VENEERS content

INTRODUCTION HISTORICAL ASPECT DEFINITION CLASSIFICATION INDICATIONS CONTRAINDICATIONS MATERIALS AND TECHNIQUES PROCESSED COMPOSITES ETCHED PORCELAINS CASTABLE CERAMICS VENEERS FOR METAL RESTORATION REPAIR OF VENEERS ON TOOTH STRUCTURE IN METAL RESTORATION CONCLUSION

INTRODUCTION One of the greatest assets a person can have is a smile that shows beautiful natural teeth. When teeth are discoloured, malformed or crooked, there are often conscious efforts to avoid smiling or causes a hand to cover the mouth or manipulation of the lips in an unnatural manner to make up for the defect.

Children are especially sensitive about unattractive teeth because of cruel remarks made by other children. Correction of these types of dental problems can produce dramatic changes in appearance, which often results in improved confidence, personality and social life.

The restoration of a smile is one of the most appreciated and gratifying services a dentist can render. The veneer is a conservative alternative to full coverage for improving the appearance of an anterior tooth. Veneers have evolved over the last several decades to become one of esthetic dentistrys most popular restorations.

DEFENITION veneer is a layer of tooth coloured material that is applied to a tooth for esthetically restoring locali!ed or generali!ed defects or intrinsic discolouration. CLASSIFICATION "ental veneers can be classified as follows# $. "irectly fabricated composite resin veneers. a. "irect partial veneers b. "irect full veneers %. &ndirectly fabricated veneers

a. 'tched porcelain veneers b. (rocessed composite veneers c. Castable ceramic veneers ). Veneers for metal restorations.

INDICATIONS $. Discolouration: Tetracycline staining, devitali!ation and fluorosis, teeth darkened with age can benefit by the process. %. Enamel defects: "ifferent types of enamel hypoplasia and malformations can be masked. ). Diastema: *aps and other multiple unsightly spaces can be closed. +. Mal ositioned teet!: "eveloping the esthetic illusion of straight teeth where teeth are actually rotated or malpositioned can be accomplished for patients who have relatively sound teeth but do not wish to undergo orthodontics. ,. Malocclusion: The configuration of lingual surface of anterior teeth can be changed to develop increased guidance or centric holding areas in malocclusion or periodontally compromised teeth. -. "oor restorations: Teeth with numerous shallow, unaesthetic restorations on labial surfaces can be dramatically restored. .. A#in#: /or discoloured teeth or attired teeth due to aging, improvement can be done by bleaching or bleaching with subse0uent veneering. 1. $ear atterns: (orcelain laminates are also useful in those cases that e2hibit slowly progressive wear patterns. &f sufficient enamel remains and the desired increased in length is not e2cessive, porcelain veneers can be bonded to remaining tooth structure to change shape, color or function.

3. A#enesis of lateral incisor: When lateral incisors are missing, veneer can be used to develop better coronal form in the canine, thus simulating a lateral incisor. These may have to be combined with veneers on the central incisor to develop a more ideal ratio in the relative proportion of the teeth, because the canine is invisible too wide when positioned ad4acent to the central incisor.

INDICATIONS $. 5tained 6 defective restoration %. "iastema ). /ractures +. ,. ttrition dolescent teeth 78arge pulps9

-. "iscolouration .. :alformation 1. :alpositions 7slight9 3. ;oot e2posure $<. 'rosion6abrasion

CONTRAINDICATIONS $9 A%aila&le Enamel: There should be enamel around the whole periphery of the laminate, not only for adhesion but, more importantly, to seal the veneer to the tooth surface. There should be sufficient enamel for bonding. =ecause bonding to dentin is generally less retentive than enamel. &f tooth or teeth are composed

predominantly of dentin and cementum, crowning may well be treatment of choice. %9 A&ilit' to etc! enamel: deciduous teeth and teeth that have been e2cessively fluoridated may not etch effectively. They may re0uire special measures to be successful with porcelain laminator. )9 Oral !a&its: (atients with certain tooth habit patterns, such as bru2ism, or tooth to foreign ob4ects habits may not be ideal candidates of veneers. +9 (i#! caries rate: in patients with high caries rate laminate veneers are contraindicated.

(ISTOR): &n $3)<s "r. Charles (incus used this porcelain veneers to improve the esthetics of movie stars teeth. >nfortunately he had to use denture adhesive to hold the veneers in place. &n mid $3.<s and early $31<s composite resin laminate veneers, wit or without a facing evolved.

t first, composite resin was added directly to facial surface of a tooth to restore fracture, discoloured or malformed incisors in a procedure known as bonding.

The early composites presented with problems like monochromatic appearance, with staining and a loss of lusture over time. 'arly composite veneers did not need any tooth preparation and a bulk of material was needed for pleasing appearance. >nfortunately over contoured restoration lead to gingival inflammation. 5econd evolution of veneers involved development of preformed veneers that were 4oined to etched tooth structure. Constructing a veneer and bonding it to etched

tooth structure is referred to as laminating disadvantages of this was ? color instability, surface staining, low abrasion resistance, poor bond. These problems led to diminished use of acrylic resins or composite resins. *la!ed porcelain is

nonporous, resists abrasion, and possesses esthetic stability, well tolerated by gingiva. &n early $31<s method of bonding porcelain to acid etched enamel was developed. 'tching porcelain using hydrofluoric acid 73@$<A9.

The application of silane coupling agent also increases bond strength, the silane@coupling agent initiates a weak chemical bond between the 5iO% of porcelain and bis@*: polymer of composite resin. The improved strength of etched porcelain permits an e2panded use of veneers and popularity has increased over the following years.

ADVANTA*ES OF DIRECT COM"OSITE VENEERS $9 Only one appointment. %9 The dentist directly controls form and colour. )9 Cost to the patient is reduced. +9 Composite veneers are repairable.

ADVANTA*ES OF INDIRECT "ORCELAIN TEC(NI+UE $9 The dentist may use the time saving and esthetic skill of a ceramist. %9 :ultiple units can be placed with less chair time. )9 (orcelain is the optimum material for color stability, esthetics, wear resistance and tissue compatibility.

"ROCESSED MATERIALS OT(ER T(AN "ORCELAIN ;esins and composites processed at elevated pressures and6or temperatures, castable hydro2yapatite and in4ectable ceramics 7"icor, Convertone9. &ndirect resins have better physical properties than direct light cure composites but decreased bond strength. Cast ceramics have advantages of wa2ing stage, e2cellent translucency, and possible decrease pla0ue adherence.

"ORCELAIN LAMINATES re thin facings of ceramic porcelain affi2ed directly to teeth using a composite resin as bonding cement. >nlike composite veneers, which are directly fabricated on the patients teeth, porcelain veneers are constructed on refractory dies made from elastomeric impressions,

The inner surface of the porcelain veneer is treated with hydrofluoric acid, etching it frosty white and increased interface area wit retentive irregularities for mechanical bond to composites. lbers indicated that a tooth to be bonded should (referably, the

have atleast ,<A of its surface composed of etch able enamel.

peripheral margins are of enamel to conform to the Bone millimeter circumferential principleC for long@term marginal integrity of the enamel resin bond.

T$O T)"ES OF VENEERS $9 "artial %eneers: &ndicated for the restoration of locali!ed defects or areas of intrinsic discoluration. %9 Full %eneers# &ndicated for the restoration of generali!ed defects or areas of intrinsic staining involving the ma4ority of the facial surface of the tooth.

&mportant factors like patients age, occlusion, tissue health, position and alignment of teeth and oral hygiene.

ADVANTA*ES OF INDIRECT VENEERS $. &ndirectly fabricated veneers are much less techni0ue sensitive to operator ability. Considerable artistic e2pertise and attention to detail are re0uired to consistently achieve esthetic and physiologically sound direct veneers. &ndirect veneers are made by a lab technician and are typically more esthetic. %. =y multiple teeth are to be veneered, indirect veneers usually an be placed much more e2peditiously. ). &ndirect veneers will last much longer than direct veneers, especially of porcelain or cast ceramic.

To achieve esthetic and physiologically sound results an inter@enamel preparation is almost always indicated.

The only e2ception is in cases where the facial aspect of tooth is significantly under contoured due to severe abrasion or erosion. &n these cases, more roughening of the involved enamel and defining of the peripheral margins are indicated.

&ntra@enamel preparation 7or the roughening of the surface in under contoured areas9 before placing veneer is strongly recommended for the following reasons. $9 To provide for opa0ue, tinting, bonding and6or veneering materials for ma2imal esthetics without over contouring.

%9 To remove the outer fluoride rich layer of enamel which may be more resistant to acid etching. )9 To create a rough surface for improved bonding. +9 To establish a definite finish line. MATERILAS AND TEC(NI+UES &t is necessary that a complete e2amination, diagnosis not treatment plan be finali!ed before the patient is scheduled for operative appointments. t the beginning

of the each appointment also carefully e2amine the operating site and assess the occlusion, particularly of the tooth scheduled for treatment.

LOCAL ANEST(ESIA *enerally veneering of teeth does not re0uire local anesthesia as most of preparation are in the enamel. &f the defect is e2tending into the dentin then use of local anesthesia is advised. &t also contributes to a pleasant and uninterrupted

operation and usually results in a marked reduction in salivation.

"RE"ARATION OF O"ERATIN* SITE Clean the operating site to remove calculus, pla0ue, pellicle and superficial stains. (rophylactic pastes containing fluording agents, glycerine, or fluorides act as contaminants and should be avoided to prevent a possible conflict with the acid etch techni0ue. 5lurry of pumice is recommended for this procedure.

TEC(NI+UES $9 "irect Veneer Techni0ue#

a. "irect partial veneers b. "irect full veneers

DIRECT "ARTIAL VENEERS 5mall locali!ed intrinsic discolouration or defects that are surrounded by healthy enamel are ideally treated with direct partial veneers. The outline form is dictated solely by the e2tent of the defect and should include all of the discoloured area. >se a coarse elliptical or round diamond instrument with air water coolant to prepare the cavity to depth of <., to <.., mm.

>sually it is not necessary to remove all of the discoloured enamel in a pulpal direction. Dowever the preparation must be e2tended peripherally to sound,

unaffected enamel. /or the masking of dark stains opa0uing agents 7e.g. Euva 5eal (. . sealant in which is dispersed an opacifying agent, titanium@dio2ide9 is used if necessary. The entire defect or stain is removed, and then a microfill composite is recommended for restoring the cavity.

:ost composites filled primarily with radiopa0ue fillers, such as barium glass, in addition to being radiopa0ue are also more optically opa0ue with intrinsic marking 0ualities. >se of these types of composites for the restoration of cavities with light residual stains is most effective and conserves tooth structure.

S(ADE SELECTION 5pecial attention should be given to matching the color of the natural tooth. "etermine the shade of tooth before the teeth are sub4ected to any prolonged drying,

because dehydrated teeth become lighter in shade as a result of a decrease in translucency. Eormally color of teeth varies from degrees of gray, yellow, orange tints. The color also varies with translucency, thickness and distribution of enamel and dentin as well as age of the patient.

:any manufactures provide shade guide for their specific materials, which usually are not interchangeable with materials from other manufactures. :ost

composite materials are available in enamel and dentin as well as translucent and opa0ue shades. *ood lighting, either natural or artificial is necessary when the color selection is done. Eatural light is preferred for selection of shades. &f dental operating light is used, it should be moved away to decrease the intensity, thus allowing the effect of shades to be seen.

&n choosing the appropriate shade, hold the entire shade guide near the teeth to determine general color. Then select and hold a specific shade tab alongside the area of a tooth to be restored. The shade tab should be partially covered with the patients lip or operators thumb to create the natural effects of shades. The cervical area is usually darker than the incisal area.

ISOLATIN* T(E O"ERATIN* SITE &solation of tooth colored restoration can be accomplished with 7$9 ;ubber dam, or 7%9 Cotton rolls and retraction cords. Contamination of etched enamel by saliva results in a decreased bond, contamination of composite, results in degradation of physical properties.

ADVANTA*ES OF DIRECT VENEER Can be done in one appointment. &t is less e2pensive. Can also be used in cases where patient doesnt have much time for repeated appointments. DISADVANTA*ES &t is very time consuming. 8abour intensive.

DIRECT FULL VENEERS &ndicated in e2tensive enamel hypoplasia involving anterior teeth. lso indicated in distema closure.

5everal important factors like patients age, occlusion, tissue health, position and ad4ustment of teeth and oral hygiene must be evaluated prior to processing full veneers. &f full veneers are done, care must be taken to provide proper physiological contours, particularly in the gingival area, to favour good gingival health. Over contoured or properly contoured veneers leads to severe gingival irritation. There is controversy involving the location of the gingival margin of veneer. 5hould it terminate short of the free gingival crest and the answer depends on individual situation. &f defect of discolouration does not e2tend subgingivally then the margin of the veneer should not be e2tended subgingivally. The only logical reason for e2tending the margin subgingivally is if the area if the area is carious or defective, warranting restoration, or if it involves significantly.

 "ark discoloration that prevents a difficult esthetic problem. Eo restorative material is as good as normal tooth structure and the gingival tissue is never as healthy when it is in contact with artificial material.

T,o &asic re aration desi#ns e-ist for full %eneers. $9 %9 window preparation n incisal lapping preparation.

A $INDO$ "RE"ARATION This is recommended for most direct and indirect composite veneers. This intra@enamel design preserves the functional lingual and incisal surfaces of the ma2illary anterior teeth, protecting the veneers from significant occlusal stress.

window preparation design also is recommended for indirectly fabricated porcelain veneers if the patient e2hibits significant occlusal function and evidenced by wear facets on lingual and incisal surfaces. =y using a window preparation the functional surfaces are better preserved in enamel. The design decreases the potential for accelerated wear of the opposing teeth that could result if the functional path involves porcelain on lingual and incisal surfaces. AN INCISAL LA""IN* "RE"ARATION &ndicates when the tooth being veneered needs lengthening or when an incisal defect warrants restoration. dditionally, incisal@lapping design is fre0uently used

with porcelain veneers, because it not only facilitates accurate seating of veneers upon cementation, but allows for improved esthetics along the incisal edge.

"ROCEDURE This procedure can be indicated when there is enamel hypoplasia involving all ma2illary anterior teeth, when diastema is present in between the teeth. fter teeth are cleaned and a shade selection done, isolate the area with cotton rolls and retraction cords. (repare the cavity preparation on both central incisor with a coarse, rounded end diamond instrument.

The window preparation is typically made to a depth roughly e0uivalent to half the thickness of facial enamel ranging from appro2imately <., to <.., mm mid facially and tapering down to a depth of about <.% to <., mm along the gingival margin depending on the thickness of enamel. heavy chamfer at the level of the gingival crest provides a definite cavity margin for subse0uent finishing procedures. :argins are not e2tended subgingivally, these areas not defective.

The preparation for a direct veneer normally is terminated 4ust facial to the pro2imal contact e2cept in areas of diastema. To correct the diastema, preparations are e2tended from the facial onto the mesial surfaces, terminating at the mesio@lingual line angles.

The teeth should be restored one at a time.

fter etching, rinsing, drying,

procedures apply and polymeri!e the resin@bonding agent. (lace composite on tooth in increments, especially along the gingival margin, to reduce the effects to allow some freedom in contouring.

5ometimes, if the teeth have tetracycline stains they are much more difficult to veneer especially if dark banding occurs in the gingival third of the tooth, for much cases the veneer margins are placed sub@gingivally.

fter cleansing and shade determination, mark the gingival tissue level prior to tooth isolation on the facial surfaces of the teeth to be veneered by preparing a shallow groove with a F round carbide bur.

=ecause the cervical areas are badly discoloured and the gingival tissue covers much of the clinical crown isolation and tissue retraction is accomplished with heavy rubber dam and no. $% cervical retainer only one tooth is prepared and restored at a time.

The outline form includes all of the facial surfaces, e2tending appro2imately <.$ to $ mm cervical to mark indicating the gingival tissue level, and into the facial embrasures but not including contact areas. s much well supported enamel as

possible should always remain at the incisal ridge to preserve strength, wear resistance and functional occlusion or enamel.

(repare the tooth i.e., concave, rounded and diamond instrument by removing appro2imately half of the enamel thickness 7<.) mm in the gingival region to <.. mm in the mid facial and incisal regions9. fter etching, rinsing and drying, apply thin

layer of bonding agent and cure. Opa0uing layer can be applied after this procedure. pply a gingival shade of composite to cover gingival third of the tooth. =lend the

incisal shade over the middle third and onto the incisal area for proper contour or colour.

DIRECT VENEER T(EC(NI+UE :any dentists find that the preparation, insertion and finishing of several direct veneers at one time is too difficult, fatiguing and time consuming. 5ome patients become uncomfortable and restless during long appointments. The veneer shades and contour can be better controlled when made outside the mouth on the cast. /or these reasons indirect veneers are preferred.

In direct %eneers include t!ose made &': $. (rocessed composite. %. 'tched porcelains 7/eldspathic9 ). Castable ceramics. =ecause of superior strength, durability and esthetics, feldspathic porcelain is by far the most popular material for in@direct veneering. Cast ceramic veneers offer comparable 0ualities but re0uire e2acting lab support and the superb marginal fit of these veneers can minimi!e or eliminate this disadvantage. &ndirect veneers are attached to enamel by acid etching and bonding with either a self@cured, light or dual cured resin bonding material.

ETC(ED "ORCELAIN VENEERS :ost fre0uently used is etched porcelain 7feldspathic9 veneer. (orcelain veneers etched with ..,A hydrofluoric acid 7.@$< minutes9. 'tched porcelain veneer are highly aesthetic, have high bond with etched enamel via resin bonding medium, stain resistant, periodontally compatible. The incidence of cohesive fracture for etched porcelain veneer is less than composite veneer.

ADVANTA*ES $9 Colour@better natural look with good stability %9 =ond strength )9 (eriodontal health +9 ;esistance to abrasion ,9 5trength -9 ;esistance to fluid absorption .9 'sthetics.

DISADVANTA*ES $9 Time %9 ;epair@not easily once luted to enamel )9 Techni0ue sensitive +9 Colour ,9 Tooth preparation -9 Cast .9 /ragility.

"ROCEDURE (orcelain laminate veneers re0uire preparation of tooth. &t is minimal and within enamel 7<., mm9. &deally finish line should be a slight chamfer placed within enamel at level of gingival crest or slightly subgingival.

STE"S a9 8abial6facial reduction. b9 &nterpro2imal e2tension. c9 &ncisal or occlusal modification. d9 8ingual reduction.

LA/IAL0FACIAL REDUCTION $. '2tended reduction is <.) mm, reduction for the incisal half of labial surface and incisal edge is <., mm. %. 8V5 depth diamond cutter is used. This stone creates hori!ontal striations or depth cut grooves on labial surface. ). This diamond comes in % si!es 8V5 Eo.$ 7<.)mm9, 8>5 EO.% 7<.,mm9. +. 5elect appropriate diamond cuter ,. *ently draw diamond across the labial surface of the tooth in a depth cuts as hori!ontal grooves, leaving a raised strip of enamel between. -. Then remaining enamel must be reduced to these cuts. .. =ulk of reduction should be done wit with a coarse round end tapered diamond bur. This completes gingival portion of facial reduction while the tip of diamond establishes a slight chamfer finish line at level of gingiva. 7/inish line should be at right angle to the gingival margin9.

INTER"RO1IMAL REDUCTION $. (ro2imal reduction is an e2tension of facial reduction. %. >sing round end tapered diamond, continue reduction into pro2imal area. ). s the bur is a carried interpro2imal embrasure, it is easy to lift instrument slightly towards the incisal, creating a step at gingival. This step should be eliminated since this can create a dark shadow. +. To correct an uneven finish line, make sure the diamond is parallel wit long a2is of tooth. These will guarantee that the gingival e2tension in the interpro2imal area is e0ual to reduction of pro2imal surface at incisal. The pro2imal reduction should e2tend into contact area but it should stop 4ust short of breaking the contact when multiple ad4acent teeth are prepared for veneers. The contacts should be opened to facilitate separation of the dies without damaging the interpro2imal finish line. INCISAL REDUCTION $. The fabrication of a porcelain veneer capping the incisal edge makes placement of restoration that much easier by virtue of having a definitive step during seating. %. The reduction should be at least $ mm if it is desired to restore original length. ). (orcelain is stronger in compression than tension. Wrapping the porcelain over the incisal edge and terminating it on the lingual surface places veneer in compression during function. aids in proper seating of veneer. +. :ultiple wheel diamond bur makes <., mm depth orientation grooves in incisal edge. ;emove tooth structure between grooves with round end tapered diamond. slight incisal overlap provides a vertical stop that

LIN*UAL REDUCTION $. Create the lingual finish line with the round end tapered diamond. Dold

instrument parallel to lingual surface, with its end forming slight chamfer <., mm deep. %. /inish line should be G$6+th the way down the lingual surface, $.< mm from centric contacts and connecting the tow pro2imal finish lines. ). &ncrease strength, increase thickness of porcelain.

IM"RESSIN* MA2IN* /irst retract with cord or cotton impregnated with astringent like aluminum sulfate. Heep coard for , minutes. &mportant material ? elastomeric@light and heavy.

"ROCESSED COM"OSITE VENEERS &n recent years, lab processed composites resins have been developed as indirect veneer material suing light, heat, vacuum, microfilled resin materials can be processed with better physical and mechanical properties. sensitive, operators skill. They are techni0ue

ADVANTA*E 5uperior shading capabilities and control of facial contours, because of microfiled resin, can be polished to a lustrous finish.

DISADVANTA*ES 8imited bond strength.

l newly developed processed composite of the hybrid type, filled with barium glass and colloidal slice, offers increased bond strength. =ecause it contains barium glass, a soft radiopa0ue filler, it can be sandblasted and etched in the lab with a mild concentration 73A to $<A9 of hydrofluoric acid to produce numerous microscopic undercuts 7etched composites9. This can help in bonding with enamel.

(rocessed composite can be placed easily, finished and polished also replaced and repaired easily. Therefore mostly placed in children and adolescents in interior restoration until teeth have erupted and achieved full crown length. 'tched composite are indicated for patients who e2hibit wear of interior teeth due to occlusal steers. window preparation design is recommended due to limited bond strength. With bond end tapered designs at depth of <., m to <.., mm then impressions are made.

light cured resin bonding agent is used for bonding. 'tch, rinse and dry the tooth, this layer of resin bonding agent is applied to etched enamel, lightly blown with air but not cured until placement of veneers. (remature curing may preclude full seating of veneers. Veneers are carefully placed on tooth and lightly 4iggled, remove e2cess bonding medium, cur for +< to -< seconds. Then finishing and flossing is done.

CASTA/LE CERAMIC VENEERS $. Castable ceramic@"icor.

%. >nlike etched porcelain veneers, which are fabricated by stacking and fi2ing feldspathic porcelain, castable ceramics veneers are cast using lost wa2 techni0ue. ). The material is grayish in colour and very translucent. +. 8ow fusing feldspathic shading porcelains fired onto surface of veneer provides final coloration. ,. (rocedures are same as etched porcelain veneers. '2cept that margins of castable ceramic veneers cannot be contoured and finished with rotary instrumentation 7it will lead to loss of coloration9.

ADVANTA*ES &t has e2cellent marginal fit.

VENEERS FOR METAL RESTORATIONS $. 'sthetic inserts 7partial or full veneers9 of a tooth coloured material can be placed on facial surface of a tooth previously restored with a metal restoration. %. /or new castings, plans are made at time of cavity preparation and during lab development of wa2 pattern to incorporate a veneers into the cast restoration. ). fter such a casting has been cemented, the veneer can be inserted as described later, e2cept that the portion of mechanical retention of veneer into casting is provided in wa2 pattern stage.

VENEERS FOR E1ISTIN* METAL RESTORATIONS $. Occasionally the facial portion of an e2isting metal restoration 7amalgam or gold9 is 4udged to be distracting. %. ;adiograph is re0uired, to determine if restoration is sound.

). 5i!e of offensive area determines e2tent of preparation. +. nesthesia is not re0uired because most of preparation is in metal or enamel.

,. Clean areas with pumice, select shade, isolated site with cotton rolls. -. When offensive metal e2tends subgingivally, the level of gingival tissue is marked on restoration with a sharp e2plorer and retraction cord is placed in gingival crevice 7sometimes rubber dam9. .. EO.% carbide bur rotating at high speed with an air water spray is used to remove metal, starting at a point midway between gingival and occlusal margins. 1. (reparation is make perpendicular to surface appro2imately $ mm deep at minimum leaving a butt 4oint at cavosurfaces margins. 3. ll of metal along facial enamel is removed and preparation is e2tended into facial and occlusal embrasures 4ust enough for metal to hide the metal. $<. The contact area on the pro2imal or occlusal surfaces must not be included in the preparation. $$. To complete outline form, preparation is e2tended gingivally appro2imately $ mm past the mark indicating clinical level of gingival tissue. $%. :echanical retention is placed in gingival area with a Eo.$6+ carbide bur <.%, mm deep along the gingivoa2ial and linguoa2ial angels. $). ;etention and esthetics are enhanced by beveling enamel cavosurfaces margin <., mm wide wit a concise, flame shaped diamond instrument oriented at +, degrees to e2ternal tooth surface. $+. fter etching rinsing and drying, cavity preparation is completed. Eew adhesive resin liners containing a chemical called +@:'T to metal may be used. $,. Composite materials inserted and finished in usual manner. capable of bonding composite

RE"AIR OF VENEERS /ailure may be because of breakage, discoloration or wear. Eot necessary to remove the whole old restoration, light cured composite is used. Veneers on tooth structure# $. 5mall chipped areas on veneers can be corrected by recontouring and polishing. %. /or direct composite veneers should be done with same material used before. ). fter cleaning the area and selecting the shade, roughen the damaged surface of veneer and6or tooth with concise, round end diamond instrument to form a chamfered cavosurfaces margin. Or mechanical locks can be placed in material with small round bur, etch, rinse, dry, bonding agent, cure add composite cure finish.

INDIRECT "ROCESSED COM"OSITES3 IN T(E SAME MANNER $. /or porcelain veneers, a mild hydrofluoric 7$<A9 acid preparation suitable for internal sue must be used to etch fracture porcelain apply rubber dam for gingival protection frosted appearance on porcelain apply silicone coupling agent to etched porcelain before boding agent, then add composite and finish. &f large replace entire porcelain veneer.

FAULT) VENEERS IN METAL RESTORATION $. Clean teeth with pumice, select shade, isolate, retract. %. ;emove old restoration wit carbide metal cutting bur. ). (lace retention with a Eo.)) I carbide burG<.%, mm deep. +. (olyester strips between teeth pro2imal surfaces.

,. Clean metal with acid. -. pply +@:'T place directly in prepared surface apply composite. dd

.. 'valuation of width of teeth achieved by boley gauge or other caliper. composite and finish.

CONCLUSION There is a definite need for an esthetically acceptable conservative treatment to correct the disfiguring appearance of malformed and discoloured teeth. This type of dental disturbance can introduce a grave psychologic effect on the patient. With the use of a specially shaded resin material, a thin plastic veneer and an acid etched techni0ue and also other laminate veneers like porcelain and ceramic veneers, an esthetic and functional restoration can be produced that will give the dentist and the patient consistently acceptable clinical results.

The greatest advantage of this techni0ue is it gives ma2imum esthetic effects and re0uires minimum or no tooth preparation.