Restoration of Maxillary Anterior Teeth With Porcelain Veneers
Steven T. Cutbirth, DDS
The evolution of dental materials and techniques has enabled the placement of restorations that are harmonious with the adjacent natural dentition. Due to their improved optical and physical properties (eg, translucency, color, fluorescence, and polishability), contemporary porcelain materials can also be utilized to replace existing restorations that are worn or have a monochromatic appearance. While technological developments enable the delivery of superior aesthetic results, the achievement of this objective depends on effective communication efforts among the members of the restorative team.
Numerous means of communication have been utilized to share the aesthetic expectations and requisites of the patient and the clinician with the dental technician. This presentation describes the use of various diagnostic tools (eg, impressions, facebow mountings, models, photographs) for the fabrication and cementation of six maxillary anterior porcelain laminate veneer restorations. When proper diagnosis and treatment planning are performed in concert between clinician and technician, aesthetics can be achieved with success and predictability.
A 55-year old female patient presented for the replacement of unaesthetic porcelain veneers that exhibited a worn, monochromatic appearance (Figure 1). Clinical examination was performed in order to assess phonetics, lip support, and the length of the existing restorations. The soft tissues were healthy, and the patient was in good systemic health. The underlying tooth structure was vital and demonstrated no indications of periapical pathology. Since moderate wear was detected along the incisal edges of the restorations, bruxism had to be considered in the development of the treatment plan. Consequently, molar and first premolar group function had to be established during working side excursive movements in order to protect the porcelain veneers that were selected to replace the existing restorations.
The existing porcelain veneers were removed with a coarse diamond bur, which was also used to refine the facial surfaces of the preparations. The preparations were confined to the enamel layer whenever possible (Figure 2). The lingual margins were established with a thin chamfer diamond, and the line angles were rounded. The interproximal regions were slightly opened with fine finishing strips to permit accurate impressions to be taken with polyvinylsiloxane material (Figure 3). Following the performance of shade evaluation and color diagnosis (Figure 4), provisional composite restorations were placed, trimmed, and polished.
A detailed color prescription was forwarded to the laboratory with two unpoured polyvinylsiloxane full-arch impressions, color photographs, a facebow mounting, stone models, and an incisal matrix that was waxed up to optimal contour and length. Six veneer restorations were fabricated in porcelain with an incisal wrap design and returned to the clinician (Figures 5 and 6). Once the provisional restorations were removed and the restorations were tried in, the preparations were etched with 37% phosphoric acid for 30 seconds and 15 seconds on the enamel and dentin, respectively (Figure 7).
The acid gel was rinsed from the preparations (Figure 8), and occlusal registration strips were placed interproximally to contain excess filled and unfilled composite resin. The preparations were then moistened with distilled water and received a 60-second application of dentin primer (Figure 9). Excess primer and acetone carrier were removed utilizing suction from a dental aspirator. The veneers were seated one tooth at a time utilizing a microfilled resin (Figure 10). Once all six veneers were seated, excess resin was removed from the margins.
Following the elimination of the gross excess, the veneer restorations were polymerized on the facial and lingual surfaces for 60 seconds using two curing lights. Cotton-tipped applicators were used to maintain seating pressure through the curing process. A scaler, #12 blade, interproximal polishing strips, and unwaxed floss were used to remove any excess composite following curing (Figures 11-12- 13). A fine diamond bur and polishing wheels, pastes, and cups were used to finish the incisal and lingual surfaces.
The definitive restorations satisfied the aesthetic objectives of the patient (Figures 14-15-16). To prevent abrasion of the opposing dentition or fracture of the restorations as a result of bruxism, a hard acrylic maxillary nightguard was fabricated. When a synergy is established between clinician and technician through enhanced communication efforts and diagnostic aids, it is possible to achieve enhanced aesthetics with success and predictability (Figure 17).
The author mentions his gratitude to Willi Geller, Zurich, Switzerland, for the fabrication of the porcelain laminate veneers depicted herein.
* Private practice, Waco, TX.