENEER:
Involves the direct placement of composite
resin restorative material
No need to etch the prepared tooth
Ensure that periphery of the preparation is
not involved or compromised by etching
Removed using hand piece and diamond
stone
DIRECT COMPOSITE RESIN VENEER
UTILIZING VACUFORM MATRIX:
Vacuform matrix is made up on
preoperative plaster cast
Separate –trim the scalloping margins
DIRECT COMPOSITE RESIN VENEER
UTILIZING VACUFORM MATRIX:

Fill the labial aspect with light cured resin

& gently place on the prepared teeth
Light cure the resin
Peel the vacuform ,trim and shape it
DIRECT ACRYLIC VENEER:

Methyl methacrylate self curing acrylic

resin is used
In doughy stage manipulate the vacuform
in position over the prepared teeth
Allow it to cure, then removed from the
teeth
Trimming and polishing has to be done
Cemented over the teeth.
INDIRECT COMPOSITE RESIN /
ACRYLIC VENEER:
Methyl methacrylate self curing acrylic
resin or composite resin is used.
Fabricated in lab on a cast of the prepared
teeth.
INDIRECT COMPOSITE RESIN /
ACRYLIC VENEER:
Manipulated the matrix and material on the
cast and cure it.
Trimming and polishing done
Luted in place
LABORATORY TECHNIQUE:

Fabricated in lab by one of the four

techniques:
Platinum foil backing
Refractory models
Direct castings
CAD/CAM machining
PLATINUM FOIL METHOD:

A very thin layer of platinum foil is placed

on the die, then porcelain is coated over
the foil
Then porcelain-foil combination is removed
from the die and fired in oven
Foil is removed before porcelain try in is
done
REFRACTORY MODELS:

Most commonly used method, restoration

fired directly on the refractory die
Repeated firings are difficult once the
veneer has removed from the die
Adv:
Tight contacts and absence of gap created
by use of platinum foil
DIRECT CASTINGS:

Cast ceramic restorations are fabricated

using the “LOST WAX” technique.
Castable ceramics or castable apatite is
used.
Eliminates the need for multiple firings.
CAD/CAM:
Can be manufactured in lab or dental
office.
A model or video image of preparation is
required.
A self contained microprocessor displays
the digitized image
Preformed porcelain ingots are used to
fabricate the prothesis
After milling the ingot the porcelain is
custom stained, glazed, acid etched,
silanated and cemented with resin luting
agent.
TRY IN:

Three phase process:

The intimate adaptation of each individual
laminate to the prepared tooth surface
must be checked.
Collective fit and relationship of one
laminate to another & contact points need
to be checked.
Color is assessed if necessary modified.
COMPOSITE VENEERS
These can be placed either directly or indirectly
Three basic preparation designs exist…
1.A window preparation without extension sub-
gingivally or involving incisal angle
2.Window preparation that extends to gingival
crest and terminates at the facio-incisal angle.
3. Veneers with incisal overlapping with sub-gingival
extension.
A window preparation design is recommended
for most direct and indirect composite
veneers.
Such a preparation, preserves tooth
structure, prevent significant occlusal loading
and reduced potential for wear.
An incisal overlapping preparation is indicated
when an tooth being restored needs
lengthening or when an incisal defect
warrants restoration.
 DIRECT COMPOSITE VENEERS

The outline is dictated solely by the extent

of the defect and should include all
discolored areas
Using a coarse , round diamond bur a depth
of about 0.5 to 0.75 mm is prepared.
Usually it is not necessary to remove all
discolored enamel but it should be
extended to sound, unaffected enamel.
Acid etching followed by composite
restoration is done.
INDIRECT COMPOSITE VENEER
In recent years, laboratory processed resins
have been developed not only for use as
restorative materials in fixed prosthodontics,
but also as indirect veneering materials.
Using light, heat, vacuum, or a combination
thereof , microfilled resin materials can be
processed to achieve physical and mechanical
properties superior to those of traditional
chair side composite resins.
Round diamond bur is used.
Depth -0.5-0.6mm-midfacially
0.2-0.3mm along gingival aspect
INDIRECT COMPOSITE VENEER

Depth cut ….no. ¼ diamond bur .

Gross reduction using round end tapered diamond
bur.
Finish line … chamfer.
Interproximal extension…should be extended
beyond the interproximal line angles of tooth yet
be positioned labial to contact.
Sublingual extension …at the level of gingival crest.
Incisally.. preparation restricted to the facial;
aspect of incisal edge.
DIRECT VS INDIRECT COMPOSITE VENEERS

• Because of laboratory processing, indirect

resin veneers are more completely cured
• Also they do not experience the same in situ
polymerization problems encountered by
direct veneers.
• Direct veneers are quite time consuming.
• Direct veneers are technique sensitive and
depend on operator’s artistic ability and
attention.
• Indirect veneers offer limited bond strength
so have restricted use in cases involving heavy
functional contacts.
DIRECT VS INDIRECT COMPOSITE VENEERS

CHARACTERISTIC PORCELAIN RESIN

• Retention/strength ***

• Surface texture ***

• Longevity ***

• Repairability ***

• Ease of placement ***

• Cost ***
CONCLUSION:
With the use of a specially shaded resin
material, a thin plastic veneer and an
acid etched technique and also other
laminate veneers like porcelain and
ceramic veneers, an esthetic and
functional restoration can be produced
that will give the dentist and the
patient consistently acceptable clinical
results.The greatest advantage of this
technique is it gives maximum esthetic
effects and requires minimum or no
tooth preparation.
REFERENCES:

Textbook of Esthetic dentistry : an artist

Science- Ratandeep Patil.
Art and science of Operative dentistry-
Sturdevant: 4th ed
Fundamentals of fixed prosthodontics-
H.T.Shillinburg : 3rd ed
.Porcelain laminate veneers :David
A.Graber, Ronald E. Goldstein, Ronald A.
Feinman
Color atlas of porcelain laminate veneers:
Freedman and McLaughlin. 1st ED
THANK
U