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18 Cards in this Set
- Front
- Back
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Cosmetic dentistry - direct composite veneers
Short history 1. Charlie Pinkas 2. Mastique laminate veneers 3. Experimental veneers 4. No prep veneers 5. No dentin bonding |
Father of cosmetic/esthetic dentistry
"Hollywood dentist" - 1930s. Made porcelain veneers and stick them onto teeth. 2. available in late 70s- early 80s. methylmethacrylate teeth that are cemented onto facial surface. No prep. Really bad since they popped off. 3. Bondin cement didn't work very well. All attempts that failed miserably 4. Porcelain with very strong acid could be bonded onto teeth. Early 80s. After a few years, they worked well but they were bulky. 5. in early 80s, could only bond to enamel and not dentin. Early porcelains were only bonding to enamel. |
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Tetracycline staining
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1950s - was used extensively for upper respiratory infections in infants almost overnight. It was teh drug of choice and used sucessfully but many years later when perm teeth erupted, there would be staining. This caused dentin discoloration.
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What are some cosmetic solutions today?
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1. tooth whitening - minimally invasive, inexpensive. 80 and 90% of peopel that whiten their teeth are happy. for splotchy discoloration it may actually accentuate the spots. unpredictablility and how long it will last.
2. thin indirect veneers - lumineers. not much preparation but not well designed for making a radical difference between a badly discolored tooth and a regular one. 3. thick veneers - porcelain or ceramic** most common 4. ceramic crowns - good for class 3 or 4 lesions. 5. direct resin veneers |
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First step in direct composite veneer
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Shade selection
Under full spectrum light, early on in appointment Map out where you want to do what shade. Match a shade based on patient. Shade matching = 1 tooth to the other tooth. Shade selection - whole set of teeth. |
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What 2 things is that will determine the ability to hide something?
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Function of
1. how deeply you prepare the tooth 2. how opaque the composite is |
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What kind of rubber dam should you use?
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A tweener -- big hole rubber dam. Slice from hole to hole and make sure you cover about 6 teeth. A 6 hole rubber dam makes you lose your perspective of the entire tooth. Gives you an almost perfect enough rubber dam.
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Tooth preparation
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no stereotypical tooth prep. If you make a minimal change, you dont need much of a prep. Amount of axial prep depends on several things..
No only canging the color but also the shape. If your making the facial surface more contoured theres no prep at all. If its over contoured or twisted tooth, prepare it more. |
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Is there a minimum depth?
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Amount of axial depth is really determined by how much of a difference you want to make between where the patient starts and finishes.
Would like to stay in enamel and not go into dentin. Enamel bonding is durable. Shallow to deep is depending on replace vs. add on and pre to post op difference. -color from "within" - can layer enamel on top of dentin opacitiy. |
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What may happen if you dont have any prep of the tooth?
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May look bulky.
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Avg amount of axial reduction?
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0.5 mm. Best way is to use a depth cutting diamond burr. 3 channelled burr, and each channel cannot be more than half a millimeter.
You then take a diamond and make it uniform to even out the depth cuts. |
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Gullwing preparation
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Sort of looks like a birds wing. Allows you to get a good esthetic result in the proximal area. If you dont do a gullwing, you'll get dark mesial and distal. Bring the gull wing so that the margins are barely touching the adjacent tooth. Make certain you go enough into the triangle (near the lingual)
Take a hand instrument and remove the fragile enamel at the margin. |
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Subgingival margins?
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The margins can be supergingival if there's no change in color but almost always you need to go subgingival or else you cant hide the ugly tooth.
Free gingiva is somewhat translucent and you want to hide the discolored tooth in the apical part of the tooth. Will need to place retraction cord so that the free gingiva will retract about 0.5 mm. Dont try to go subgingival without moving the tissue away. |
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Once its prepared properly, what is next?
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For direct veneer, take plastic strip on mesial and distal and wedge very tightly on both sides. Need to make 2 small strips.
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How long do you etch?
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For enamel at least 15 sec but no problem with overetching enamel. Dentin no more than 15 sec. Rinse with a steady stream of water. Don't dessicate the dentin and shouldn't be bone dry. If its all enamel, you dont need a primer. Just a seal. Primer only primes dentin.
Bonding agent may pool or puddle in corners so no thick application. Take a brush to eliminate the puddling. After you cure it, you have a reactive air inhibited layer. |
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Stratification of colors
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you need to feather one color on top of each other, not have blocks of tooth colors.
Cervical - slightly yellow color. as you go towards incisal its thinner. Tints and opaquers - a blue tint and designed for subsurface characterization and covered with a translucent composite. Tints can be very intense so dont over do it. Place it and blot it away. Cure the tints and then cover with a translucent enamel like material. Finish it with disks to cut a flat and convex surface. |
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Final appearance
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-composite material - how good a shade selector you were.
- the tooth below -the surface contours -surface texture |
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Partial veneer
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Only a portion of the tooth needs to be fixed like the incisal edge. Body of tooth is good color and only prepare the discolored area. How deep you go are to either remove the discoloration or to go deep enough the mask the discoloration. At least 0.5 mm is needed to mask a discoloration.
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Prognosis of direct veneer
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This is fair, but not great.
-only fair color stability - composite it environemtnally sensitive so it can wear over time. -only fair wear resistance -not as durable or as esthetic as ceramic -requires artistic talent -requires time! |
