They are thin plates of ceramic material retained by adhesive cement through etching and bonding mechanisms Their

r use is Considered conservative and aesthetic technique that can be applied when restoring the mouth for improved aesthetics. The longevity of the veneers is good and they are durable,especially if the right indications are in place and the correct techniques are applied.

Stained / defective restoration. 2. Diastema Closure. 3. Fractures. 4. Young aged patients where full coverage is contraindicated. 5. Slight malposition. 6. Craze lines within enamel. 7. Mild Attrition /erosion / abrasion. 8. Root Exposure.
1.

 Excellent esthetics. Long term durability due to high abrasion resistance, color stability and bio compatibility of porcelain. Inherent porcelain strength. Good marginal integrity. Minimal tissue reduction (only 0.5 mm within enamel). Excellent bio compatibility of the highly glazed ceramics. No need for anaesthesia. Usually do not require temporization.

Multiple visits are required. High cost. Fragility during try-in and cementation. Lack of repairability. Difficult color matching. Shade alteration is impossible after cementation. Irreversibility although tooth reduction is minimal. Cant be temporarily cemented for evaluation.

Bruxism with tooth wear. Very Short tooth. Tooth with inadequate enamel for retention (severe abrasion). Endodontically treated tooth with little remaining tooth structure. Patient with parafunctional activity e.g. nail biting bruxism, clenching.

The facial view : When the smile is analysed from a full-face perspective, only mesio-distal or vertical problems can be dealt with. In the illustrated case it is evident that the centralsoverlap, causing a vertical canting of the mid-line that is visible even to people with no dental knowledge. Proportionally speaking, the existing teeth are short for the face. The golden proportion is evident from this aspect. (1:1.618)

45 angle view (checking buccal-lingual dimension):

This angle allows the dentist to check the crowding in a more reliable manner. In this case it is evident that the mesialincisal tip of upper right 1 is more buccally placed relative to the upper left 1.

Aesthetic occlusal plane (AOP): The third dimension to be checked in the aesthetic evaluation is the AOP, which can simply be done from a saggital view. In this case, a deciduous canine exists (tooth c ), which creates a problem related to the AOP since it is too short. Also the upper centrals appear from this aspect to be tilted a bit palatally which wanst evident from other views.

When Seeking the best results and in order to make sure that going for tooth preparation to receive a laminate veneer is the treatment of choice , and that it would satisfy the patients needs you would better follow the following steps :

1. 2. 3.

4.

5.

Take a primary impression and construct study casts . Prepare the teeth on the model if needed. Wax the teeth on the model up so that you can reach a close form of the restoration you are intending to construct. Evaluate the results and discuss with the patient in order to put the final treatment plan. Take an impression of the waxed up model and get the second cast poured.

The next step would be the construction of a vaccuum transparent sheet on the poured model and loading it with flowable composite or temporary crown material and placing it into the patients mouth and curing . Also the direct method can be used which is building freehand light cured composite on the teeth to be veneered.

Tooth preparation: 1. Facial and interproximal Reduction : The procedure should begin with the use of a depth cutter which indicates the exact depth that is to be prepared which should be minimal, limited to enamel if possible but sufficient to provide correct contour of restoration (approx. 0.5 mm while 0.3 mm cervically). Followed by the use of a round end fissure or tapered stone to finalize the facial reduction preferably having an end with a finer grid. Once this reduction has been performed, the preparation is finished at the gingival margin and then extended towards the papilla to finish the interproximal elbow preparation.

Although the previous procedure in preparation of the laminate veneer is the most widely used method, it did not promote optimal preservation of enamel.

The simplest and most important tool for enamel reduction is a well-adapted, horizontally sectioned silicon index from the wax-up.

Recommended preparation procedure: Initial control with silicon index. Axial reduction I: interdental preparation using ultrasonic osscilllating instrument

The amount of interdental preparation depends on the type of interdental contact.

In cases of multiple neighboring teeth , wrapping of old class III restorations and reduction of diastema, extensive interdental preparation will be required.

2. incisal preparation and palatal wrap around:

The incisal edge might not be included as in Window and feather preparations however each has its disadvantages . Minimal incisal beveling can be done in Beveled type of preparation.

The incisal preparation ideally must not be less than 0.5 to 0.75 mm for strength.
The extent of wrapping is dependant on the initial situation and the prosthetic objective. Establishment of interproximal and incisal wrap around offers many advantages: i. it facilitates the esthetic definition of the laminate veneer in the incisal zone. ii. It enhances form and emergence profileof the restoration. iii. It facilitates the placement and stabilization of the final restoration. Moreover it facilitates easy access to all margins during bonding. iv. Better stress distribution and superior intrinsic resistance in the restoration itself.

For maximum remaining tooth substance, a minichamfer or butt margin is recommended to avoid the palatal concavity.

For moderate crown fractures (incisal one third) or moderate wear, the palatal finish line is localised in the zone of maximum tensile stresses. A butt margin is indicated.

Ideal levels of palatal margins:

I. thin versus thick teeth.

II.Existing class III restorations: Veneering teeth with pre-existing class III composite restorations arises the problem of interdental penetration and positioning of the margin. Moreover additional factor that must be considered in this situation is the curing contraction of the luting composite and the extremes of thermal changes.

Any Suitable impression material for fixed prosthodontics can be used . Example : polyvinyl siloxane or polyether can be used. Gingival retraction is necessary in many cases specially if slightly subgingival finishline is prepared. Casts should be full arch and articulated to preserve the anterior occlusal guidances.

Sometimes Not needed if conservative simple preparation is achieved. If extensive preparation is done a provisional restoration is required which can be done either directly or indirectly using light cured composite or chemically cured temporary crown material. Non eugenol temporary cements are used to avoid affecting the final cementation or zinc phosphate or spot etching and bonding.

Choice of fabrication technique: I. Refractory die technique: ceramic fired over refractory die is the oldest and most widespread method for fabricating a porcelain piece.

II. Platinum foil technique: superior marginal fidelity of platinum foil veneers has been recorded . III. Cast glass-ceramic restorations (Dicor): IV. Pressed ceramic (Empress): this offers two modalities: the reinforced pressed porcelain is used to fabricate either an entire restoration or only a core. V. Slip casting (Inceram ): It can generate restorations with higher intrinsic strength compared to other systems. VI. Machined ceramics (Cerec, Celay):

Try in of the laminate veneers is a critical step and influences the success of the final restoration. Try in shade kits are available that mimic the colour and appearance of different shades of luting resin cement.

Etching of the enamel surface using 37% orthophosphoric acid or laser etching. Etching of the laminate surface by hydrofluoric acid. Silanization of the laminate fitting surface. Placing the preselected cement shade on the laminates fitting surface. Removal of excess using a brush moistened with bonding agent. Curing.

Finishing is performed using finishing stones with fine grit . Followed by polishing paste with 2-5 micron particle size Interproximal abrasive strips. Evaluate the contact with unwaxed dental floss. Check occlusion by articulating paper.

Special effects: I. Shape effects:

II. Masking effects: Superficial and localized defects can be removed mechanically during tooth preparation. The discolored substrate is maintained, and masking is obtained by integrating a certain degree of opacity into the ceramic work piece.

Glass ceramics

Oxide ceramics

Feldspathic porcelain Leucite re-inforced (Empress) Lithium disilicate (emax)

 1. 2. 3. 4.

Aluminium oxide ceramics Inceram alumina Inceram spinelle Inceram zirconia (67%) Procera all ceram Zirconium oxide ceramics

This requires that we have simple classification of the cases first :

Type 1 patients : in these cases the veneers are not exposed to functional loading, and are referred to as simple esthetic facets.

Type 2 patients : in these cases the veneers are exposed to functional loading, and are referred to as functional esthetic facets.

Type 1: is further subdivided according to optical characteristics to: Type 1-A : these are subjects programmed to receive simple esthetic facets where the substrate teeth present no color alterations. Type 1-B : these patients are likewise programmed to receive simple esthetic facets, though in this case the substrate teeth present color alterations.

Since these are patients with facets that will not be subjected to functional loading and present a clear substrate, the material used only aims to solve problems relating to tooth shape. These are consequently favorable cases, since moreover only a small ceramic material thickness is required. In these situations we therefore recommend the use of conventional feldspathic ceramics, in view of their excellent optic characteristics that afford optimum esthetic results. The absence of occlusal stress in these cases, and the use of the currently available adhesion techniques (which improve resistance to fracture of these ceramics) contribute to ensure prolonged restoration survival.

Diastema closure using conventional feldspathic porcelain

These patients present facets that will not bear functional loading but which show moderate to severe alterations in dental color that must be effectively masked by the restoration. In these situations both the porcelain and cement must present various degrees of opacity in order to hide the color alterations .

Restored with empress (leucite reinforced) opacity grade II

Reinforced glass ceramics with the lost wax technique (ex: Emax , Empress) because of its esthetic properties and predictability. or oxide ceramics are indicated.

They are contact lens thin kind of laminate veneers around 0.3 mm thick. They require no preparation. They are helpful for phobic patients. They are reversible as there is no tooth destruction. It is alledged that they do not pose a problem for the emergence profile though still questionable. They r not tolerated by some patients. They might cause discomfort and gingival inflammations.

Fracture / chipping. Impaired esthetics. Gingival inflammation. Mrginal discoloration and decreased marginal integrity. Incomplete fit of laminate. Debonding. Patient discomfort. Hypersensitivity. Caries.