Complex dental cases require proper treatment planning to ensure a successful outcome. These cases must consider the patient’s concerns and desired result as a starting point and then create a
One of the most common options for treating an All-On-4® case is a hybrid prosthesis. But all “hybrids” are not created equal. We are a long way from the days of the only option being a cast metal substructure with traditional acrylic and denture teeth.
Teeth play an important role in daily life. They are not just for chewing, but they also help with speaking clearly, give faces shape, and correct support. Teeth can also
Choosing the most suitable material for a smile restoration is crucial to success in dentistry. Learn the three primary characteristics necessary for dental veneers.
Porcelain veneers were introduced by Dr. Charles Pincus in Hollywood in 1928 to enhance an actor’s appearance for close-ups in the movie industry. Dr. Pincus used thin methyl-methacrylate veneers that he temporarily affixed with denture adhesive for filming and then removed afterward. Today, everyone wants a HOLLYWOOD Smile.
“The cornerstone of every good treatment plan is an accurate diagnosis. An esthetic treatment plan requires an esthetic diagnosis. The truly esthetic dentist devises an attractive dental composition not only from stereotypical guidelines of form and function but also as an organic expression of personality, status, lifestyle, gender, occupation, and other characteristics that distinguish one individual from another.
The smile is perceived as an integral part of the face and, in a larger sense, of the whole person. It is an expression of beauty, youth, age, or persona. In addition, the esthetic dentist must be aware of contemporary fashions, perceive patient expectations and self-image, and have the creativity and technical skill to orchestrate this information into a successful therapeutic result.
The prep for a veneer needs to be designed to be complementary to the end goal for the individual patient, and the existing conditions and the final desired results must be taken into consideration.
The perennial debate about veneer prep
There are many philosophies about how to prep for a porcelain veneer, each camp is fiercely loyal to the dogma of their methods. The truth is, as with many techniques in dentistry, it should be dependent on the individual patient’s specific situation and goals. What I seek to accomplish in this article is to present three variations of veneer preps and what conditions are best addressed by each prep style.
The first step in deciding the appropriate prep for a given patient is to ask, why are veneers a considered treatment plan for this patient?
Veneers
A medium-grit, round-ended diamond bur is used to remove a uniform thickness of facial enamel by joining the depth-cut grooves.
The diamond bur is angled to bevel back the incisal edge.
Factors for treating with porcelain veneers
The following indications may be managed by more conservative preparation:
Mildly discolored teeth
Teeth with enamel defect
Worn or foreshortened teeth
Chipped or broken teeth
The following indications require a more aggressive preparation:
Multiple unsatisfactory with spacing
Misaligned teeth
Insufficient display of teeth incisally, facially, or buccally
Badly discolored teeth, especially those with grey, black, or dark banding
The NO Prep Veneer: Myth or Magic?
One of the valid arguments for being as conservative as possible is the fact that research on adhesive dentistry tells us preserving as much enamel as possible facilitates the maximum adhesive bond strength. While on the topic of conservative veneers, the NO prep veneer needs to be discussed.
Event the legendary Dr. Robert Ibsen, the creator of Lumineers®, did “enamel contouring” in strategic areas and “freshened up” the enamel by bur-etching the surface and creating some finish lines with a diamond bur. The point is that, literally, all veneer cases need to be touched with a bur. The debate is, how much is too little and how much is too much?
Below are a few considerations that must drive the decision-making process regarding how much to prep.
1. The material properties of ceramic veneers
The minimal thickness of even the strongest materials is realistically 5 mm.
Fabrication limitations – While it is possible to make veneers thinner than .5 mm, it becomes unpredictable both in the fabrication process and in being able to seat the veneer safely if the veneer is made much thinner than .5 mm.
Optical limitations – As thickness decreases, there is a diminishing ability to block out underlying color and still have a vital appearance. Some veneer companies boast the ability to make veneers that are approximately .2 mm thick and are highly translucent, allowing them to replicate the natural appearance of enamel. We find that most patients want some shape change and a brighter smile, but they do not want their teeth to look like white Chiclets. What patients want is a beautiful, brighter smile that looks natural. That requires some prepping and a layered ceramic.
Finish-line margins are important to allow accurate seating and minimize the resin cement junction, which can stain in the future.
Veneers that have proper room can yield natural looking results versus opaque monochromatic veneers that are the result of too little preparation for a vital natural result. (See images below.)
2. Adhesive properties of tooth structures
It is generally accepted that the bond strength to etched enamel is higher than that of the bond to dentin. So maintaining as much enamel as possible is a worthy goal, but it is not the only element to consider. Dentists bond in ceramic crowns every day, and they bond them primarily to dentin.
Today’s adhesive has increased their ability to bond to dentin. This can vary significantly between which brand and generation of adhesive that you use. Some systems have virtually the same bond strength to both dentin and enamel, depending on how they are used. You need to be aware of how much dentin you are bonding to as you choose your adhesive material and protocols.
It is up to the clinician to determine how to achieve the goals of each case best.
There is no one style that fits all. As with all cases, it is essential for clinicians to be the bridge between the patient and the dental lab, but especially with elective cosmetic cases like veneers. There is an important line to walk between the patient’s cosmetic goals and the clinical requirements of each case. Knowing and accepting that there are choices in ceramic materials and understanding the subsequent preparation and adhesive requirements are critical ingredients for success in cosmetic veneer cases.
Types of veneers
Before I outline preparation variables, It is important to have a basic understanding of the ceramic materials typically used for veneers.
They can be broken down into three basic groups:
1. IPS E.MAX – Ivoclar Vivadent
Pressed or milled Lithium Disilicate is typically pressed and layered for veneers
Flexural strength of 500 MPa
2. IPS EMPRESS – Ivoclar Vivadent
Pressed or milled lucite-reinforced ceramic is typically pressed and layered for veneers
Flexural strength of 160 MPa
3. Feldspathic veneers
Hand-layered on platinum foil or on a refractory die
Flexural strength of 100 MPa
3 Basic Preparation Groups
1. Minimal Preparation Veneers
Minimal preparation veneers are best used when minimal shade or shape change is desired.
Prep parameters
.5 mm to .7 mm facial tooth preparation
Margin prep, .3 mm chamfer margin at or slightly subgingival
Preparation extending into the interproximal, 1/2 of the way through the contacts.
Incisal edge prep can be .75 mm to 1.5 mm – 90º “butt joint” prep is best.
Feldspathic layered veneers are the indicated restorations.
Pressed e.max can be layered if the incisal edge length is prepped at least 1mm and the incisal facial plane is also prepped to be slightly retroclined to allow for layering porcelain. (see image below)
The incisal can also be layered if the tooth is being lengthened, but facial incisal plane must still be prepped back.
It is important to note that a minimal facial prep can be used if it is acceptable to build out the veneer to >.5mm, for example, a .3 mm prep with a final veneer thickness of .5mm.
2. Classic Veneer Preparation
The Classic Veneer Preparation is most often used for veneer preparation and can accomplish moderate shade and shape changes.
Prep parameters
.8 mm to 1.00 mm facial preparation
.3 mm chamfer margin at or slightly subgingival
1 mm to 2 mm incisal edge reduction 90º “butt joint” prep is best.
Prep into the interproximal contact about 1/2 of the way through the contact
The incisal facial plane also be must be prepped to be slightly retroclined to allow for layering porcelain.
Interproximal Dog Leg / Elbow
It is essential to prep a “dog leg” lingual from gingival margin up under and into the contact slightly. This will prevent side views of the interproximal to reveal underlying tooth color in the area emerging from the papilla. (See image below)
This prep style is best used in teeth that:
Need moderate alignment corrections
Have diastema correction of less than 1mm
Have shade changes up to 3 steps in chroma or value (eg. A4 to A1)
Best material choices for this preparation:
Pressed layered ceramic like e.max.
Feldspathic layered veneers
Veneer material can be used depending on the clinician’s goals and preferences.
3. More aggressive veneer preparation
This preparation is used to correct for deficits like plat papilla, instant ortho, and diastemas.
Prep parameters
1 mm to 1.5 mm facial preparation
.3 mm chamfer margin at or slightly subgingival
1 mm to 2 mm incisal edge reduction 90º “butt joint” prep is best.
A “slice prep” through the contact to the cingulum needs to be at least .5 mm subgingival.
The incisal facial plane must also be prepped to be slightly retroclined to allow for layering of porcelain. (See image below)
This prep style is best used in teeth that:
Need more severe alignment corrections – “Instant Orthodontics”
Have diastema correction that exceeds 1mm, especially multiple diastemas
Have shade changes up to 3 steps in chroma or value. (Eg. A4 to A1)
Greater shade correction can be achieved with the use of spacious ingots or opaque layers built into feldspathic veneers.
Best material choices for this preparation:
Pressed layered ceramic like e.max.
Feldspathic layered veneers
Either veneer material can be used depending on the clinician’s goals and preferences.
Focus on patient-centered treatment
Understanding patient goals is the critical element of an esthetic veneer case. The materials and prep requirements fall into place once you focus your clinical knowledge on patient-centered treatment. Then coordinating that desired outcome with a cosmetic dental lab like Burbank Dental Lab will deliver the WOW factor for your patient.
Burbank Dental Laboratory offers a full range of ceramic and porcelain veneer
solutions with three distinct categories of veneers, to cover any need that may arise in your practice.
Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.
Our New State-Of-The-Art 3d Printers
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.
Fabrication of the future is here!
Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.
Our New State-Of-The-Art 3d Printers
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.
What Our Clients Say
“I appreciate the quality and efficiency of this lab. I especially like the turn around times for their crowns (about 5 days). Thank you for your work and I highly...
“Burbank Dental Lab’s Smile Design Group helped to transform my patient’s smile with their exceptional attention to detail and overall quality of the emax crowns. The case was a success,...
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“I am a Heartland dentist in Texas and I have been looking for a comprehensive lab that I could use for implants, removable, and fixed. I discovered Burbank a few...
“Delivery time was excellent! The fit of the screw retained implant crown including emergence profile, contacts, seating, and occlusion were perfect. Didn’t do anything but seat it and torque the...
“Absolutely gorgeous and high-quality maxillary zirconia hybrid on Ti-bases. Their lab followed my prescription exactly. Their technicians have amazing talent. Thank you, Burbank!”
“We were looking for a lab that could accept our digital scans and produce high-quality centric-relation nightguards for patients. Burbank Dental Lab was recommended by a dental school classmate. We...
Burbank Dental Lab has far exceeded all of my expectations, and has fully delivered top tier prosthodontic work. What sets this lab apart from others is the constant communication. When...
“This lab provides restorative dentists with excellent technical support and high-quality lab work at reasonable fees. Their restorations are consistently excellent both from a functional and esthetic standpoint.”
“High quality dental lab with years of experience. Very professional service and results are second to none. Whether its cosmetic work, implant work, or digital, Burbank has their act together....
“In 25 years practicing dentistry I have not delivered a better full mouth rehabilitation crowns and bridge case like the one I did today. Aesthetics, fitting, contact, and occlusion was...
“I have been using Burbank for a while now. They are the only lab I’ve worked with who delivers consistently superior results. Their esthetic and implant work is second to...
“Full Arch fixed prosthetic cases go extremely smoothly with Burbank Dental Lab and their imetric photogrammetry in-office workflow. Highly recommend this workflow for anyone doing full Arch cases. Working with...
“Great Dental Lab for removable and crown and bridge. Amazing customer service. Vince and Dmitri are very accommodating and will ALWAYS work with you. Their product is top notch!” (click...
Hi Tony, hope you’re well. I’ve sent you a before and after case of a #8 old PFM replacement – single tooth next to natural #9. (Click for photo). Also...
“Just wanted to let you all know that I retired a few years ago but I sincerely appreciated both the help and especially the great quality of the work you...
“The implant department at Burbank is amazing! They have delivered casework that has exceeded my expectations and our patients are thrilled! We switched from a local lab to Burbank; our...
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“Burbank Dental Lab has provided us with many years of high-quality work, timely service and friendly staff. Our thanks, from all of us at Westlake Dental Associates.”
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This case is the case where you sent me the samples of the acrylics for a patient who is very sensitive to different chemicals, etc. She wore each sample disc...
“What an amazing lab to work with. Each person I have encountered has been amazing. From Joel and Kenny to Laura in Accounting to Tony himself. The crowns go in...
“We have used this lab for 18 months. They have proven to be very patient and customer-centric. They produce some really nice work and are easy to work with. Cases...
“Vincent and Karen are the best! I worked with Vincent on a full mouth rehab case. Everything turned out great and the patient is very happy. Working with Vincent made...
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“Burbank Dental Lab is our most trusted dental lab for all of our dental work. They are extremely reliable and deliver exceptional products. They are always available for questions and...
“Amazing lab! The work always comes back in a timely manner and is beautiful! Marissa is who we are lucky enough to have help us with our cases and she...
“Very nice case! This patient was very happy. My only adjustment was to reduce the excess in the ovate pontic area that was overdone.” MARGINS: Excellent CONTACTS: Excellent CONTOUR: Excellent...
“I absolutely love this lab, very quick, beautiful work, and very professional. Marissa is so much help, and has answers every single time! Wouldn’t use anyone else!”
“For more than 5 years I have sent my removable lab work to Burbank Dental Laboratory. I delivered a new FUD and new mandibular distal extension RPD with a locator...
“Implant abutment and crown – this case was great! Thank you! The pink porcelain looked great where the gingival margins needed to be leveled.” MARGINS: Excellent CONTACTS: Excellent CONTOUR: Excellent...
“This was the first crown I inserted since we talked about the contacts being tight. This crown was PERFECT!!! Absolutely no adjustments were needed! This was one of those “throw...
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“Burbank is an excellent lab! It is one of the most high-tech operations in the country and I have visited many of them. Tony, Andrew, and the entire team have...
Thank you Joel for an excellent job. What I really love about Joel and Vincent from Burbank Lab is that 1. They listen to the instructions and follow them. 2....
“Thank you Joel for an excellent job. What I really love about Joel and Vincent from Burbank Lab is that: 1. They listen to the instructions and follow them. 2....
“Just completed a maxillary Prettau Zirconium bridge on 5 implants and am very pleased with the service, the attention to detail, and the communication skills of this lab, in particular...
This dental lab is world renowned for high quality of their crown and bridgework. I especially appreciate their expertise in implant castings. I happen to work with a couple of...
