Dental News - Porcelain laminate veneers: an excellent option to correct esthetic and functional problems

Dr Robert A. Lowe, USA

Thu. 17 December 2009

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Today, the number of elective esthetic dental procedures being performed continues to rise. This phenomenon is due to several reasons. Increased patient awareness of cosmetic and esthetic procedures in medicine and dentistry are increasing demand for these services. Patients want to look better and feel better about themselves and, for many, this means improving their smiles.

Placement of porcelain laminate veneers continues to be an excellent option to correct many esthetic complaints that our patients may have with their smiles.

Some of the more common indications for their clinical use include: 1) Minor corrections of anterior tooth morphology and emergence angles to fill in spaces in the gingival embrasure areas when these spaces are an esthetic concern for the patient; 2) Minor corrections in tooth position (rotation, labio-lingual arch position, and crowding) if orthodontics is either not indicated or accepted as a treatment option by the patient; 3) Diastema closures and corrections of anterior tooth proportion (golden proportion); 4) Establishment of anterior guidance and canine disclusion in patients where preparation for full coverage restorations would necessitate unnecessary removal of healthy tooth structure; and 5) Changing tooth color for a patient where tooth whitening was not a treatment option or did not yield a satisfactory result for the patient.

Customized tooth reduction

The amount of tooth reduction required for porcelain laminate veneers depends on the specific clinical situation. For select cases where the patient’s teeth are small in size and have flat labial surfaces with large facial embrasures, a “no-prep” veneer may be an option.

In general, most clinical situations require a minimal preparation of 0.5 mm to 0.7 mm of tooth reduction. If changes in tooth position are required, some areas of the tooth may be prepared more, others less.

If the teeth are located out of the proposed arch form, it is recommended to first contour the teeth to ideal position using a cylindrical diamond, then use depth cutters to remove a uniform amount of tooth structure to compensate for the thickness of the restoration.

In cases where a low value (dark) preoperative tooth color is to be changed to a high value (light) color, more tooth structure should be removed (1.0 mm to 1.25 mm) to create enough space for opacious dentin or opaquers to block out the darkness.

For patients who may benefit from the added flexural strength of pressed ceramics due to functional concerns, 1.0 mm to 1.25 mm of space may be required to achieve a functional and aesthetic result.

Gingival margins on the facial aspect should be placed at the gingival crest or slightly above (except if the preparation is dark). The interproximal margins should be carried into the lingual portion of the contact area.

If diastemata are present, the interproximal margin of the preparation should be carried lingually to the linguo-proximal line angle and be placed slightly below the crest of the tissue to squeeze the gingival papillae to fill the “black triangle.”

Once the preparations are finished, it is recommended to use a fine cylinder finishing diamond and Enhance point (Dentsply/Caulk) to make the preparations as smooth as possible.

Fine sandpaper strips can be used interproximally to smooth interproximal enamel surfaces without compromising the proximal contact.

By using a regimented approach to treatment and following the guidelines for preparation, provisionalization, impression making and placement, porcelain laminate veneers can be a good long-term esthetic solution for a patient looking for that dazzling smile.

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