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Major Keys for Veneer Success

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Without a doubt, patients will walk into your practice asking about veneers. At times, this question will come from a mouth of bombed out molars, and you must educate the patient on disease control and an ethically scheduled treatment plan. However, there are other patients whose “social six” chief complaint should be a priority. Being familiar with the different applications of veneering treatment is essential to a successful practice. In this post, I will not discuss ceramics, although Molly Stice has written a great blog post on this very topic, which was published on November 24, 2015. Instead, we will look at the different types of preparations for veneer restorations.

In all these cases, it is good to take initial impressions for a diagnostic cast, and then identify regions that need preparation to achieve the desired result. A diagnostic wax-up allows you to see the extent at which contours are possible. Areas where wax is too thin or absent will need reduction. It is important to have a plan prior to the arrival of the patient. Also when deciding the length of crowns, it is important to assess lip line when patient is smiling.

Although somewhat controversial, no preparation veneers are the first type (or lack thereof) of preparation. In this scenario, teeth are simply impressed and sent to the lab for fabrication. Ceramics can be processed to very thin dimensions (0.3mm), which is sufficient to block out even dark stains from tetracycline. However, margins will never be ideal in this preparation. This is why many clinicians do not believe this to be a proper technique. Advantages include shorter chair time due to no provisional restorations and optimal bonding to all enamel (given erosion has not removed most enamel already). No prep veneers have improved drastically due to improvement in technology and materials, but ultimately they lack a flush margin that will cause future problems with soft and hard tissues. No prep veneers are only utilized when existing teeth are in optimal position and the clinician wishes to change length/shape or cover over stain.

Selective preparations include shallow (into enamel) and heavy (into dentin) chamfers. The most important aspect of preparing teeth for veneers is proper treatment planning. By doing a diagnostic wax-up in conjunction with a diagnostic preparation, you can determine the proper alignment of the teeth. Sometimes, lower teeth need to be modified as well to achieve your goal. A lot of times patients who have high expectations can be difficult to manage and it is difficult to make them happy. It is important to have sufficient preparation prior to the appointment to achieve a good result. Without the time put in before the appointment, it is difficult to achieve the desired result. You must pay attention to details to achieve sufficient results.

            Most clinicians prefer shallow preparations into enamel. Enamel is most abundant in the incisal edge. As you move toward the CEJ, where your margin will be, there is less enamel. When preparing the tooth, it is important to be careful around the gingival area to not prepare more than 0.4 mm, otherwise you will end up in dentin and lose the bonding potential of enamel. At the incisal edge, you can prepare up to 0.8 mm in enamel, which may be needed to reduce the length of a tooth. A reduction of 0.3mm is desirable for all depths of the veneer, as this is adequate thickness for the ceramist to block out stain and fabricate an esthetic restoration. Remember to reduce your facial surface in 3 planes: gingival, middle, and incisal. Extend your preparations proximally without breaking contact. Reduce the incisal edge up to 1-1.5mm, placing a moderate chamfer on the incisolingual line angle.

The other type of veneer preparation involves heavy chamfers into dentin. In certain cases it may be necessary to prepare into dentin to achieve a desirable contour as decided by your wax-up. Bonding to dentin is significantly weaker than enamel, and should be avoided if at all possible. In order to add retentive strength, it may be necessary to extend your preparation through the proximal contacts. This is also necessary if any proximal decay is present. When preparing into the proximal areas, you need break the gingival contact by 0.3mm and ensure that your preparations draw from a facial point of view. In the event proximal decay is not removed, do not extend your axial walls pulpally. Leave this decay until it is time to cement the veneers. At this time, a slow speed handpiece is used to remove decay and the luting cement will fill the round preparation. In the event that retentive strength is compromised, retentive grooves can be placed interproximally to prevent restorative failures from mandibular protrusive forces.

Remember that enamel bonding is your best friend in veneer prepartions. Do not reduce teeth beyond what is necessary. Diagnostic preparations and wax-ups are imperative to a successful case and stress-free appointments. Good luck!