Case Report 2

Feldspathic Veneers:
What Are Their
Indications?
By Edward A. McLaren, DDS, MDC; and Brian LeSage, DDS, FAACD

B
abstract

Many different materials and

treatment options are available in ased on their strength, longevity, conservative nature,
esthetic and restorative dentistry. biocompatibility, and esthetics, veneers have been con-
Various newer products, such as sidered one of the most viable treatment modalities
pressed ceramics, offer enhanced since their introduction in 1983.1,2 Still in use today,
functionality; however, in thinner porcelain laminate veneers have undergone a signifi-
dimensions, they lack the inher- cant evolution, spreading across the globe for treat-
ent esthetic beauty of traditional ment of various indications.1 Once considered merely
materials such as feldspathic as simple coverings for anterior teeth, the use of veneers has expanded
porcelain. As patient demands for into different indications, including coverage of coronal tooth structures.1
better esthetics have increased in Interestingly, today’s philosophy of using no-preparation or mini-
recent years, so too has the need mal preparation veneers is not new.3 In the early 1980s, innovative con-
for restorative materials that cepts of bonding thin pieces of porcelain to teeth with little-to-no tooth
closely mimic the patient’s natu- preparation were developed to satisfy patients’ needs.4,5 Using layered
ral dentition. Initially used for the feldspathic porcelain, these veneers were placed on the facial surfaces
creation of porcelain dentures, of the teeth to create highly esthetic results.5 Unfortunately, due to the
feldspathic porcelain has emerged advent of pressable materials and computer-aided design/computer-
as the premier esthetic material aided manufacturing (CAD/CAM) technology, the customization and
for custom veneer restorations.
high esthetic value typically seen in feldspathic veneers is being lost or
In recent years, the use of hand-
diminished.6,7 In some ways, the art of creating beautiful hand-layered
layered powder/liquid feldspathic
feldspathic veneers is akin to the ancient art of Venetian glass blowing.8
porcelain has been revived based
For example, a talented and artistic glass blower creates a unique, custom-
on its highly esthetic values and
little-to-no preparation require- ized piece that is far superior and much more stunning than something
ments. By keeping preparation to mass-produced and available at a typical retail store. However, just as a
a minimum, less tooth structure is talented glass blower undergoes challenges in creating the perfect piece,
lost and procedures are much less so do dental ceramists.8
invasive, which is exactly what
patients desire.

44 compendium April 2011 Volume 32, Number 3

Material Characteristics of Pressed Ceramic Veneers
Feldspathic Porcelain
To correct the low-strength problem, manufacturers introduced
Feldspathic veneers are created by layering glass-based (ie, products to replace feldspathic porcelains as a veneer material.8
silicon dioxide) powder and liquid materials.8,9 Silicon dioxide, These new materials, termed pressable ceramics, were manu-
also referred to as silica or quartz, contains various amounts factured to be extremely dense and demonstrated much higher
of alumina.8,9 When these aluminosilicates are found naturally strength ratings, such as flexural strengths up to 180 MPa.8 Due to
and contain various amounts of potassium and sodium, they their improved strength and composition, pressed ceramics were
are referred to as feldspars.8,9 Feldspars are typically modified considered ideal for many indications, including inlays and onlays,
in different ways to create glass that then can be used in dental anterior crowns, bicuspid crowns, veneers, and posterior crowns.8
restorations.8 Synthetic forms of aluminosilicate glasses also Pressed ceramic restorations were fabricated using the lost-
have been developed for use in dental ceramics.8 Whether these wax technique.12 The first step was to wax a pattern onto a die,
synthetic porcelains perform equally or better to naturally oc- which was then invested and burned out.12 Small ceramic discs,
curring feldspar is still debated.8 called ingots, were then melted to a thick liquid consistency and
pressed into a pattern.12 The final step was to layer powder or
liquid porcelains onto the fabricated and pressed restorations.12
Original Feldspathic Veneers
This enabled technicians to make the pressed blocks more es-
Feldspathic porcelain was the key material for creating porcelain thetically pleasing to the patient.12 In addition, pressed ceramics
denture teeth.8,9 This material provided great esthetic value and could be waxed to full contour, which continues to be a significant
demonstrated high translucency, just like natural dentition.9 Ex- advantage of this type of porcelain.13 However, these full-contour
perts in porcelain layering and veneering later would stack this restorations often appeared monochromatic and required super-
fine powder and liquid material onto a core composed of metal, ficial surface staining and glazing in order to build in the esthetics.
alumina, or zirconia to create esthetic restorations.8 Unfortunately, this process tended to lower the optical “value” of
By using a layering and firing process, ceramists then began the restoration and, further, these built-in esthetic effects would
developing veneers that could be made as optically close to be lost if any adjustments were needed to the restoration postce-
natural teeth as possible.9 When feldspathic veneers were mentation, or over time as a result of in vivo wear.
introduced, they presented 0.5 mm of thickness and tapered As CAD/CAM technologies developed, the availability of comput-
down to practically nothing at the margins.3 Refractory dies erized pressing and milling machines further simplified this process
and platinum foil techniques were used to fabricate feldspath- by developing blocks of pressed materials into the exact size and
ic porcelain veneers. 8 Feldspathic veneers could be placed shape necessary to complete the restoration.8 CAD/CAM technol-
conservatively because the porcelain could be layered very ogy for veneers, however, is still an evolving, yet promising, modality.
thinly.9 Significant loss of tooth structure was not an issue; These processes were well accepted by technicians and laboratories
the veneers were so thin that they could be placed directly because they were already accustomed to the waxing techniques
on the enamel.9 that had been used in the past to create metal- and alloy-based res-
A major concern with feldspathic porcelain veneers, how- torations and because CAD/CAM machines were becoming more
ever, was their strength, which was only approximately 70 readily available.8,12 These materials, however, required more room
MPa to 90 MPa.9 Also, when the veneers were placed without for incorporating the optical nuances of dentin and enamel, mak-
preparation, periodontal problems could occur as a result of ing more aggressive tooth preparation necessary in order to keep
overcontoured teeth with unnatural emergence profiles. 10 the veneers within the natural emergence profiles.12 Conventional
After much research, however, it was determined that feld- feldspathic veneers required tooth reduction only up to 0.5 mm, and
spathic veneers would last long term, especially when bonded it was possible to work in dimensions down to 0.3 mm.14
to enamel. Therefore, to preserve the health of the gingival Conversely, pressed ceramics required at least 0.75 mm or
tissues and prevent overcontouring, a slight 0.5-mm reduc- more of reduction.14 Another issue with pressed ceramics was
tion of tooth surface was found to work best.3 Because the their tendency to appear less transparent and less esthetically
feldspathic veneers were typically 0.5 mm, the lost tooth pleasing than traditional feldspathic veneers.9 These new pressed
structure was replaced and the original emergence profile materials tended to appear more opaque and monochromatic and
was nearly restored.3 required the addition of extra veneering porcelain to match the
To solve the perceived issues regarding strength, other types natural dentition.8,9 Newer versions of pressed ceramics are more
of porcelains were developed by manufacturers.11 However, translucent. However, in the authors’ experience, such materials
challenges arose when trying to create very thin, minimally still require an average thickness of 0.8 mm or more for work-
prepared veneers using these new materials.8 ability and high esthetics.

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 Case Report 2

Today’s Minimal or No-Preparation

Feldspathic Veneers

As patients have begun requesting less invasive treatments and

higher levels of esthetics, the use of feldspathic veneers is resurg-
ing.6,7 With this comes the desire for thinner veneers and preser-
vation of natural tooth structure.6,7 Modern feldspathic veneers
allow ceramists to create thicknesses of less than 0.5 mm, which
can be fabricated to a minimum thickness of 0.3 mm.3 Through
Fig 1. Fig 2.
the use of advanced bonding agents, the capacity to predictably
bond veneers to enamel is great as well.6,7 Today, many ceramists
are not being trained in the art of sculpting powder/liquid porce-
lains to form the highly esthetic feldspathic veneers, especially
thin veneers.8 This creates a problem because the esthetic value
exhibited in these restorations depends on the ceramist’s ability
to build depth of color and translucency into the restoration.8
Dentists and their ceramists must also know when it is appro-
priate to use this slightly weaker restorative material in order to
prevent posttreatment fracture issues.8

Indications

Although pure porcelain-bonded restorations are the most

Fig 3.
conservative and esthetic restorations, they are also the weak-
est.15 Therefore, important parameters and guidelines must be
Fig 1. The patient presented with a desire to close the diastemas.
followed when undertaking a restoration fabricated from pow- Fig 2. Try-in of a “mini” no-preparation veneer. Fig 3. Four polished
der/liquid feldspathic porcelain veneer materials.15 Generally, no-preparation “mini” veneers, postcementation.
feldspathic porcelain materials are indicated for anterior teeth
when significant enamel is remaining.8 Occasionally, feldspathic
porcelains may be used on bicuspids, but rarely on molars.8 In because dentin tends to be more flexible than enamel.8 If bond-
the case of molars, all risk assessments must present as low as ing to enamel, the flexural risk is low to moderate.8 A simple but
possible.8 Bond maintenance through absolute ideal isolation strong determinant of tooth flexure is to observe mesial–distal
procedures during cementation, or what has been described as craze/fracture lines on the lingual. Tensile and shear stress risk
protection of the internal surface of these restorations, is also assessments are also necessary when deciding on feldspathic
absolutely necessary for long-term success.8 porcelain veneers.8 Generally, higher tensile and shear stresses
Of the many factors to consider, space requirement is im- occur when there are large areas of unsupported porcelain, deep
portant and can affect the outcome of the finished restoration.9 overbites or overlaps of teeth, bonding to more flexible substrates
When creating a feldspathic porcelain veneer, it is necessary to such as dentin and composite, bruxism is present, and the restora-
realize that the space required for shade change ranges from 0.2 tions are placed more distally.8 In these higher-risk clinical situa-
mm to 0.3 mm per shade.9 It is also important to consider the tions, a pressed or machined glass ceramic should be considered.8
condition of the substrate to which the veneers will be bonded.9 Finally, there must be an absolute low risk of bond and seal failure
To successfully bond feldspathic veneers, the requirements that when placing restorations fabricated from feldspathic porcelain.8
must be met include 50% or more enamel on the tooth, 50% of
the bonded substrate must be in the enamel, and 70% or more
Case Study 1
of the margin must be in the enamel.8 It is always preferable
to preserve the cingulum and lingual marginal ridges, as these In this case, “mini” no-preparation veneers were used as an al-
anatomic landmarks provide the tooth with more than 80% of ternative to direct composite veneers. The patient presented
its strength.8,16 wanting to close the diastemas (Figure 1). Impression taking
When deciding whether to use feldspathic veneers, it is also required only 10 minutes. At the cementation appointment, the
necessary to undertake a flexural risk assessment.8 Flexural veneers were tried in (Figure 2), and the cementation and finish-
risk tends to be higher when bonding to higher levels of dentin ing protocol required only 30 minutes (Figure 3). Although this

46 compendium April 2011 Volume 32, Number 3

 Fig 10.

Fig 4. Fig 5.

Fig 6. Fig 7.

Fig 8.

case necessitated two appointments, the fact that no preparations

were required made the overall restorative process time efficient. Fig 9.

Case Study 2 Fig 4. Preoperative view of a patient presenting with a desire for
longer, fuller teeth and diastema closure. Fig 5. Facial view of mini-
In the case of a patient presenting with a request for longer, fuller mal preparations. Fig 6. Incisal view of minimal preparations. Fig 7.
View of anticipated porcelain restorations on the cast. Fig 8. Internal
teeth and diastema closure (Figure 4), extended veneers with
view of the “taco shell” veneer design. Fig 9. Post-cementation view
minimal preparations mostly in enamel were planned (Figure of the extended coverage porcelain veneers.
5 and Figure 6). These veneers covered the facial and lingual
aspects (Figure 7), and a “taco shell” preparation design was in-
corporated on the lateral and distal of the central incisors (Figure
8). Overall, this case exemplifies the use of minimal preparation
veneers when the criteria for Category 1 ceramic use are met
(Figure 9).

www.dentalaegis.com/cced April 2011 compendium 47

 Case Report 2

Case Study 3

A 35-year-old woman presented with teeth that were unsightly

due to chipping, severe wear, unnatural contours, and gingival
asymmetry (Figure 10). In addition, pre-existing composite res-
torations were on the mesial aspects of teeth Nos. 9 and 10, and
diastemas also were present (Figure 11). In this era of minimally
invasive dentistry, tooth preservation should be every clinician’s
Fig 10. Fig 11.
goal. Due to the severe damage and occlusal pathology evident in
this patient’s dentition, an occlusal equilibration and composite
mock-up for more than 5 months was performed as trial occlusal
therapy to test the proposed new length and contours.
The patient was comfortable and stable during this time.
Using a putty matrix fabricated from the diagnostic wax-
up, a bis-acrylic preparation guide was applied to the teeth.
Preparations consisted of placing 0.5-mm depth cuts into the
incisal and facial aspects of the bis-acrylic preparation guide.
A modified prepless veneer preparation (ie, according to a clas-
sification system developed by one of the authors) was made on
teeth Nos. 6 to 8, with the depth-cutting grooves minimizing the
Fig 12.
potential for overpreparation.
With minimal preparation and based on the patient’s desire
for maximum esthetics, stacked feldspathic porcelain veneers
(Creation, Jensen Dental, www.jensendental.com) were planned
for teeth Nos. 6 to 11. Completion of the minimally invasive,
stacked feldspathic porcelain veneer treatment resulted in en-
hanced smile esthetics (Figure 13 and Figure 14) and a conserva-
tive and pleasing outcome (Figure 15).

Fig 13. Fig 14.

Conclusion

Patients today demand much more from their dentists and labo-
ratory ceramists.1 As a result, highly esthetic restorations and
minimal-to-no-preparation restorations are no longer mutu-
ally exclusive. Therefore, dental professionals must consistently
find a way to select treatment options that focus on the patient’s
best interest. With this in mind, a recent resurgence in the use
of conventional feldspathic porcelain veneers has developed.7
These conventional dental restorations are generally indicated
for anterior teeth and occasional bicuspid use; rare molar place-
ment would be acceptable only when all risk parameters are at
the least risk level.8 In addition, feldspathic porcelain veneers are
ideal when significant enamel remains on the tooth and generally
Fig 15. when there is low flexure and stress risk assessment.8 Finally,
these restorations absolutely require long-term bond mainte-
Fig 10. Preoperative view of the patient’s natural smile. Fig 11. nance for success.
Retracted view of the patient’s preoperative condition. Fig 12.
View of the minimally invasive preparations on teeth Nos. 6 to 8, With increased patient demands for enhanced esthetics and
and 0.5-mm depth cuts into the bis-acrylic preparation guide as a need for restorative materials that closely mimic the patient’s
shown on teeth Nos. 9 to 11. Fig 13. Retracted postoperative view natural dentition, feldspathic porcelain represents the premier
revealing the patient’s restorations. Fig 14. Postoperative view
of the patient’s natural smile. Fig 15. Portrait view of the patient esthetic material for custom restorations that are conservative
displaying a confident postoperative smile. and predictable for appropriate indications. Based on its high

48 compendium April 2011 Volume 32, Number 3

 Mass Dent Soc. 2002;50(4):16-20.
esthetic value and little-to-no preparation requirements, feld- 10. DeLopez TE. Predictable pressed ceramic anterior restorations.
spathic porcelain enables dentists and their ceramists to provide Clinical observations. Dent Today. 2002;21(4):68-73.
esthetic treatments that are much less invasive, which is precisely 11. LeSage BP. Minimally invasive dentistry: paradigm shifts in prepa-
what patients expect. ration design. Pract Proced Aesthet Dent. 2009;21(2):97-101.
12. Roulet JF, Degrange M. Adhesion: The Silent Revolution in Den-
tistry. Carol Stream, IL: Quintessence Publishing; 2000.
Acknowledgments 13. Cattell MJ, Chadwick TC, Knowles JC, et al. Flexural strength
optimisation of a leucite reinforced glass ceramic. Dent Mater.
The dentistry and laboratory work for Cases 1 and 2 were per- 2001;17(1):21-33.
formed by Dr. McLaren. The dentistry for Case 3 was performed 14. Friedman MJ. A 15-year review of porcelain veneer failure—a clini-
cian’s observations. Compend Contin Educ Dent. 1998;19(6):625-630.
by Dr. LeSage, and the laboratory work was performed by Do-
15. Castelnuovo J, Tjan AH, Phillips K, et al. Fracture load and mode
menico Cascione, CDT, BS, from Burbank Dental Laboratory. of failure of ceramic veneers with different preparations. J Prosthet
Dent. 2000;83(2):171-180.
16. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior
ABOUT THE AUTHORS Region: A Biomimetic Approach. Chicago, IL: Quintessence; 2002.

Edward A. McLaren, DDS, MDC

Professor, Founder, and Director
UCLA Post Graduate Esthetics
Director, UCLA Center for Esthetic Dentistry
Founder and Director
UCLA Master Dental Ceramist Program
UCLA School of Dentistry
Los Angeles, California

Brian LeSage, DDS, FAACD

Founder and Director
UCLA Esthetic Continuum
Los Angeles, California

Founder and Director

Beverly Hills Institute of Dental Esthetics

Private Practice
Beverly Hills, California

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