“Tack & Wave”™ Veneer Cementation By: David Hornbrook, DDS, FAACD San Diego, California

The placement of porcelain veneers is probably one of the most stressful things a clinician faces in their restorative practice. Avoiding contamination, ensuring complete seating, maintaining uniform shading, and the high expectations of the patient are just a few of the reasons for this stress.

The resin cements and adhesive systems utilized for the bonding of veneers do not always provide the ease of use and simplicity to rescue the technique sensitivity with this procedure. Multiple-bottle dentinal bonding systems have created confusion resulting in sensitivity and microleakage that could have been avoided if the systems were more user friendly. The resin cements are frequently sticky and runny and removing the excess prior to light polymerization becomes a tedious and time consuming endeavor, and a miserable experience if excess is left and then light cured.

Manufacturers have recently introduced adhesive and resin systems that have significantly eased the placement of bonded restorations. The introduction of single-bottle adhesive systems was made several years ago, but now the body of excellent, unbiased research has proven the efficacy and reliability when compared to previous generations. New resin cement systems now offer the advantage of being initially light polymerized, establishing a “semi-gel” state, which will allow a peeling away of the excess cement prior to complete polymerization. The new resins are utilized in a technique affectionately titled by the attendees and faculty at PAC~live as “Tack & Wave”, because the restorations are initially spot “tacked” into place for 1 second using a 2.0 mm light guide and then a larger light guide is “waved” about 1 inch above the restorations for an additional 3 seconds. This eliminates the need to brush away the excess sticky, uncured resin prior to polymerization and reduces the difficult task of removing any remaining cured cement. The detailed technique is described below:

Photo 1) The pre-operative photo of the unaesthetic smile

Photo 2) The provisionals (Luxatemp-Zenith) are removed using a straight-tipped hemostat and the preparations are etched with 35% phosphoric acid for 10-15 seconds

Photo 3) An anti-bacterial/desensitizing agent (SuperSeal- Phoenix Dental) is placed on the preps prior to the dentinal adhesive

Photo 4) A single-bottle adhesive (Single Bond- 3M) is placed on all preparations for at least 20 seconds

Photo 5) The Dentinal adhesive is light polymerized for 20 seconds

Photo 6) The veneers are placed using a light-cure only resin veneer cement (Relyx Veneer Cement-3M)

Photo 7) Each restoration is “Tacked” to place using a 2.0 mm light guide in the center of the restoration for 1 second

Photo 8) The light guide is waved for 3 seconds from the buccal and 3 seconds from the lingual surfaces approximately 1 inch from the ceramic surface

Photo 9) Excess cement is easily “peeled” away from the margins using an explorer. After the excess cement is removed, the restorations are flossed to remove interproximal excess

Photo 10) Final polymerization is achieved by curing for at least 1 minute per tooth

Photo 11) Margins are checked and adjusted using finishing diamonds (Axis Dental)

Photo 12) The “New Smile” immediately after restoration placement

Dr. David Hornbrook graduated from UCLA School of dentistry and currently practices at “Dentistry for the Quality Conscious” in La Mesa California. He has been a guest faculty member of the post-graduate programs in Cosmetic Dentistry at Baylor, Tufts, SUNY at Buffalo, UMKC, and the UCLA Center of Cosmetic Dentistry. He has consulted with numerous manufacturers in product development and refinement and is on the editorial board of Practical Periodontics & Aesthetic Dentistry, Signature, and is the past editor of the Journal of the American Academy of Cosmetic Dentistry. He is also the current clinical editor of Dental Practice Report, as well a member of the Esthetic Dentistry Research Group, which publishes REALITY and REALITY NOW. He is an accredited member and Fellow of the American Academy of Cosmetic Dentistry and is the Director of the Pacific Aesthetic Continuum which is an advanced education facility for practicing clinicians desiring to enhance their cosmetic dentistry practices. David is also the founder of the Pacific Academy of Esthetic Dentistry. He has lectured internationally on all facets of esthetic dentistry and has published articles in most of the leading dental journals.
Contact David Hornbrook at: Dentistry for the Quality Conscious 7777 Alvaredo Rd, Ste 210 La Mesa, CA 91941 (619) 463-7797 Fax: (619) 463-1351 E-mail: drdavid@connectnet.com