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Veneers
by David Hornbrook, DDS, FAACD, FACE
Utilizing Silicon Matrices
to Optimize Ideal Preparation Design
Simplifying and providing
Fig. 1
predictability at your
smile-design appointment
As the clinical director of education at
Keating Dental Arts, I am asked often by
our dentists how to best take control of the
veneer preparation appointment to ensure
optimal results.
Fig. 2 With this in mind, I have created a
series of matrices that will simplify this
very important, and often times, confus-
ing appointment with your patient.
When preparing natural teeth, the goal
should be to remove a minimal amount of
tooth structure while optimizing esthetics
and function, all the while providing ade-
Fig. 3
quate room for the restorative material.
The first step in a successful esthetic
result is the initial smile-design visit. At
this appointment, the clinician evaluates
the deficiencies of the patient’s smile and
determines key elements, such as incisal
edge position, smile line, incisal edge
inclination, midline, profile, and buccal
Fig. 4 corridor. This information should then be
transferred to the diagnostic esthetic waxer
so that an aesthetic and functional wax-up
can be designed (Figs. 1-3).
The goal of the kit is to provide a set
of matrices to act as prep guides to ensure
that you do not under prep or over prep.
This kit includes an esthetically
Fig. 5 Fig. 6
designed wax-up, a stone duplicate of the
wax-up, a modelplasty model marked by
the waxer, a clear, thin, plastic suck-down
stint of the wax-up, two preparation sili-
cone matrices, and a silicone matrix of the
wax-up to be used to fabricate beautiful
provisionals easily and predictably (Fig. 4).
The facial and lingual matrices are
used as clearance guides. One is for the
buccal or facial surfaces, and the other is
for the lingual surfaces (Figs. 5 & 6).
The final item that is made is a clear
plastic matrix. This is used to match any
tissue changes in the mouth that may have
been made on the model during the wax-up
to improve symmetry and esthetics. This
clear matrix can also be used to ensure
adequate reduction (Figs. 7 & 8, see p. 58).
The diagnostic or esthetic waxer will
send you a model of the areas that had to
be modified prior to beginning the wax-up
(Figs. 9 & 10, see p. 58).
Usually these areas are marked
in black. I call this modelplasty. Any
areas where the teeth are misaligned or
over-contoured to meet the esthetic and
functional desires will need to be modified
prior to beginning the wax-up.
Using this model where changes are
made, reproduce this in the mouth (Figs.
11-13, see p. 58). I prefer to use a fine-tip
Sharpie felt pen to mark areas on the teeth
to match the reduced model.
If the enameloplasty exposes dentin,
anesthesia will be required. If the tissue
levels were modified by the waxer, this can
be evaluated and marked using the clear
matrix (Fig. 14, see p. 58).
A diode laser can be used to modify
the gingival contours to match the wax-up
(Fig. 15). After the enameloplasty is per-
formed, in the facial and lingual/incisal
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matrices try to ensure that you have
removed enough of the enamel or dentin
(Figs. 16 & 17). With a malposition­­—
instant-orthodontic case as the one pre-
sented—the facial silicone matrix is also
used to ensure enough proximal reduction
was performed to match the facial embra-
sures of the wax-up.
After reduction is verified, load the
putty matrix with a bis-acryl material,
which is placed in the mouth for two min-
utes and then removed (Fig. 18).
After putty removal, evaluate the
esthetics of the wax-up transferred to the
mouth (Fig. 19)
Fig. 7
Fig. 8
Fig. 9
Fig. 10
58 JANUARY 2016 // dentaltown.com
After aesthetics are approved, use a
Fig. 15
cutting diamond of 0.3mm–0.5mm depth
and place depth cuts into the intraoral
mock-up transfer in the gingival, middle
and incisal thirds (Figs. 20 & 21).
Depending on the amount of incisal
characteristics you want (I prefer at least
1.5mm), place a depth cut into the incisal
edge using a chamfer diamond (Fig. 22).
Fig. 16
After incisal and facial reduction is
made, remove excess bis-acryl using an
explorer or scaler, and evaluate the teeth
for any remnant of the depth cuts. Remove
the tooth structure down to the depth
cuts. Final preparations should utilize light
Fig. 11 Fig. 17
Fig. 12
Fig. 18
Fig. 13
Fig. 19
Fig. 14
Fig. 20
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chamfer margins placed at tissue level (slightly supragingival) and
rounded line angles.
The positon of the lingual margins will be determined by
where the waxer had to extend wax to achieve ideal function and
aesthetics. Due to the extent of the malpositions in this case and
the attempt to lateralize a canine, the amount of tooth structure
was significant.
After final impressions and all additional records are taken,
provisionals are made using a “shrink to fit” technique and the
original putty matrix with bis-acryl. Photos are taken of provision-
als at full-smile close-up, chin-to-eyebrow, and profile for further
evaluation and lab communication.
The objective, as mentioned previously, is to design the prepa-
rations so that the wax-up can be reproduced in ceramic, assuming
the clinician took the time to design the smile correctly and then
transfer this information to the aesthetic and diagnostic waxer.
Prep
Fig. 21 Fig. 22
The utilization of silicone matrices ensure this is the case when
used properly and decreases the chances of under or over-reduc-
ing the natural tooth structure to yield the desired results. In the
case presented, the patient was given the option of orthodontics
followed by restorative, but was adamant about only wanting
“instant-orthodontics” utilizing all-ceramic restorations.
After two years, the patient has not experienced pain, micro-
leakage, or gingival concerns, and is extremely satisfied with the
final results. ■
Questions about veneer preparation?
Comment on this article at Dentaltown.com/magazine.aspx.
Author Bio
Dr. David Hornbrook maintains an active private practice in
San Diego, California. He is also the clinical director of edu-
cation and technology at Keating Dental Arts in Irvine, Cali-
fornia. He is one of the original founders and past directors
of LVI, and founded PAC~live and the HornbrookGroup live-
patient educational programs, as well as the founding director of Clinical
Mastery. He has lectured internationally on all facets of esthetic and restor-
ative dentistry and is an adjunct faculty member at numerous universities.
He can be reached at David@hornbrook.com

Before After

Fig. 23 Fig. 24

Fig. 25 Fig. 26

Fig. 27 Fig. 28

Fig. 29 Fig. 30

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