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Porcelain veneers and full ceramic crowns

Mohammad Elwir

Dr. AHED WAHADN

-- / 1 /2014

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The Dr started the lecture by showing some of his cases

Esthetic cannot be achieved by metal ,esthetic need care , understanding and meticulous finishing and a good technician

porcelain laminated veneer

Veneers is a very thin layer of ceramic , its like a fingernail very thin (0.5 mm) if you use it for your patient you wont need anesthesia you dont need retraction cord , you dont need palatal reduction

If you dropped it will fracture, but it will not fracture in the patient mouth The doctor said that he never saw a fractured veneer inside the patient mouth his entire life

Veneer is very different than any other prosthesis once you do it you will forget about it and the patient , also you will never have a patient came complaining about it

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indications for veneers a-Gingival Abrasion b- Peg lateral c- Hypoplastic d- Fracture but not heavy fracture e- Discolored tooth f- diastima Most important indication is discolored tooth (you can do bleaching , but bleaching is recurrent because the enamel and dentine are porous so will absorbed the stain from foods and drinks ) Contraindications A- If the tooth is severely destroyed of worn out it doesnt work , the tooth need to be crowned to protect it BIt the teeth are over lapped

CLINICAL TECHNIQUE

TEETH PREPARATION

Supragingival finish line , only labialy , chamfer preparation , 0.5 mm reduction (using tabard bur ), no anesthesia , no need for retraction cord

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Dont exert pressure on the bur let the bur cut by itself you just direct the bur

Four types of preparation for the incisal edge 1. Bevel :- Bevel we do our preparation 0.5 reduction and in the incisal edge we do a bevel we tilt the bur 45 degree and bevel it 2. Feather edge 3. intra enamel window ( dont use it ) 4. Incisal overlap :- Over lap we use this kind of preparation when we want to change the incisal plane so I have to cut from the incisal edge and to restore with ceramic

Overlap

feather edge

We do Either bevel or over lap

Why beveling ?
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So we can give the technician a room in the incisal edge to add extra porcelain to reproduce the translucence

in the lower teeth I have to cover the incisal edge why is that ? because if we left it uncover the incisal edge the palatal surface of the upper will start pushing it away from the tooth surface ,, so I have to cover it

Proximal contact you have to cover in your prep whatever you see take this as a general role

Impression
What we use in the crown polyether or condensianl silicon , in the lab there are different technique depending on the material we use

Lab work
- pouring the impression , pour the die with special investment then the start applying porcline (which come as a powder and liquid) using brush not with metal instrument because metal particles may interfere with the ceramic and affect the shade - then the technician with the bur start to do some adjustment - sandblasting using aluminum oxide Al2O3 used to remove 50 micron from the veneer or the resin bonded work to remove the reaming of the die from it *** very important

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Etch :
under rubber dam clean the tooth with pumice the etch it with 37% phosphoric acid for 60 seconds {2009 script} we use pumice not prophylactic paste , because prophy baste contain Fluoride which interfere with polymerization of the cement\composite

we do etching for the fitting surface with phosphoric acid , and we also etch a thin surface of the veneer normally it comes etched from the lab its etched by hydrofluoric acid ( this will be a question on the exam) The only acid that is used to etch the porcelain is hydrofluoric acid for 1minute

Bonding :

Then we apply saline coupling agent on the veneer , you do nothing just wait it till its dry

Saline coupling a gent is found in composite is used to make the filler and resin as a homogenous one unit , so they coat the filler with it and then mix it with the resin to have one form

Cementation
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Then we put the cement and the veneer, the excess cement will go out we remove it and then we cure it from all direction why ? Otherwise the contraction will go to one side , this in inherent in the material , so we need to light curing in all direction so that the contraction will be very minimal otherwise there will be a gap in certain area which will make leakage

Finishing :
remove the excess of the cement with diamond bur, then polish the surface

diastema closure

If we have diastema and the patient want to close it you can use veneers Imagine if you have 1 mm diastema and you want to close it with crown so you are being too destructive , so we go with veneers very minimal preparation .

all ceramic crown we do the same preparation as ceramo-metal crown , but you have to make sure that all the margin all rounded

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for this cases we did what we call resin bonded bridge bonded on the enamel only

the doctor start showing some of his cases , I will try to summarize some of the main point he was saying

- in all ceramic crown we can achieve top aesthetic , we can create translucency which is impossible in ceramometal crown - in the preparation we have to have a shoulder finish line - the connector should be 4*4 mm otherwise it may break - we can make different shade in the same restoration for example A3 cervicaly , A2 insicaly - in esthetic dentistry we try to combine between digital and manual skills in selecting the shade ,, there is a digital machine we put the tip on the tooth and it will give us the shade of the tooth for example it could give you A2 and B2 and you should decied temporization same as bridge but we have to avoid any thing that contain floride

how we remove bridges all ceramic bridges can we use bridge mover , no we cannot ,,, we said that if we dropped the vener on the floor it will fracture but in the patient mouth it will not fracture , why ?

the doctor give example about the wood Formica , it is very thin layer of wood and very brittle but once its cemented to the wood block it will become part of it , same goes for veneer crown-less bridge technique we should know the name only cad-cam computer added design computer aided machine
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you prepare the tooth , and theres a Minnie camera will take a photo of the tooth structure , this camera is connected to a machine with two bur the company will supply you with a block of ceramic then the machine will cut the shape to look like the picture so we will end up with a crown

all ceramic abutment implant :- implant is the same but the abutment is made totally of ceramic top esthetic

all ceramic implant :- the implant itself is made from ceramic , even the burs are made from ceramic

ceramic inlays , same as amalgam class 1 ,2 cavity preparation but without any undercuts if it MO we call it inlay , MOD onlay , cover all the cusp we call it overlay

THE END DONE BY :- MOHAMMAD ELWIR