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12 Dental Tribune Middle East & Africa Edition | March-April 2015aesthetics > Page 13 The importance of cementation: A veneers case using a new universal cement By Mitch A. Conditt, DDS I ntroduction Esthetic options in dentistry are the prevailing choice of most patients today. Veneers and bleaching in particular have become buzzwords in popular culture, and TV sitcoms, film and magazine advertising have turned these cosmetic tech- niques into household names. As a result, dental teams must accommodate the demands of their patients, becoming highly versed in placing metal-free res- torations. Practitioners can find a multi- tude of educational articles and courses teaching the science and technology of porcelain, zir- conia and composite. But while emphasis is frequently placed on the final prosthesis or direct restoration, often overlooked are the increasingly important auxiliary materials that contrib- ute equally to the clinical suc- cess of these new materials and restorations: impression and provisional materials, bonding agents and cements. Education is imperative because cementa- tion and bonding are two areas of esthetic dentistry that have evolved through generations of products and techniques.1 These processes are essential in mak- ing esthetic restorations both functional and comfortable. That’s why veneering can be an optimal, conservative alter- native to crowning teeth, since preservation of tooth structure is important to dentists and pa- tients alike. The highly esthetic results are due to the fact that ceramics have a translucent fin- ished surface texture similar to that of natural enamel.2 Dentists, assistants and lab technicians spend vast amounts of time and effort perfecting veneers and avoiding fracture through pains- taking preparation, material and shade selection, fit and fabrica- tion. Yet even after such arduous processes, clinical failure and patient dissatisfaction can read- ily occur with errors in cemen- tation. Cementing veneers is a delicate process with a historical litany of potential problems – color instability, insertion difficulty, handling and cleanup issues, unsatisfactory radiopacity, low translucency after curing, mis- match between try-in gels and final cements, and debonding, to name a few. Cement selection in certain applications neces- sitates knowledge of the chem- istry and physical properties of the particular cement type, and insertion requires an exacting technique for successful clinical results.3 This article outlines a veneer case using NX3 Nexus® Third Generation—a new, universal cement from Kerr. The subject is a long-standing patient-of-re- cord with a current radiological and medical chart. This focus is on the steps and techniques im- plemented at final cementation of the prostheses. Clinical Case A female patient in her mid- fifties presented a chief com- plaint of being unhappy with her smile. An examination of her hard tissues revealed immediate concerns of multiple fractures, hypocalcification, shortened an- terior teeth due to wear and an asymmetrical smile line (Fig- ures 1 and 2). After proposing a first phase treatment plan to restore all of her compromised upper ante- rior teeth, the patient consented to restoring only teeth numbers 6-11. The patient ultimately qualified for and accepted ve- neers as the mode of indirect restorative treatment. Prior to preparation, the tissue around tooth No. 8 was recon- toured. Then, the teeth were prepared for pressed ceramic veneers and provisionalized in the standard manner. Oc- clusal analysis and adjustments were performed over a period of weeks and the veneers were tried-in. After the requisite steps were completed preceding in- sertion and the veneers were finalized, the provisionals were removed and the teeth were cleaned (Figure 3). Expasyl™ was used for gingi- val retraction and hemostasis in order to gain cervical access and control bleeding in that area (Figure 4). The teeth were then etched for 15 seconds with Kerr Gel Etchant, which is composed of 37.5% phosphoric acid (Figure 5), and then rinsed and slightly air-dried. (Note: While a total- etch technique was used, NX3 works with both total-etch and self-etch protocols, adding to the distinctiveness of the product.) Per manufacturer directions, OptiBond Solo™ Plus (Kerr) was brushed onto to the tooth sur- faces for 15 seconds (Figure 6), air-thinned for 3 seconds, and cured for 10 seconds using the L.E. Demetron II curing light (Kerr) (Figures 7 and 8). After etching and bonding, the veneers were cemented using NX3 light-cure cement in the clear shade (Figure 9). The ce- ment was dispensed directly onto the internal surface of the veneer and was expected to ooze from all margins when the veneers were placed onto the prepared teeth. With the choice of either the single-syringe light-