Aesthetic Veneers: Types and Application

• Aesthetic veneers are a type of restoration that covers the unsightly areas of teeth and enhance appearance.
• They involve bonding thin laminates or facets to the prepared facial surface of anterior teeth or buccal surfaces of premolars.
• Facial aesthetics and a harmonious smile impact well-being, self-esteem, social success, and career opportunities.
• Harmony in tooth shape, shade, alignment, and positioning within the arch is fundamental for achieving an optimal dentofacial aesthetic.
• Factors like genetic anomalies, structural changes from caries or trauma, and tooth discoloration affect dental harmony.

Veneers as a Treatment Option

• Veneers are used to cover unsightly areas.
• Veneers are bonded to the facial surface of prepared teeth.
• Veneers can be applied to anterior teeth or buccal surfaces of premolars.

Techniques for Veneer Application

• Direct Techniques involve using resin composite material and do not require laboratory processing.
• Indirect Techniques use composite or dental ceramic.
• Indirect Techniques require laboratory processing.

Indications for Veneer Materials

• Resin composites are used for direct and indirect restorations, as well as luting cement.
• Resin composites use light-curing or self-curing mechanisms.
• Dental ceramics are exclusively for indirect restorations and require laboratory firing for manufacturing.

Components of Resin Composites

• Organic Monomer Matrix: A resinous base structure
• Si-Based Glass Fillers: Provide strength and X-ray opacity
• Silane Coupling Agent: Promotes adhesion
• Pigments: Enhance aesthetics
• Activators, Inhibitors, and Stabilizers: Regulate setting reactions

Goals and Benefits of Veneers

• Veneers provide aesthetic recovery by enhancing the visual appearance of teeth while preserving tooth structure.

Adhesion Mechanisms

• Adhesion occurs between prepared tooth tissue and cement and between resin composite cement and indirect restorative materials.
• Chemical Adhesion: Molecular-level contact forms chemical bonds.
• Retentive Adhesion: Includes macromechanical and micromechanical retention.

Chairside Preparation for Veneers

• Structural Reduction: Performed primarily on enamel surfaces, and may extend to the superficial dentin layer in specific instances
• The success is higher is bonding restricted to enamel due to the need for a dry surface for adhesion
• Dentine reduces success
• Preservation of Dentin is important to prevent pulpal damage and maintain better bonding to etched enamel.
• High-quality aesthetic outcomes require reproducing the original tooth's shade and translucency.

Thickness dimensions

• The incisal, middle and cervical thicknesses for the finish line are 1.1-1.3mm, 0.8-1.0mm and 0.3-0.4mm respectively.

Historical Background of Veneers

• Dr. Charles Pincus introduced ceramic veneers in the 1930s for Hollywood artists, shifting the focus from function to aesthetics.
• American cinema popularized dental treatments and emphasized having an appealing smile.
• Early challenges with ceramic veneers included thin ceramic layers bonded to teeth, and high costs made them inaccessible.
• Direct composite resin veneers were introduced as a cost-effective alternative but had limitations in aesthetics and retention.

Advancements in Veneer Technology

• New adhesive resin composite cements and composite science led to improved bonding, retention, durability, and aesthetic results.
• Improved technology led to widespread adoption of veneer techniques, increasing accessibility for direct and indirect applications.

Direct vs. Indirect Veneers

• Direct Veneers: Tooth preparation limited, faster technique in a single appointment, conservative approach with minimal tooth structure removal.
• Indirect Veneers: Preparation extends beyond surface, additional steps including impression, temporary restorations, and laboratory work.
• Indirect veneer is a less conservative procedure.

Indications for Veneers

• Tooth Discoloration: veneers are indicated where discoloration from Amelogenesis imperfecta, aging, trauma, fluorosis cannot be bleached
• Bleaching is the first option
• Structural or Aesthetic Indications: Extensive caries, multiple restorations, rotated/inclined teeth, diastema closure, short teeth, microdontia, or aesthetic transformation.
• Contraindications include bruxism, parafunctional habits, edge-to-edge occlusion, severe structural issues, inadequate oral hygiene, and periodontal disease.

Advantages of Veneers

• Achieve full coverage of the tooth's labial surface, ensuring harmony in shade and shape.
• Allow adjustments of aesthetic parameters using colored characterization materials.

Durability and Stability

• Indirect Ceramic Veneers: Greater durability and color stability, resistant to abrasion and discoloration.

Challenges with Direct Veneers

• achieving consistent color stability and high skill needed by the aesthetician to achieve ideal shade, texture and contour
• The high tendency of Direct Veneers to incorporate air bubbles during application, leading to staining and degradation.
• Limited preparation depth prevents adequate composite thickness to mask dark backgrounds, challenging natural translucency.

Treatment Planning & Simulation

• Veneers can achieve complete cosmetic transformations.
• Color, shape, size, and position of teeth, along with surface characteristics can be corrected.
• Simulation includes diagnostic wax-ups, digital smile design, and intraoral mock-ups.
• Mock-ups help visualize the final outcome and guide tooth preparation with materials like putty silicone and bis-acryl composite.
• It is necessary to evaluate the patient and determine whether to use direct or indirect techniques.

Principles of Preparation for Veneers

• Only remove a thin layer of the labial tooth surface.
• The depth of needed preparation depends on the area of the tooth, intensity of chromatic alteration, shape, and its position.
• Preparation limited to enamel avoids exposing dentin, especially in the cervical region.
• The amount of needed enamel thickness of central incisors to remove are cervical (0.5 - 0.7mm), middle (1.1 - 1.4mm) and incisal (1.2 - 1.8mm) alterations.
• Enamel thickness informs the size of rotary instruments.
• In mild chromaticity, cervical thirds to be 0.4mm. / middle and incisal thirds to be 0.5mm
• More severe chromaticity, cervical thirds to be 0.5 Middle & incisal thirds: 0.7–1 mm.
• Small or peg-shaped teeth may require less removal.
• Lingually inclined teeth: May require minimal or no labial surface preparation.
• IDS - immediate dentin sealing avoids sensitivity during temporization and seals freshly cut dentin.

Tools and Techniques

• Preparation guides ensure depth control and tooth structure removal.
• Create preparation guides with a putty viscosity silicone impression material, including a silicone base and catalyst.
• Trayless Impression Technique: involves a silicone base and catalyst mix being applied by hand in labial surfaces and adjacent teeth.
• Cutting the Impressions: Perpendicular cuts through the tooth's long axis first.
• Analyze and confirm adequate tooth structure removal.

Cervical Cavosurface Margin

• Affected by gingiva and neighboring tooth.
• Height of the lip line during maximum smile determines the visibility of the cervical tooth region.
• Placement Options: Inside gingival crevice vs closing to gingival margin.
• Cervical placement should be 0.1-0.3 mm inside gingival sulcus to hide effectively.

Proximal Margins:

• Slight Color Alterations: Proximal margins should be placed before the proximal contacts.
• Intense Discoloration: Preparation should extend halfway into contact area to mask the dark background. Extend Preparation to interproximal surfaces.

Viewing Perspectives

• Provides proper restoration of the contour, Static and Dynamic.
• The static area is observed at a 90-degree perpendicular angle and the Vision is led the gingival embrasure.
• The dynamic area can be seen at angles smaller than 90 degrees to get a better view and ensure al discoloration is reached and the right cut is achieved.

Recommendations for dentists.

• Constantly change the viewing angle to ensure no dark areas remain unprepared and the restorations covers everything that can now show.
• Integrate soft tissue during preparation.

Incisal Edge Preparation

• Designed to work with direct composite veneers, with a feathered edge type.

Three Types of Incisal Edge Preparations:

• Features a feathered edge to aid with direct composite veneers with thick incisal edges (Type II).
• Involves Incisal Reduction and butt joint -Type II
• Combines Incisal Reduction with Chamfer III - used and can work on thin incisal edges is is preferrable for ceramics.

Advantages of Overlapped incisal Edge Perparations

• Better margin.
• Provides increased strength.
• Increases aesthetics.

Clinical Benefits of Direct Veneers:

• Enamel Restriction: Typical preparation is performed in Enamel and allows minimal postoperative complications.

• Periodontal Health: Proper gingival anatomy and benefits do occur from the alterations of the teeth - Deep Overbite cases, veneers are preferable to insufficient lingual surfaces and anterior veneers which allow better pulp preservation.

• Use caution with gingiva due to need for thin material.

Sequence of Tooth Preparation

• Involves determining the maximum preparation depth, depth for tooth discoloration, periphery depths for cervical area, extending Peripheral depth, Cervicoincisal depths cutting, connecting depth and improves preservation of margin.

• If aesthetics is requried then 0.2 is inside the gum.

• The steps include connections of cuts, evaluating reduction, and refining of margins. Gingival tissue should be protected using: metallic gingival retraction/protection instrument.

• When Standardizing Depth the bur needs to penetrate the diameter of the dimensions of the teeth: No. 1011--0.8mm and will product Reductions of 0.4 No. 1012...Diameter 1.0--Reduction 0.5

In small alteraction plan 0.4 reduction In severs plan for 0.5 reduction .

Depth Limiting Points

• The Features: include inactive areas between the wheels of the point, to keep the structure and create a way to con toth. Steps : 1)Periperalcut,2Use Limited points, 3) is to connect cuts.

Incisal Edge

• Should be used with indirect veneers - needs to prevent factures, ensures durability functionality - Includes Types - 1) Butt Joint, 2)wrap Prep.

• The Advantages of Putal Chamfer - 1) Reduces shear 2) Improved Functional Guide.

1) Instruments Selection:

• Slight discoloration NO: 2135
• Darker Teeth Use: No. 1014

Technique:

• Postition Points prependicularly.

Putal Chamber Length: 0.5-1mm

• use point postioned Perpellicualr and extend point.

Direct Veneer Restoration

To begin this must include:

Material Selection;

• This can include a Composite Veneer - best with Microdyrib compositics.
• Must start with test Run.

1) Must have Mocked ups

1)Applt same Compostition to all shades 2) then see adhesion 4) see if works and pull with probe.

Then benefits include maskin

• Isolator Of Operartive file: Use retration cords or rubber dam. Acid Techqinue - with phospholic acid Rince. Prepare with prime if doing dentin. Make must that you: Etch with aprime or Bond.

• The limited preparation requires: The need for a homogenous Surface Apply layers to dential shafe - then. If for more Texture . Replace old restoration previously - this simplify preperation. Use material to add colors.

• To begin , Custom Make Matrix to isolate restoration and make the proper mold - must test the matrix: Before isolations

• Adhensive: Perfom pre with - tooth prep and Compostities layers

• Matrix: place the cutom madi matrix

• Shade - use enamel compaotite .

Then 4) Light curi

• Finish and polysh:

Indirect Veneers

• This uses composite and ceramin . Preparation is otuide the mouth.
• use for impression and scanninh
• pretreamren = enhaance tooth structire/surface

1) The Ceramincs

• Definitiion: nonmetallic / with High Temps

use in:

Metal

• all Ceraminc

• all teeth

• Characterstucv- color , stability chemical composition - structer. traditonal flendsm.

• It's importnat yo test-In before acid each is preofermed

Impression-scan- tooth prepartion of

• Purpose is to take the tooth an dmke impressions . 1)Gingital: ebsire the accutrste magain of detalits = avpd interfernce

Prodecure for Retraction cord packer:

Place thin retraction cord: in Hemopathtich

• then Remove ticker Cod. These include all the Material and steps;

• If Retratin is done then dont deep Prep. Must be high precison.