Dramatic Smile Makeover Without The Removal Of Sensitive Tooth Structure By: Xinyi Yu, DDS
Vice President of Clinical Affairs, Den-Mat Corp.

The first step in dental restorative procedures, including porcelain veneer restorations, is to decide type and amount of tooth preparation. There are two factors that determine tooth preparation. The first factor is when the veneer material determines the preparation procedure, for example, a popular pressable porcelain requires a 0.8mm facial reduction. The second factor is the type of training the clinician has received. For example, many dentists were taught in dental school to create shoulder, knife-edge, or chamfer margins.

There are limited porcelain materials available for veneer restorations. All of these porcelains have varying levels of opacity and multiple shades. Compared to all porcelains, Cerinate® porcelain stands out with the highest flexural strength. What does high strength mean in the dental practice? It means that sensitive tooth structure does not have to be sacrificed due to weaker porcelain. With Cerinate, tooth preparation becomes an option, and in many cases, no anesthetic (no shot) is required. A thin, contact-lens-like Cerinate veneer can be fabricated to achieve cosmetic purpose.

It is important to think about preparation with an open mind. In essence, prep if you have to, do not prep if there is no need to. Either way, Cerinate veneer restorations provide superior results.

The following case demonstrates the ability of Cerinate veneers in both non-prep and minimal contour situations. The patient wanted a changed smile. The main complaints were:

(1) crooked teeth, (2) short teeth, and (3) a narrow smile (Fig. 1). The examination revealed malpositioned laterals, unlined midlines, a bilateral crossbite, and less than ideal proportionate ratio of height to width of central incisals (0.87).

To lengthen teeth 8–10, a fine diamond was used to trim the gingival after topical anesthetic gel was applied (Fig. 2). The patient was given Rembrandt AgeDefying® Mouthwash before and after the procedure.

Figure 3 shows excellent gingival healing after two days. To correct malpositioned teeth 7 and 10, the facial prominent areas were contoured with a fine diamond without any anesthetic.

Fig. 1

Fig. 2

Fig. 3

Figures 4 and 5 illustrate the occlusal views before and after the minimal preparation. It is important to note that no definitive finishing lines on the prepared teeth were necessary. After taking an impression, veneers were created in the Cerinate Laboratory. The veneers were first tried on the teeth. The teeth were then etched using Etch’N’Seal®, followed by Tenure® Uni-Bond®.

Fig. 4

Fig. 5

Fig. 6

Cerinate veneers, from teeth 4 to 13, were cemented with Ultra-Bond® Plus and cured using the Rembrandt Sapphire® Light. The excess cement was removed using a Schure instrument (No. 0349) (Fig. 7). A CeriSaw was then used to open the fused contacts (Fig. 8).

Figure 9 shows the new height-to-width ratio of the central incisals. An ideal ratio (0.75) was achieved.

Fig. 7

Fig. 8

Fig. 9

An excellent “before and after” comparison is shown on Figure 10. I was able to change the height-to-width ratio from 0.87 to 0.75 with no preparation using Cerinate.

Figure 11 illustrates the Golden Proportions achieved with this case.

Fig. 10

Fig. 11

Summary
Porcelain veneers have the ability to improve one’s smile as well as enhance appearance and confidence.

 

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Dr. Yu is a native of China and holds dental degrees in both the US and his homeland. He has published more than 60 clinical and research-related papers in the area of adhesive dentistry. Currently, he is Vice President of Clinical Affairs for Den-Mat Corporation.