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Ultra-Bond: for One-Step Composite Restorations and Porcelain Veneers By: Dr. Xinyi Yu
Den-Mat Vice President for Clinical Affairs

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Porcelain veneers have become a routine procedure in today’s modern practice. They are widely used to improve overall appearance by lightening the teeth, closing spaces, and improving the shape and alignment of the teeth. But, veneers have many applications. For example, they are frequently the best treatment option to restore large carious lesions and large incisal fractures of the anterior teeth. In this situation, the traditional sequence of treatment has been to first restore the caries or fractures, and then to perform the tooth preparations for the porcelain veneers. However, a more efficient approach using Ultra-Bond™ can be achieved by restoring missing tooth structure and cementing porcelain veneers at the same time.

Ultra-Bond is both a light cured resin cement and an ADA accepted light cured anterior restorative material. It simultaneously offers stress-resistant, non-micro-leaking final restorations, and at the same time, exceptionally well bonded veneers. A recent clinical study (H.E. Strassler & S. Weiner, Long Term Clinical Evaluation of Etched porcelain Veneers, JDR, 80:60, 2001.) reported unprecedented 16 year follow-up results for Cerinate™ porcelain veneers bonded with Ultra-Bond.

Case Report
A patient presented complaining of sensitivity in the maxillary anterior teeth. Clinical and x-ray examinations revealed large composite restorations with leaking margins on teeth #7, 8, and 9. Caries were evident at the distal of tooth #8. Tooth #10 had a PFM crown with an unsightly metal margin showing at the distal gingival area. Also, the gingival margin for this tooth was observed to be at a lower level than the gingival margins of the adjacent teeth.


Figure 1 shows the pretreatment dentition
Two treatment plans were presented to the patient: 1) redo the composite restorations; or, 2) replace the large composite restorations with Cerinate porcelain veneers, and replace the PFM crown with a Cerinate pressable crown. Option 2 provided a much more esthetic result with alignment of the teeth, improvement of the shade of the teeth, and elimination of the crown metal margin. The patient selected option 2.

At the first appointment, the gingival margin of tooth # 10 was re-contoured at a higher level to align the gingival margin with the margins of the adjacent teeth. This was performed with an 880 coarse diamond bur after removing the old PFM crown. The caries at the distal of tooth #8 were removed, and then typical veneer preparations were performed for tooth #8 and 9. No veneer preparation was needed for tooth #7.

An impression was made with 1st Impression PVS™ and tooth #8, 9, and 10 were temporized. The temporaries were made by applying Virtuoso Flowable™ composite resin to the unetched surfaces of the teeth (including the cavity preparation in tooth #8), and curing with the Rembrandt Sapphire™ high intensity PAC light for 1 to 2 seconds. The resulting slightly under-cured composite resin surfaces provide for temporaries that are attractive, serviceable, and well sealed, but that can easily be removed with an instrument when desired.

Figure 2 shows the finished preparations
At the second appointment, the patient reported that the sensitivity of the teeth was completely resolved. Presumably, this was the result of treatment of the caries and the covering and sealing of defective margins by the temporaries. The temporaries were removed, and the Cerinate veneers and Cerinate Pressable crown were tried in. The patient was extremely pleased with the appearance of her new smile. After removal of the veneers and the crown, the old composite restorations on tooth #7 and 9 were removed. The teeth were thoroughly cleaned with a rubber cup and prophy paste, and then etched, rinsed, and air-dried. A bonding agent, Tenure A/B™, was applied on the surface as well as into the cavity preparations. Ultra-Bond were first applied to the cavities and then on the inside surfaces of the Cerinate veneers and the Cerinate Pressable crown. They were all then positioned in place on the teeth. Before curing, gross amounts of excess Ultra-Bond along the gingival margins were removed with a sable brush wet with unfilled resin, and a Tenure S Dab-Eze™ was used to adapt and contour the Ultra-Bond. After this procedure, there is frequently a thin film of excess Ultra-Bond still remaining at the margins. The Sapphire light was used to cure each veneer at the incisal region for 5 seconds. After this initial curing, a shear 349 instrument was used to easily remove any remaining excess, as it was still in the gel stage due to the short time of initial light exposure. The Sapphire light was then applied again for a 5-second exposure at the gingival region and a 3-second exposure on the lingual surface of each tooth. Accordingly, each veneer received a total light exposure of 13 seconds. It should be noted that, in the past, 120 seconds of exposure per tooth were required for curing veneer restorations. The amount of time saved with the high intensity Sapphire PAC light for bonding porcelain veneers is a good convenience for busy clinicians. A 12-fluted bur was used to refine and clean the porcelain margins on tooth #8, 9, and 10. Additional attention was given to tooth #7 because the non-prep design invariably requires some additional contouring of the gingival margins of the veneer. A fine diamond bur was used to trim, and then to polish, the porcelain margins. Next, a sharp explorer was used to confirm that there were no “catches” at the margins. Finally, a 30-fluted bur was used on all of the bonded porcelain margins.

Figure 3 shows the finished case
At the third appoint-ment, the contacts were released with a CeriSaw™. The CeriSaw is specially designed with a very thin blade that cuts composite resin but does not cut porcelain or tooth structure. Accordingly, there is no opening of the contacts. The contacts were then finished with a polishing strip. It should be noted that the procedures for the third appointment could easily be incorporated into the second appointment if desired. However, many clinicians feel that it is desirable to have the patient return several days after cementing of the veneers to make any minor adjustments that might be needed. This also keeps each appointment relatively short, and avoids patient fatigue.

Conclusions
1. The double role of Ultra-Bond as a restorative and as a cement allows for treatment of caries and replacement of faulty restorations at the same time as cementation of porcelain veneers.
2. The procedure is simple, efficient, and predictable.
3. The benefits provided by the versatility of Ultra-Bond are an advantage for patients and clinicians. DT
Dr. Yu is a native of China and holds dental degrees in both the United States and his homeland. Presently, he is vice president of clinical affairs at Den-Mat Corporation.
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September 2025
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