Dental Tribune United Kingdom Edition

May 21-27, 201220 Cosmetic Tribune United Kingdom Edition A s patients get older, anterior teeth com- monly show wear, chipping and discolouration. These changes are the result of a number of factors asso- ciated with ageing. There is increased awareness of these unattractive teeth and the desire to have a more youth- ful appearance. Because of the recent media attention on changing one’s appearance with veneers, there is a much greater demand for cosmetic dentistry procedures. Over the years in the prac- tice of dentistry, I have devel- oped products and techniques that have improved my prac- tice significantly. However, it was not until I took on an associate, who had been in practice for 18 years that I be- came aware that these were new and innovative ideas to him, as well as to other den- tists he knew. I have been placing veneers for more than 25 years and de- veloped a technique that can make a single veneer blend so naturally with the other teeth that it is undetectable. Various nuances in technique make preparing and bonding veneers quick and easy. I have a CEREC machine that works especially well for a single veneer. Six or eight veneers can be done on the CEREC, but this is then rather time consuming. Two or three cases of the same number of teeth could have been prepared, impressions taken and sent to a labora- tory in the same period. It is more cost effective to use a laboratory but you have to have the best laboratory avail- able to you if you expect per- fect results. Feldspathic porcelain is the only material that will look natural. Pressed ceram- ics will look more opaque, somewhere between a por- celain-fused to metal resto- ration and a natural tooth. For patients requesting bril- liant white, feldspathic por- celain can work well too and one can adjust the colour by the bonding composite used under the veneer. Very little shade adjust- ment can be done under pressed ceramic porcelain. Flowable composites work the best and come in many shades, which makes shade adjustments easy. The flowa- ble composite by Kerr has the right consistency for veneers and with OptiBond Solo the company offers the strongest bonding agent. The preparation requires only a little more than 0.5mm of reduction so that it does not go through the enamel, if pos- sible. The bond is the best on enamel. There should be the same reduction over the total facial surface for the labo- ratory to make a perfect ve- neer. Cut three or four depth grooves of 0.5mm then remove the enamel to the grooves. If instant orthodontics is the treatment plan, some teeth may need to be reduced more and others less. Run the preparation interproximally from gingival to incisal to hide the margin visually, but do not break the contact point. The gingival margin should be at the gingival crest or a little be- low. It should have a chamfer for ease of finishing, preclud- ing any chipping at the mar- gin. Some dentine will show through at the gingival mar- gin because the enamel is less thick there. If there is room, insert a thin piece of gingival braid, which can be left there during the impression. Reduce the incisal by approximately 1mm so the finish line is on the lingual, and round the incisal-facial junction so that there are no potential fracture lines in the veneer. When the veneers come back from an excellent labo- ratory there should be little or no adjustments necessary before bonding them to the teeth. Etch them with hydro- fluoric acid gel for at least three minutes. Rinse them thoroughly, neutralise them with a baking-soda slurry and then rinse them thor- oughly again. Dry them with a dry air source until a chalky appearance is visible on the interior of the veneer. Ceramic primer is then applied for one Making a single veneer blend so naturally that it’s undetectable Dr L Emery Karst, USA shares his techniques for natural blending Fig 1a Fig 1b ‘Over the years in the practice of dentistry, I have developed products and techniques that have improved my practice significantly’ Fig 2a Fig 2b Fig 3a Fig 3b