Learning objectives

• Define veneer
Ceramic Veneers
Dr Jason Wang BDS DCD
Specialist Prosthodontist
• Indications and Contraindications
• Understand preparation designs and features
• Understand path of insertion and amount of tooth
structure removal
• Explain the difference between enamel and dentine
bonding
• Describe veneer provisionalization technique
• Describe veneer cementation technique

What is a ceramic veneer

• Bonded ceramic restoration: anterior
• Ceramic bonding
• Tooth (enamel and dentine bonding)
• Path of insertion: commonly buccal
• Boundary between crown and veneer can be loose
• 360 veneers/creneers
Indication of ceramic veneers Contraindication of ceramic veneers
• Shape and size change • Caries/perio and other unresolved active disease
• Peg laterals • Heavily restored/broken down tooth lacking enamel
• Traumatic damage
• Minor alignment issues • Labially proclined teeth
• Colour change • Moderate to severe alignment issues
• Trauma+/- RCT (cannot completely resolve with ext/int bleaching) • Severe discolouration
• Surface defect/hypocalcification
• Tetracycline (cannot be completely resolved with ext bleaching) • Parafunction/bruxism
• Largely intact tooth with abundant buccal enamel • Unrealistic expectation/body dysmorphic
 Why do we do it Things to watch out for
• Achieve shape/size/colour change without removing • Cost
as much tooth structure as a conventional full crown • Difficult to temporize
• More durable than CR, resistant to stain and wear and • Colour is not completely predictable
tear
• Debond risk
• Quicker than orthodontics but carries a biological
• Limited ability to repair
restorative burden

Bond to enamel Bonding to ceramic

• Predictable • Etchable ceramic only

• Durable • Lithium dicilicate
• Leucite reinforced
• Good seal • Feldspathic
• Preferably 100% margin
• Strict protocol to achieve
• Stiff substrate SILANE BONDING
Diagnostics Veneer preparation guidelines
• Varies in shape
• Plan before you prep • Goal is to achieve enough space while removing as little
tooth as possible
• Models • Depth cut
• Depth wheels
• Photos • Additive approach
• Stay in enamel as much as possible
• S i e De ig • Space requirement (0.3- 0.8mm) depends on
• Material selection

• Wax up
• Colour correction require 0.3mm per step
• Light rounder shoulder or deep chamfer(0.3-0.5mm)
•
• Mock up •
No incisal reduction or 2mm
Decision about interproximal contacts
• Consent • Buccal path of insertion

Veneer preparation guidelines Crown prep vs Veneer prep

• Varies in shape
• Goal is to achieve enough space while removing as little • Palatal coverage
tooth as possible
• Depth cut • Buccal path of insertion
• Depth wheels
• Additive approach
• Stay in enamel as much as possible
• Lack of resistance form
• Space requirement (0.3- 0.8mm) depends on
• Material selection
• Structure removal (Edelhoff
•
• Colour correction require 0.3mm per step
Light rounder shoulder or deep chamfer(0.3-0.5mm)
and Sorenson 2002)
• No incisal reduction or 2mm
• Decision about interproximal contacts
• Buccal path of insertion
Crown prep vs Veneer prep A no e abo enamel As
• Palatal coverage
• Buccal path of insertion
• Lack of resistance form
• Structure removal (Edelhoff
and Sorenson 2002)

Provisionalisation
• Difficult and unpredictable
• Warn the patient it may dislodge
• Spot etch technique
Cementation
• Conventional non self adhesive resin cement only
• Strict bonding protocol and moisture control
• Colour of cement
• Try in paste
• Watch out for colour stability
• Light cure only
• New generation dual cured
Outcome
Layton and Walton 2007
• Feldspathic only
• 80% enamel
• 96% at 5 to 6 years, 93% at 10 to 11 years, and 73% at 15 to 16
years
• Aesthetics (31%), mechanical complications (31%), periodontal
support (12.5%), loss of retention (12.5%), caries (6%), and
tooth fracture (6%)
• If you do 8 veneers it will be 0.93 to the power 8= 56%
 Wh o probabl on be able do his
Commercialisation in student clinic
• Marketing • Panavia F is the only resin cement available in student
• B a ded Ve ee
• Eg Glamsmile, Lumineers clinic which is not colour stable
• N Pe • Difficult to provisionalise
• Remember what you are: a health care professional
• Patient need to be aware of the irreversible nature of this treatment • Lab support long turn around time
• Veneers -> Veneers -> Crowns -> Crowns+/-RCT ->Tooth loss? • Diagnostic ability
• Ca he a ie b e be ed i h h d ic a d
bleaching?
• Would you do this to your family
Questions?