Using Rembrandt Veneers in My Daily Practice By: David Ouellet, DDS

Porcelain laminates have been available for over 20 years. The advances in both porcelain and adhesive technology make porcelain laminates common techniques in the general dental office. There have been diverging philosophies regarding the preparation of porcelain laminates. The general dentist should be aware of these techniques that are needed to treat different cosmetic cases. Dental school philosophy has taught us to focus on a margin for all indirect restorations. Therefore, if clinicians advise no preparation for laminates, many questions arise. The major clinical difference between the non-preparation techniques and preparation techniques is the finishing of the margin. The following examples are different non-prep and prep cases where specific cosmetic evaluations were determined to suit each case.

Reasons to Modify a Tooth:
• Severely prominent teeth
• Severely discolored or dark teeth
• Poor arch contour
• Misaligned or rotated teeth
• The ability to wrap the incisal edge-need at least .5-1mm clearance
• Using a laboratory that utilizes weak porcelain-compensating for bulky porcelain materials

Benefits of Not Removing Sensitive Tooth Structure:
• No post-op sensitivity
• No anesthetic necessary
• No temporaries
• Ease and comfort for patients
• Greater patient acceptance
• Better bonding to enamel
• Increased patient referrals
• Option for reversible treatment-if patient not satisfied
• Uses a laboratory that utilizes the strongest porcelain (Cerinate®)

Case 1
The patient inquired about new laminates because she was unhappy with her smile. Her 10-year laminates were done by another dentist and had a slight chip on Tooth 7 and slight marginal staining. The evaluation of her smile revealed that the teeth were short and a somewhat gummy smile (Fig. 1). Figure 2 shows one side with gingival recontouring-the proportions are much better. Figure 3 is a view after gingival recontouring and laminate removal. The prep involved no shoulder/chamfer along the gingival line, other than removing old laminates. Rembrandt® Veneers made of Cerinate® Porcelain were fabricated for Teeth 6-11 and bonded using Tenure® and Ultra-Bond® (Den-Mat®). The after view shows a dramatic improvement in proportion and tooth positioning with the upper lip (Fig. 4).

Figure 1		Figure 2
Figure 3		Figure 4

Case 2
The patient inquired after completing a Smile Evaluation form. He was interested in a better smile but was told by two dentists that his smile “looks natural” and “it would be too difficult to fix.” The challenges in this case were the peg laterals in cross bite (Fig. 5). The many articles by Dr. Robert Ibsen about cuspid-guided occlusion with bonded porcelain demonstrated a critical preparation. This preparation requires preparing the lingual of the upper tooth and on the labial of the lower tooth to create an inter-arch space without shortening the teeth (Fig. 6). Incisal tooth structure will give support to the porcelain. When you compare the “before” photo (Fig. 6) to the prep photo, you can realize that if you prep the lingual of teeth 7 and 10, the laterals are now in an edge-to-edge relationship. The lower cuspid was also recontoured labially. The Cerinate Laboratory then constructed the laterals forward and down to solve the esthetic problems (Fig. 7) along with veneers on teeth 5, 6, 8, 9, 11, and 12. The 11-year recall demonstrated the clinically proven performance of Cerinate Veneers and Ultra-Bond in a very unique case (Fig. 8).

Figure 5		Figure 6
Figure 7		Figure 8

Many porcelain manufacturers recommend preparation to allow the laboratory to fabricate thicker laminates for either strength or esthetics. Rembrandt Veneers made of Cerinate Porcelain are made of a high-strength, reinforced leucite glass, which requires minimal thickness. And, if you plan a non-prep case, it is important that you send the case to a “non-prep” laboratory that creates non-prep veneers.

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David Ouellet, DDS is a native of Boston and graduate of Georgetown University Dental School. He has conducted clinical research for placement and evaluation of composite resin and is a consultant for a large dental materials manufacturer. David has published numerous clinical and research oriented papers and is an accredited member of the American Academy of Cosmetic Dentistry. David is in private practice, where he specializes in adhesive cosmetic dentistry. He has conducted lectures and hands-on workshops on aesthetic materials and techniques throughout the United States and overseas. You can contact Dr. Ouellet at DrO123@aol.com or 805-925-8767.