Operative 20 Veneers
Operative 20 Veneers
Operative 20 Veneers
Dr.Mona
The Art of Smile Design
Using Dental Veneers
وبعدين نبدأ الساليدسveneers هنبدأ بمقدمة سريعة عن ال
-laminated veneers became a want-based dentistry not a need-based
dentistry.
يعني دلوقتي المرضي بيطلبوه بنفسهم
# the steps of the procedure:
- treatment planning
- designing
- fabrication
- cementation which is the most critical step as most of veneers failure
due to bonding
# it could be :
- direct composite resin
- indirect composite resin
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- ceramics
- hybrid composite
- hybrid ceramics
● History of veneers:
- introduced into dentistry around 1938 ( by charles pinus )
- faunce and calamia 1987 (work on adhesion)
- They became a more reliable procedure after the introduction of acid
etching and silanization of the veneers before cementing them with a
resin luting cement (1990s).
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● Indications for Veneers: (essay#)
-Alignment : to certain extent as minor alignment or major alignment
provided ( patient with major alignment is going an ortho RX )
بس بعد االورثو لو الحالة تستاهلveneers ممكن نحطmajor في ال
- Diastema closure
- Shape
- Size: peg laterals ( veneers are the best Rx as minimally invasive )
- color: extrinsic staining, fluorosis, non-vitality, yellowing teeth by age
and pipe smoking
دلوقتي الموضوع اختلفindicated for crown زمان كان اي سنة بنعملها اندو بتكون
في البدايةdiscoloration وبعد كذا سنة نالقي حصلtrauma لما بيجيلنا بيشنت اخد
تسمح بكده ساعتها بنلعبbite لو الveneers وبعدهاnon vital bleaching بنعمل
لون السنةblock عشان نresin cement بالوان ال
- tetracycline cases
- to correct discrepancies in tooth size and length. ( open bite cases as
there is no stress on incisal edges )
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● Contraindications (essay#)
- Aesthetic veneers, regardless of their type, should not be performed
under the following circumstances:
- N.B : Do not to place porcelain veneers on any tooth that has more
than 30% exposed dentin after preparation.
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4. To be able to copy well tooth natural colors, both at cervical and at
its middle portion and incisal.
5. To be biocompatible
6. To be wear resistant.
7. To be highly resistant to staining.
8. To be easy to perform.
9. When in service, to resist fracture and be easily repaired or
substituted in case fracture does occur.
- the composite block , the are not pure composite , they are
composite resin and ceramic
- so it is not brittle , resilient like dentin that reduces fracture .
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علشان تبقيcomposite فاضافوا عليهاbrittle الخام بتكونceramic الفكرة جت ان ال
more resilient
■ VITA ENAMIC
- The first hybrid ceramic that combines the best properties of polymer
and ceramic.
مش رخيصة ابدا بس يعتبروا الindirect composite blocks بالرغم ان اسعار ال
ceramics بتاعهم افضل كتير من الbonding
-N.B :
- if you make a ceramic veneer , you need a finish line as a step
veneer يعني حاجة تقعد عليها ال
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Advantages of Pressed Ceramics
• Strength : at least two times stronger than feldspathic.
• Wearability : Pressed ceramic porcelain is less abrasive to opposing
teeth than feldspathic porcelain.
او الempress لوحده مش وحش وكتير بيستخدموه لكن لو جيت قارنته بالemax ال
light reflection and refraction حيكون فيه اختالف في الfeldspathic
TOOTH PREPARATION:
- Some controversy exists regarding the extent of tooth preparation
that is necessary and the amount of coverage for veneers
- Direct and indirect preparations are identical
# Preparation
▪ Preparation remains in the enamel
▪Facial reduction 0.3-0.5mm
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# Exception:
- facial aspect of the tooth is under contoured because of severe
abrasion or erosion.
- In these cases, mere roughening of the involved enamel and defining
of the peripheral margins are indicated ( but still need to have finish
line )
- so , minimally invasive prep with very thin margin.
mm thickness0.2 تتحمل لحدceramics وفيه دلوقتي
#Outcomes:
• Group A under-reduced
• Group B over-reduced, but within 0.1mm
• Group C over-reduced, but preferable to group B
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بس شكلها غلط ومكتوبة في ورق السنة الليpreferable to group A في الساليد مكتوبة
B فاتت
# $ conclusion:
- if you need to start a veneer prep , you need to use depth gauge burs
( gp C)
index يعني نستخدمgp B and C الدراسة ديه قديمة النهم بيقولوا ان االفضل حاليا نستخدم
>>> ودا اللي قالهdepth gauge burs ونقطع من خالله باستخدام الmock up اللي هو
# Galieb Gurell
- mock up using digital smile design ( act as a guide for cutting "mock
up guided prep" )
# Proximo-gingival متشرحش
- in all cases it is a must to go subgingival and this area , as this area
covered with free gingiva (not attached interdental papilla)
- by time recession ,exposure of finish line, stained and discoloration
would occur
WINDOW PREPARATION
■ Requires strong tooth structure at the incisal edge
■ Most commonly used on canine and posterior teeth
■ Contraindicated if the patient has any habitual function on the incisal
edge
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مش بنكسرها اال في حاالت معينة
ceramic to ceramic علشان اسهل ليه يعملcontact المعامل دايما تقولك اكسر ال
contact
- we prep in 2 facial planes (gingival 1/3, incisal 2/3)
double coded وده بظبطه باستعمال الfull coverage restoration زي كإني بعمل
burs (green and red)
- after prep ,Remove the “Lip” on the Proximal Surface Use needle
diamond bur
G.MARGINS:
- equigingival ( except proximo-gingiva >> subgingival)
-Long chamfer
-Obtuse cavosurface angle to expose the enamel prisms ends at the
margins for better etching and bonding.
- incisal overlap must be away from occlusal contact
علي الموديلinsertion عن طريق قبل الocclusal contact ممكن اتاكد من حكاية ال
قافلين فين بالظبطlowers اقفلهم علي بعض واشوف ال
- outline is proximal to contact area
H. FINISHING:
- must be rounded with no sharp internal margins ( by interproximal
finishing strips )
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● N.B : in veneer prep
- firstly , we do depth cut grooves by using burs which is cylindrical in
shape in one or two thickness
- secondly, we use double coded burs (green and red )
• green in middle and incisal thirds
• red in cervical third
loss بتاعته بتكونtip والdouble colors العادي بس بTR وده بيكون شبه ال
عشان تختفي وبكداgrooves اقل وباستامه بمشي علي الprep علشان تعملcourse
الصحthickness اكون وصلت لل
اللي جاي ده كله الدكتور مشرحتهوش في الفيديوهات وفيه ناس قالتلي المفروض ان كان له
فيديو بس منزلش عامة هكمل عادي
!اد ايه ؟prep حاالت العيادة واعرف هعملهم٣ طيب دلوقتي هنقول
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1.If Change in Shade Between Intended Veneer Shade and Prepared
Tooth Shade is 2 or Less (A3 >> A2 )مثالthen :
■ Gingival Reduction is 0.3 mm
■ Facial Reduction is 0.5 mm
يعني بيلعب في درجتين زيادة اوA2 وعاوزها تكونA3 يعني لو فيه بيشنت درجة اسنانه
نقصان بس
● Multiple teeth
- When multiple teeth are being prepared , incisal reduction should be
symmetrical (eg, both both prepared lateral incisors should be the
same length) for more uniform esthetics in the final restorations .
- After completion of all veneer preparations , the dentist should
retract the patient’s lips and confirm the preparations are symmetrical
and parallel to the horizon.
● lower veneers
الدكتورة قالت مش مهم ومش هتسأل فيه وقالت انه زمان كان مش بيتعمل من صعوبته
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- make certain of a uniform reduction of the incisal edge ده اللي نعرفه
# Techniques :
- Spot-tacked freehand composite resin
- Vacuum-formed matrix method :
• Composite resin
• Triad
• Acrylic resin
• Provisional Acrylic Resin
- Bond to a 2 mm dot at the labial of etched tooth
# Microfilled Composites
- Chemically-cured (automix) :
■ Luxatem
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■ Integrity
■ Protemp Garent
■ Temphas
- Dual-cured :
■ Provipont DC
# case :
- cured from the buccal and the lingual
•Once curing is complete the stent is removed and cured again.
• It is important to open the gingival embrasures so that they do not
impinge the papilla and be easily cleansed.
● Resin cements
• Probably the most complex case of bonding involves cementing of
ceramic restorations. 1.Enamel and dentin are etched, primed, and
bonded.
2.The restoration is etched with hydrofluoric acid and bonded with
silane coupling agent.
3. Composite cement is used to attach the bonded dental surfaces to
the silanated ceramic surfaces.
● CERAMIC BONDING
• F ETCHING
• High-Leucite Porcelains
• High-Alumina Porcelains
• Alumina Cores (ProCera)
• Zirconia Cores (Cercon, Lava)
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- Four interfaces are actually involved : tooth structure / bonding agent
/ cement / silane / ceramic.
-The principles are all the same for the situation as in others.
● Veneer try-in
• Porcelain Veneer is fragile before cementation, handle with care.
• Try-in gel: Water soluble orresinbased
• You do not have to apply the try in gel to all veneers
● Cementation
• Cementation and selection of the of the right shade and opacity is
vital
• Following the sequence of the steps is the most important for the
ease of cementation.
- Indirect ceramic veneers are cemented with Dual cure or light cure
resin cement having different shades and opacities
# Value Shading
• 7 LC value shades
- MV0 very translucent High values brighten Low values provide a
warming effect
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# case:
- Polymerize “dead center” each restoration)
- Light polymerize for at least 60 seconds per tooth from both buccal
and lingual
-“Pick" away excess using Bard Parker or scaler
-Remove excess resin cement with Scaler, #12 & #15 Bard-parker
Blades
- Ceri-saw
- 15 micron finishing diamond (Brasseler))
- 15 micron football-shaped diamond on lingual
# tooth :
Remove provisionals
Clean
Etch with H3PO4 for 20 - 25 sec ( enamel)
Rinse and dry
Apply adhesive
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Light cure
# then:
- apply light cured cement onto veneer
- deliver veneer to prep
- tack cure for 2-3 seconds
- clean excess cement ( using floss )
- finish light cure
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