Ceramic restorations:
Bonded porcelain veneers - Part 1
By David M Roessler, BDS, MDSc, FRACDS, FADI, FPFA, FICD, MRACDS (Pros)
So what's possible?
Some of the biggest problems I see with
veneers occur when they are attempted
in inappropdate situations. Veneers are
totally dependent on bonding, and preferably, bonding to enamel, for their
strength. My rule here is that you want
a minimum of two thirds of the margin
bonded to enamel. Less that that and you
should start to think a crown might be
more appropriate.
An increased risk offailure is present
only when veneers are partially bonded
to dentin. The estimated survival probability over a period of 10 years is 91 %.
Dumfahrt & Schffer
Int J Prosthodont 2000; 13:9-18
Veneers can make only mild changes
to tooth colour. One of the things that
make veneers look so good is their lack
of an opaque layer giving them beautiful,
natural translucency. The fiipside of this
is that if the tooth underneath is too dark,
either it will show through, or you will
need an opaque layer which will make
the veneer look like white paint instead
of tooth structure. Again, if you're aiming
for a big shade change, think either whitening plus veneer or crown. And if the
tooth is very dark, you're probably better
off with porcelain/metal than an allceramic crown.
If the ceramic thickness is iess
than 1.0mm... colour matching of the
abutment is required.
Vichi et al.
J Prosthet Dent 2000; 83: 412-7
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prosthodontic PERSPECTIVE
Tooth preparation
I'm going to focus on upper anteriors initially and we'll discuss lower anteriors
a bit further on. There are three possible
situations here:
I.The tooth is intact and you are not
changing its length (Figure lb);
2. The tooth is intact and you are intending
to make it longer incisally (Figure lc); or
3. The tooth has a fractured incisai comer
and/or Class III or Class IV composite
resin(s).
Before knowing what to do, we need to
know what we're aiming at. As much as
possible, we want to stay in enamel. As a
mle of thumb, 0.5mm thickness of porcelain bonded to enamel is about as strong as
1mm thickness bonded to dentine. So we're
going to try to keep our preps conservative.
Second, it's important to maintain a
horizontal labial or, at worst, labioincisal
path of insertion. Why? When there is a
labial path of insertion, neither the mesiodistal taper of the tooth from incisai to
gingival nor the labial convexity in the
gingival third is of any concem. However, as the path of insertion becomes
January/February 2013
more incisai, these areas become potential undercuts requiring much more tooth
structure removal.
So, in point I (Figure lb), we should
be aiming for a veneer that has a fairly
even thickness covering all of the visible
parts of the tooth. Stop at the incisai edge
- there's no need to go over it. The one
exception here is an edge-to-edge occlusion - we don't ever want the opposing
incisai edge to be in contact with one of
our margins in centric occlusion.
Exactly how much tooth reduction you
require will depend on a few factors. If you're
maintaining the same tooth position and
making a fairly minor colour change, then
1 would suggest you need a 0.5mm reduction in the incisai two-thirds and a 0.3mm
reduction in the gingival third. Yes, this
will mean that the veneer is a bit over-contoured (not overhanging!) in the gingival
third but that over-contour doesn't affect
gingival health and it's really not visible.
In the more common point 2 (Figure
lc), veneers are used to lengthen teeth or
restore lost length. So we have a couple
prosthodontic PERSPECTIVE
Figure 3. Prep viewed from incisai edge when closing diastema between two upper central incisors.
the labial and palatal surfaces, the technician has no way to develop a smooth
anatomical transition from tooth to veneer.
What you end up with is a bulge of porcelain that forms a sideways overhang at the
margin. Generally, this area will also be
too translucent because of the lack of porcelain, so it will look dark. The solution
is to take the prep through to the palatal
third (Figure 3). Now, the technician can
develop adequate contour and opacity.
While we're talking about preparation, I
should mention lower anteriors. First, I'm
sure that we all agree that lower incisors in
particular are horrible little teeth and any
time you can avoid restoring them, do so!
If you are going to porcelain veneers, however, start by accepting that the veneers
are going to be over-contoured unless you
outrageously over-prepare them. You probably can't reduce the labial by more than
about 0.3mm without ending up in dentine,
and you really want to stay in enamel. So
check to see that you have occlusal room to
make over-contoured restorations.
The other modification is that you should
always cover the incisai edge when doing
lower veneers. First, because, if you don't,
you will have the incisai margin of your
veneer under heavy load in centric and in
function. Second, because the incisai edge
of a lower anterior is the most visible surface, so it won't look very good if there's an
interface there. So, you need to reduce the
incisai edge to make about 1.2mm space
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prosthodontic PERSPECTIVE
between it and the upper so you have 1mm
of bonded porcelain there. By the way, if
the patient is having some form of orthodontics, you can deliberately make that
space between the uppers and lowers so
you don't need to reduce the teeth so much.
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