Case Presentation By: Dr. Xinyi YU

The indications for porcelain veneers are well known. Examples include, fractures/chipping, discoloration, diastemas, and PFM crown/bridge repairs. Veneer restorations are standard procedure in some dental offices, but in a recent survey of over 150 dentists, fewer than 10% said they did over 50 veneers last year. The group of dentists who regularly place veneers responded that they place less than 20 veneers a year. When the same group of dentists were asked how many PFM’s they had placed, over 90% responded more than 50.

I believe the chief reason for the PFM restoration preference is that we were taught in dental school how to place PFM’s but not laminates. Most of us learned veneer procedures after graduation from continuing education courses with different speakers talking about different techniques. Until practitioners feel comfortable with a practical and reliable technique, laminate cases will continue to be limited.

Tooth Preparation
The extent of preparation is a major consideration dentists face when establishing a treatment plan. The question: why do we prepare the teeth and reduce about one millimeter of sound tooth structure? Is it necessary for the margins of porcelain veneers to end in a chamber or a shoulder similar to crown margins? Is it necessary to remove tooth structure for the teeth to remain close to their original thickness? An important factor of preparation is the strength of the porcelain. A new approach is available using exceptionally strong Cerinate® Porcelain allowing for very thin laminates. In many cases, thin laminates provide the opportunity for completely esthetic and pleasing results with non-prep or minimal-prep techniques. The practitioner must judge whether the thickness of the teeth is appropriate and evaluate overall alignment of the arch, mouth, and face. If a non-prep approach is selected, teeth will be slightly thicker than their natural teeth. Although sometimes there is patient hesitation, after proper placement and finishing, the veneers look perfect. Ultimately, the guiding principle for preparation should be: prep if you must, prep less if you can, and don’t prep if you don’t have to.

Case Presentation
In the following case, a non-prep technique was used to preserve tooth structure and the results were beyond the patient’s expectations.

The patient presented with protruding laterals and a highly discolored right central incisor resulting from prior endodontic treatment (Figure 1). The patient only expressed concern about the discolored central incisor. Traditionally, the standard treatment would be to prepare the discolored tooth for a full crown, either ignoring the mal-aligned teeth, or recommending orthodontic treatment. A treatment plan placing two Cerinate veneers on both central incisors was presented, and quickly accepted by the patient. The advantages are:
1. A simplified treatment procedure with no anesthetic, no preparation, and no loss of natural tooth structure

2. Improved alignment of the anterior teeth for a better esthetic result

3. Achievement of what the patient came for: correction of the discolored right central incisor

From the patient’s point of view, treatment with two veneers instead of one crown is a good value because of the above advantages. From the dentist’s point of view, the treatment plan is desired because of additional benefits to the patient and greater patient acceptance.

Treatment was accomplished with two appointments. At the first, tooth shades were recorded, photographs were taken, and impressions were made using First Impression® PVS. Subsequently, the Cerinate Laboratory made two veneers. At the second appointment, step one was etching of the two central incisors followed by application of Tenure® bonding agent. A thin coat of TetraPaque® opaquing agent was applied to the discolored central incisor. (It should be noted that to mask a single discolored tooth is always challenging. Tetrapaque works very well for this purpose.) The veneers were cemented with UltraBond® Quik Resin Cement, and final photographs were taken after minor finishing procedures.

Figure 2 shows the final result. Note the life-like variations in tooth shade that are possible by the thinness of Cerinate veneers. The procedure was simple, the outcome was excellent, and the patient was extremely happy.

Solutions to many clinical problems can be accomplished with porcelain veneer restorations. For success, each case requires thorough evaluation and consideration of treatment alternatives. The advantage of non-prep Cerinate veneers is they expand benefits and treatment possibilities.

For more information on Cerinate Porcelain veneers call 800-872-8384 and choose option 2. Additional information is also available at www.denmat.com.