Dental Veneers

1. the esthetic option of veneers

2. what is meant by dental veneers? Dental veneers are custom made shells made from tooth colored materials that facilitate covering the front surface of the tooth and these are alternately known as dental laminates . Dental veneers are normally classified under cosmetic dentistry

3. types A composite veneer can be build up in the mouth by directly placing it can be fabricated in a dental laboratory A porcelain veneer made out of cannot be built in mouth and hence fabricated outside and fitted later.

4. Indications of veneers Esthetically compromised anterior teeth Poorly shaped or crooked teeth Stained teeth (intrinsic/extrinsic) Closure of diastemas Enamel hypoplasia Fractured teeth Anatomically malformed teeth Tooth wear

5. Contraindications of Porcelain veneers Crowded or misaligned teeth Teeth with inadequate enamel present Patient with habitual clenching and grinding Non-ideal occlusion Periodontal disease Teeth weakened by existing large restorations

6. Advantages of porcelain veneers Esthetic stability Stain resistant Stronger and durable Gum tissue tolerates porcelain well The color of a porcelain veneer can be selected such that it makes dark teeth appear whiter. Veneers offer a conservative approach to changing a tooth's color and shape.

7. Disadvantages of porcelain veneers The process is irreversible M ore costly than composite veneers Not suitable for patients with clenching or grinding habits N ot repairable should they chip or crack T ooth may become more sensitive to hot and cold foods and beverages They can dislodge and fall off Technique sensitive

8. Advantages of composite veneers One visit procedure Less expensive Repair potential Chair-side control of the anatomy Minimal irreversible loss of tooth structure

9. Disadvantages of composite veneers Tend to discolor Wear out quickly Marginal staining Shade matching difficulty Often require repair and replacement

10. What makes an esthetic smile? Lips should be symmetrical A pleasing smile should ideally show canine to canine or premolar to premolar

11. Symmetrical gingiva 75 to 80% of max incisors showing, women show more of their maxillary incisors whereas men typically show more mandibular teeth

12. Common problems with gingiva Excessive root surface exposure Loss of papilla between teeth Excessive gingival display Uneven gingival contour How to deal with these problems: For root surface exposure/loss of papillae Crown lengthening and root grafting For excessive gingival display Excision of excessive gingiva For uneven gingival contours Excision of excess gingiva when needed

13. Shade selection Understanding tooth light interaction rather than selecting a shade Hue, Chroma, Value Age consideration Natural color progression of dentition Maxillary central incisor- dominates smile, color, shape and position Lateral - similar hue to central Canine - appear darker due to intense Chroma Premolars - similar to lateral Different shade system Increased translucency At interproximal surface At incisal edge Different areas of teeth Cervical area Incisal

14. Patient examination and treatment planning Comprehensive clinical examination may reveal failing restorations , recurrent decay, marginal leakage, and staining. A full series of intra- and extraoral images a re taken for treatment planning , marketing, and case documentation. These images a re studied—along with clinical examination notes—prior to treatment so that a basic plan could be formulated . Patient’s preferences must be kept in mind while deciding a treatment plan including his/her financial status.

15. Direct Composite veneer

16. Anesthetization and tooth isolation Shades of composite are tried on Assessment on a central incisor Any existing composite resin or decay is removed Tooth is roughened and a slight finish line is created Contoured anatomical matrix is placed and wedged loosely Tooth is then etched and a dentin bonding agent is applied Composite is placed and cured and shaped with a composite roller technique

17. Basic shape is formed with a finishing diamond bur Embrasures are shaped and refined with three levels of finishing disks Interproximal areas are shaped with abrasive strips Additional polishing and shaping are completed three days later

18. Case presentation

19. Case # 1 Bio data : A 25 year old female presented with an unaesthetic smile . Chief complaint : “Discoloration of my front teeth since childhood ”. Treatment plan : As clinical examination revealed fluorosis of the entire dentition so composite veneers were suggested and carried out on only the anteriors as per the patients demand .

20. After placing composite veneers

21. Case # 2 Bio data : 35 year old male . Chief complaint : “Unhappy with the space, shape and color of my front teeth ”. Treatment plan : Suggested porcelain veneer as the optimal treatment but based on cost decided to use composite veneer .

22. Etching Bonding Finished composite veneers

23. Porcelain Veneer

24. technique First Appointment (VENEER PREPARATION PROCEDURE ) Shade Selection- Clean teeth with pumice and water Select a tentative shade with your patient participating Tooth preparation- A uniform 0.5mm intraenamel reduction is sufficient Preparations are extended to the gingival crest and into the interproximals without breaking contact Three ways to manage incisal edge coverage No incisal edge coverage Cover incisal edge Wrap around incisal edge

25. Impression- The retraction cord should be left in place if possible during the impression Use a polysiloxane or polyether material for the impression Temporary Veneers- They are placed when necessary or desired Hand sculptured using composite, kept supragingival and attached by spot etching

26. Second Appointment (VENEER CEMENTATION PROCEDURE) Remove temporary- Care must be taken not to damage margin areas of preparations Clinical try-in- Contacts need to be carefully assessed Proximal contacts can be adjusted

27. CEMENTATION Steps Try-in paste allow you to mask any underlying color abnormalities and select cement shade. Apply saline solution to the internal aspect of the veneer. Etch, rinse, dry but do not dessicate. Apply primer/adhesive to the tooth and lightly air dry. Apply cement to the internal aspect of the veneer, seat the veneer, clean off excess cement, light cure. Floss contacts and adjust occlusion.

28. Case presentation

29. Case # 1 Biodata : 66 year old female. Chief complaint : “I hate the spots on my front teeth”. Previous medical history : German measles during tooth development resulted in hypoplastic enamel. Previous dental history : Areas of pitting restored multiple times with composite. Treatment plan : Full porcelain crowns on 11, 21 and 23.

30. After placing porcelain veneer

31. conclusion This procedure is becoming more common in dental offices because everyone wants a great smile It is a great way to change a smile that shows yellowed, stained teeth into one that makes you look fantastic. But remember veneers are not for everyone, and if your teeth are not strong enough you will not be recommended to have the dental veneers applied

32. Thank you