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Porcelain laminate veneers: an excellent option to correct esthetic and functional problems |
Today, the number of elective esthetic dental procedures being performed continues to rise. This phenomenon is due to several reasons. Increased patient awareness of cosmetic and esthetic procedures in medicine and dentistry are increasing demand for these services. Patients want to look better and feel better about themselves and, for many, this means improving their smiles.
Placement of porcelain laminate veneers continues to be an excellent option to correct many esthetic complaints that our patients may have with their smiles.
Some of the more common indications for their clinical use include: 1)
Minor corrections of anterior tooth morphology and emergence angles to
fill in spaces in the gingival embrasure areas when these spaces are an
esthetic concern for the patient; 2) Minor corrections in tooth
position (rotation, labio-lingual arch position, and crowding) if
orthodontics is either not indicated or accepted as a treatment option
by the patient; 3) Diastema closures and corrections of anterior tooth
proportion (golden proportion); 4) Establishment of anterior guidance
and canine disclusion in patients where preparation for full coverage
restorations would necessitate unnecessary removal of healthy tooth
structure; and 5) Changing tooth color for a patient where tooth
whitening was not a treatment option or did not yield a satisfactory
result for the patient.
Customized tooth reduction
The amount of tooth reduction required for porcelain laminate veneers
depends on the specific clinical situation. For select cases where the
patient’s teeth are small in size and have flat labial surfaces with
large facial embrasures, a “no-prep” veneer may be an option.
In general, most clinical situations require a minimal preparation of
0.5 mm to 0.7 mm of tooth reduction. If changes in tooth position are
required, some areas of the tooth may be prepared more, others less.
If the teeth are located out of the proposed arch form, it is
recommended to first contour the teeth to ideal position using a
cylindrical diamond, then use depth cutters to remove a uniform amount
of tooth structure to compensate for the thickness of the restoration.
In cases where a low value (dark) preoperative tooth color is to be
changed to a high value (light) color, more tooth structure should be
removed (1.0 mm to 1.25 mm) to create enough space for opacious dentin
or opaquers to block out the darkness.
For patients who may benefit from the added flexural strength of
pressed ceramics due to functional concerns, 1.0 mm to 1.25 mm of space
may be required to achieve a functional and aesthetic result.
Gingival margins on the facial aspect should be placed at the gingival
crest or slightly above (except if the preparation is dark). The
interproximal margins should be carried into the lingual portion of the
contact area.
If diastemata are present, the interproximal margin of the preparation
should be carried lingually to the linguo-proximal line angle and be
placed slightly below the crest of the tissue to squeeze the gingival
papillae to fill the “black triangle.”
Once the preparations are finished, it is recommended to use a fine
cylinder finishing diamond and Enhance point (Dentsply/Caulk) to make
the preparations as smooth as possible.
Fine sandpaper strips can be used interproximally to smooth
interproximal enamel surfaces without compromising the proximal contact.
By using a regimented approach to treatment and following the
guidelines for preparation, provisionalization, impression making and
placement, porcelain laminate veneers can be a good long-term esthetic
solution for a patient looking for that dazzling smile.
by Dr Robert A. Lowe, USA
www.dental-tribune.com
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