Case Presentation by Harvey Putter, DDS

Traditionally, treatment choices have been limited to multiple PFM restorations with further destruction of remaining healthy tooth structure. A different approach is available using strong Cerinate porcelain allowing for very thin porcelain restorations. How to prep the teeth for bonded porcelain restorations remains a debate. The practitioner must judge whether the thickness of the teeth is appropriate and evaluate overall alignment of the arch, mouth, and face. In many cases, thin Cerinate porcelain provides the opportunity for completely esthetic and pleasing results with non-prep or minimal prep technique. The guiding principle for preparations should be: prep if you must, prep less if you can, and don’t prep if you don’t have to.

The following case report demonstrates the technique that uses Cerinate porcelain veneers and V-shaped porcelain crowns to restore worn tooth structure and improve the overall esthetics of the mouth.

Figure 1

Case Report:
The patient was a 28-year-old male with a Class I occlusion. His desire was to have larger teeth in order to improve his smile (Fig. 1). The exam revealed that the lingual enamel of #7 to 10 was missing (Fig. 2). The patient admitted to having the habit of biting and sucking on lemons. The treatment plan was presented to the patient; multiple PFM crowns and porcelain bonded restorations.

Figure 2

The patient chose to have the work done without any preparations. The polyvinyl impression was taken and forwarded to the Cerinate lab. Four V-shaped crowns for teeth #7 through 10 and 2 veneers for teeth #6 and 11 were ordered. Figure 3 shows the porcelain restoration. The V-crowns and veneers were bonded with Tenure and Ultra-Bond combination which has an established success record in Dr. Strassler’s 15-year study.

Figure 3

Figure 4 shows the lingual view of the finished case. Note the complete coverage of lingual worn dentition. Figure 5 shows the finished case.

Figure 4

Figure 5

Discussion and Conclusion
Clinical studies have demonstrated that porcelain bonded restorations are durable and reliable. Many clinical restorations can be accomplished with porcelain veneer bonded restorations. For success, each case requires a thorough evaluation. This paper presents an approach for porcelain restorations without preparation. The technique offers bonded porcelain restoration placement with less expense than that of traditional techniques that require extensive tooth reduction.

Some people will disagree on less prep technique. However, as pointed out by Dr. Gordon Christensen, “there is an obvious trend in the dental literature and in continuing education courses to promote over cutting teeth when preparing them for restorations. There are many reasons for over cutting. Some feel there is a more optimum esthetic potential when the teeth are prepared more deeply, which is a debatable view. The result of these described conditions (over cutting) can result in postoperative tooth sensitivity, low retention of restorations and weak overall restorations. In my opinion, the trend to over cut teeth should be reversed.” (JADA, Vol. 133, Page 105, January 2002) I agree with Dr. Christensen.