A Guide To Perfecting Veneers

ONE OF DENTISTRY'S MOST DIFFICULT ESTHETIC CHALLENGES

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One of dentistry's most difficult esthetic challenges is matching single anterior veneer restorations to the existing dentition. In many instances, cases like these may require several attempts to achieve an optimal result. If these types of cases are not appropriately managed, they can lead to unhappy patients.

There are, however, steps that can be implemented that will help ensure a more predictable outcome. Preparation, material choice, communication, and laboratory support are critical in achieving a proper match that can exceed patient expectations.

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Communication
Porcelain veneers - shade communication

Communication is critical in cases requiring matching a veneer to the existing dentition. These cases require a high level of evaluation to achieve a natural result. The assessment needs to begin with recording the characteristics of the existing dentition.

Here the shade, value, level of translucency, shape, surface texture, and luster should be evaluated.

Make sure to provide the following:

  • Take the shade before prepping. Taking the shade needs to be done early in the appointment as dehydration can occur after only a few minutes, affecting the color evaluation's accuracy.
  • The patient should be sitting upright.
  • Use either natural light or color corrected lighting.
  • Use cheek retractors to eliminate shadows.
  • Teeth should be at the evaluator's eye level.
  • Hold the shade tab in the same place as the dentition being evaluated, with the guide's incisal edge placed at the tooth's incisal edge.
  • Take a shade of the teeth after preparation.
  • If two shades seem close, go with the lighter as corrections will be more comfortable.
Canon

Photography

To obtain the best results, photographs are essential. They are not effective in communicating color, but they are crucial to providing characteristic information such as showing teeth with hypo calcification or crack lines. Pictures should also be taken when evaluating the shade of the dentition and shade of the preparation.

Whenever matching a restoration to natural dentition, provide the following photos:

  • A photo of the patient smiling
  • An image with the lips retracted
  • A full-face photo
  • Pictures showing the shade tabs in the same plane as the tooth with the tab's incisal edge directly in line with the dentition

During this appointment, it is good to have the patient involved in the color selection process and educate them on the challenges inherent in matching dental restorations to the existing dentition.

Material Choice

In most cases, when matching a veneer restoration to natural dentition, a lithium disilicate (IPS eMax) material such as Burbank Dental Lab's Nano® Press & Layered Veneers or our SimplyThin Veneer are ideal material choices. In some cases, feldspathic porcelain veneers are the best option.

Nano Press & Layered Veneers

Nano Press & Layered Veneers should be requested when a more aggressive preparation is needed. For example, these veneers work well where a shade correction is required.  This option is ideal when a shift in color of up to three steps is necessary to match dentition properly. These veneers are pressed and then layered and come in ingot shades that vary in color and opacity levels.

Preparation design:

  • Reduce the facial enamel by 1.00 mm to 1.50 mm
  • Create a .3mm chamfer margin
  • Incisal "butt joint" preparation with .75mm to 1.5mm reduction.
  • The facial plane at the incisal edge needs to be prepped at a retroclined angle.

SimplyThin Veneers

SimplyThin Veneers can be used when minor color changes are needed, and no major alignment issues are present. These restorations are fabricated to full contour and then stained. A glaze layer is added over the stain. These are best in cases where minimal preparation is required.

Preparation design:

  • Reduce the facial enamel by .5mm to .7mm
  • .3mm chamfer margin at or slightly subgingival
  • Extend the prep into the interproximal contact area about halfway
  • Incisal "butt joint" preparation with .75mm to 1.5mm reduction.

Feldspathic Porcelain Veneers

Feldspathic porcelain veneers are entirely layered to mimic natural dentition. They are great for cases where unfavorable underlying colors, such as those found in tetracycline cases, need to be blocked out to match the natural dentition properly. These veneers can mask out severe discolorations while providing a very natural translucent result. They are fabricated using either foil or refractory die.

Preparation Design:

  • Labial tooth preparation - .8 mm to 1.0 mm
  • Create a .3mm chamfer margin
  • Extend the prep into the interproximal contact area about halfway
  • Incisal "butt joint" preparation with 1.0 mm to 2.0 mm reduction

Each case must be evaluated separately. The preparation can vary and require variation from the above recommendations. It is critical to review all of the information on the case and then prepare the case accordingly.

The following case was presented with two old composite veneers

Before-e.Max veneers
Burbank Dental Lab patient before veneers

on tooth numbers 8 and 9. The patient's biggest concern was the discoloration that had developed over time. There were also some shape issues. After receiving the color information and noting the underlying color, it was determined that Nano Press & Layered Veneers would provide the best results.

It is crucial to try in the veneers with try-in gel before cementation to evaluate color and shape before the final cementation. This case resulted in a more harmonious result with the restorations matching the color and shape of the existing dentition beautifully.  This outcome is achievable when proper communication is provided.

Burbank Dental Lab patient after veneers on two front teeth
Burbank Dental Lab after e.max veneers on front teeth

Matching a single anterior veneer to natural dentition is a challenge and many factors can affect the outcome of a case. Fortunately, providing the right information to the laboratory helps to manage the success of these cases. Informing the patient of the difficulties involved is paramount in managing the expectations of the patient. Today we have various material options that can provide successful results in just about every situation and without being adjusted repeatedly.

Call or chat with our Smiles by Design team today to plan your next veneer case.

Smiles By Design

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of the future
is here!

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Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

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