Ross W. Nash, DDS
In 1997, I placed eight porcelain laminate veneers for a young woman who wanted lighter teeth without whitening procedures. Her oral health was excellent, and I was able to use thin veneers bonded to enamel on minimally prepared teeth to achieve her goal. Vita shade A1 was chosen by the patient in 1997. She was excellent with her home care and made nearly all of her recare appointments during the following years.
In 2016, she decided that she wanted to replace her veneers with the new bleach-shaded materials available today. In Figure 1, you can see her veneers as they appeared after nineteen years. Note the excellent tissue health and minimal tissue recession. There was a small fracture in the disto-incisal corner of the right central incisor. The incisal view at this date can be seen in Figure 2.
By carefully removing the veneers with fine diamond burs in a high-speed handpiece with water spray, I was able to minimize additional tooth structure removal, and no anesthetic was needed. Figure 3 shows the facial view after removal of the veneers. The incisal view can be seen in Figure 4. The patient decided that she wanted two additional veneers for her second premolars. Final impressions were taken, as well as a facebow record and occlusal registration. The patient chose Vita OM2 bleach shade as her desired color.
At dental laboratory, ten IPS e.max laminate veneers (Ivoclar Vivadent) were fabricated. They can be seen in Figure 5 photographed on a mirror surface. Notice the internal etched surfaces. As you can see in Figure 6, the veneers are very thin (approximately 0.3 mm).
THE CEMENTATION PROCEDURE
The veneers were bonded to place using a self-adhesive light-cured luting composite (Fusion-Zr Veneer Cement, Taub Products). The four incisors were isolated with thin metal strips and an enamel etching gel was placed on the prepared enamel surfaces (figure 7). The etching gel was rinsed thoroughly and the teeth were air dried. The etched enamel surfaces can be seen in Figure 8.
No bonding agent is needed for the enamel and no silane is needed for the ceramic with this self-adhesive cement. The “opal white” shade was chosen and placed on the intaglio surfaces of the veneers (figure 9). The four veneers were placed on the teeth and lightly seated. The marginal cement was spot cured for two seconds using a LED curing light (figure 10). The marginal cured cement was teased away using a number 12 surgical blade (figure 11). Interproximal resin was removed with dental floss. Light curing was then completed by using the LED curing light for 20 seconds on the facial and lingual surfaces of each veneer (figure 12). Excess cured resin was removed with a small carbide finishing bur (figure 13) and the margins were polished using a polishing cup (Enhance finishing cups, Dentsply Sirona).
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THE FINAL RESULT
The new veneers are shown from the facial view in Figure 14 and incisal view in Figure 15. In the radiograph in Figure 16, the thin veneers can be seen in place. This case illustrated to me that thin veneers bonded to enamel have the potential to last for many years.