Porcelain Laminate Veneers Taylor
-
Upload
spartak-ianakiev -
Category
Documents
-
view
227 -
download
1
Transcript of Porcelain Laminate Veneers Taylor
![Page 1: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/1.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 1/41
Porcelain Laminate Veneers Porcelain Laminate Veneers
Peter A. Taylor BSc, DDS, Oakville, Ontario
![Page 2: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/2.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 2/41
¶A captivating smile showing an even row of natural,
gleaming white teeth is a major factor in achievingthat elusive dominant characteristic known aspersonality.·
Dr. Charles Pincus, 1938
Historical Perspective
![Page 3: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/3.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 3/41
Fea tur es of PLV·s
Advant agesAdvant ages
ColourBond StrengthPeriodontal HealthResistance to AbrasionInherent StrengthResistance to Fluid
AbsorptionEsthetics
Di sadvan t agesDi sadvan t ages
TimeRepairTechnique-sensitiveColourTooth PreparationFragility
Cost
![Page 4: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/4.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 4/41
![Page 5: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/5.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 5/41
Diastema Closure
Malpositioned Teeth
![Page 6: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/6.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 6/41
Malocclusion
Worn Restorations
![Page 7: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/7.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 7/41
Aging
Wear Patterns
![Page 8: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/8.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 8/41
Agenesis of the Lateral Incisor
![Page 9: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/9.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 9/41
Porcelain Materials for Veneers
Pressable CeramicsPressable Ceramics
eg. Empress 2high equipment costshigh strength
many indications
Feldspathic PorcelainFeldspathic Porcelain
highly estheticconservative preparation0.3 mm thickness possible
![Page 10: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/10.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 10/41
PRINCIPLE
The long-term preservation of the tooth²restorationcomplex.- requires the achievement of a sufficient ceramicthickness to provide the restoration with some intrinsicmechanical resistance.
-recommended thickness:
cervical < 0.3-0.5mmmiddle & incisal thirds 0.7mmincisal coverage 1.5mm
Pascal et al. 2004
![Page 11: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/11.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 11/41
ToothTooth--Preparation StrategiesPreparation Strategies
1. Driven by the existing tooth surface.
![Page 12: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/12.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 12/41
2. Driven by the final volume of the preparation
![Page 13: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/13.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 13/41
1. Preparation Driven by Existing Tooth Surface1. Preparation Driven by Existing Tooth Surface
- goal is to remove a uniform layer of the toothstructure
- using burs with calibrated diamond rings- reduced diagnostic steps- intrinsic principle is the reproduction of the initialsituation( form and function)- can lead to dentin exposure- cases are rare and typically involve patients withdiscolored teeth
![Page 14: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/14.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 14/41
Existing Tooth SurfaceExisting Tooth Surface
![Page 15: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/15.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 15/41
2. Preparation Driven by Final Volume of Restoration2. Preparation Driven by Final Volume of Restoration
-diagnostic approach that requires a high level of
communication with the dental laboratory- aim is to restore the original volume of the tooth- cases include patients with thin enamel or alteredtooth shape- diagnostic wax-up mandatory- saves hard tooth structure as well as the criticaldentin- enamel junction- key: well-adapted horizontally sectioned siliconeindex from an additive wax-up
![Page 16: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/16.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 16/41
Final Volume of RestorationFinal Volume of Restoration
Step 1- Preliminary restorative goal
![Page 17: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/17.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 17/41
Step 2- Fabrication of corresponding acrylic template inthe patients mouth using self-curing resin( Lang DentalManufacturing, Wheeling, ILL) molded to the existingtooth surfaces with the silicone matrix.
![Page 18: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/18.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 18/41
![Page 19: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/19.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 19/41
![Page 20: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/20.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 20/41
Step 3- Conformity with the lower lip contour is ofparamount importance in esthetic evaluation in 1 or 2
weeks
![Page 21: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/21.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 21/41
Step 4- Critical step of facial reduction is assisted by
two round diamond burs
2.5mm 2.9mm
![Page 22: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/22.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 22/41
-DC 0.7 shaft is placed against the incisal third of thefacial surface- a single horizontal groove is obtained and marked witha pencil
![Page 23: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/23.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 23/41
-DC 0.5 shaft is placed against the junction of thecervical and middle third of the facial surface andscalloped
- mark with pencil
![Page 24: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/24.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 24/41
Step 5 - Remaining part of mock-up is removed followedby the use of traditional burs until the pencil marks arecompletely removed
- Round-ended, slightly tapered burs at rightangle to the initial reduction grooves
![Page 25: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/25.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 25/41
Step 6- A horizontally sectioned silicone index is used toevaluate facial clearance; a palatal index is used toassess the 1.5mm incisal clearance
![Page 26: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/26.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 26/41
Step 7- Finishing procedures include a slight proximalseparation with disks, round transition line angles withfinishing diamonds, and lastly seal dentin with
adhesive(eg. Clearfil LB2, Clinical Research, London, Ont).
![Page 27: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/27.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 27/41
Step 7- Fi nal impr ess io ns are made with appropriatesoft-tissue protocol using desired impression material.Tem poriz atio n may be completed intra-orally with thesame principles used for the mock-up with self-curingresin.
- Alt erna ti vely, a clear impression( ClearlyAffinity, Clinicians Choice, New Milford, Conn) is made ofthe wax-up.
![Page 28: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/28.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 28/41
- Spot etch if less than four preps. Lubricate lingual andsoft-tissue with a thin film of pet role um jelly. Syringef lowable c omposit e( INTRO, Clinical Research, London,Ont) directly into the facial/internal aspect of the matrixbeginning with the incisal.
![Page 29: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/29.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 29/41
- Gently place the matrix over the prepared teeth.Light-cure each preparation from the facial aspect 5seconds and remove matrix.
![Page 30: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/30.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 30/41
- Excess may be easily removed with a bladed instrument.Li ght-cu re again for 20 seconds facial and inciso-lingualareas. Polish with Enhance cups(Dentsply, 624055X) anddisks followed by Green r ubber cups(Vivadent, Size C,D).
![Page 31: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/31.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 31/41
Insertion ProtocolInsertion Protocol1. Remove temporary and thoroughly cleanse the teeth.2. Check for individual fit (passively). Microfine
diamond bur at undercuts and contact points.3. Collective fit try-in.4. Assessment of contour and colour. Initially wet only,
then using water soluble shade modifiers if required.5. Veneer placement procedure(with rubber dam):i) T issue management - lightly place #00 cord
ii) Seating sequence - central incisors individuallyfirst, laterals, and so on.iii) C hemical treatment - veneer:etch 37%phosphoric acid, rinse then silanate to enhanceadhesion for 30 sec; prep: etch, prime andcure(20sec), bond resin(uncured) air thinned.
![Page 32: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/32.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 32/41
iv) Lig ht or dual-cured cement - gently pulsate veneerwith luting cement into position with dead-soft matrixstrips separating contact points; wipe excess with abrush; spot cure for 3-5 sec on facial and remove grossexcess with sharp carving instrument.
![Page 33: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/33.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 33/41
v) F inis hing - only once all veneers are in place and havebeen cured 40 sec each surface. Carbide finishingburs(ET6014, H379M018 Brasseler) gently placed atthe gingival and lingual margins), Enhance cup, porcelainpolishing cups(K000010, Brassseler) and metal finishingstrips(Compo-strips 100UF/F, Premier) are all used tocomplete the seating.
![Page 34: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/34.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 34/41
Esthetic ConsiderationsEsthetic Considerations1. MidlineMidline- located in the center of the face, perpendicular
to the interpupillary line.
![Page 35: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/35.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 35/41
2. Incisal LengthIncisal Length- maxillary central incisors are the mostimportant determinant in the creation of a smile;maximum length is 70% of the distance between theupper and lower lips.
![Page 36: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/36.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 36/41
3. Gingival EmbrasuresGingival Embrasures- reduce in volume in a posteriordirection.
![Page 37: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/37.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 37/41
4. Gingival ContoursGingival Contours- nicely scalloped with the lateralcrest inferior to central and cuspid.
![Page 38: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/38.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 38/41
5. Incisal EmbrasuresIncisal Embrasures- become larger and widerposteriorly.
![Page 39: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/39.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 39/41
6. MaxillaryMaxillary Incisal Edge ContourIncisal Edge Contour- follows the curvatureof the lower lip.
![Page 40: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/40.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 40/41
Fi nal C onsi dera ti onsFi nal C onsi dera ti ons
- ti me: 2u/veneer(minimum 2 veneers) at prep & insertappt.- longev it y: 5-15 yrs depending on O.H., maintenance, andhabits.- spli nt t hera py: highly recommended.- ex per ti se : 2-3 yrs.
- f ees : 90-95% of full coverage equivalent.
![Page 41: Porcelain Laminate Veneers Taylor](https://reader031.fdocuments.us/reader031/viewer/2022021214/577d2bb21a28ab4e1eab2648/html5/thumbnails/41.jpg)
8/7/2019 Porcelain Laminate Veneers Taylor
http://slidepdf.com/reader/full/porcelain-laminate-veneers-taylor 41/41
Thank-You
Peter A. Taylor DDS, Oakville, [email protected]