Vol. 1, No.

2, 2001

Esthetic
Technique ™

Clinical Case Studies and Technique Review

Diagnostically Based Protocol

for Tooth Preparation
John C. Kois, DMD, MSD; Steve McGowan, CDT

Sponsored by Brasseler USA 2 Hours of Continuing Education Credit

A Supplement to Contemporary Esthetics and Restorative Practice® An MWC Publication
©2001. Dental Learning Systems Co., Inc.
 Dental Learning Systems Co., Inc. ADVISORY BOARD
241 Forsgate Drive, Jamesburg, NJ 08831-1676 • (800) 926-7636 • Fax (732) 656-1148

Dear Reader:

The preparation of anterior adhesive ceramic facial veneers or full-

ceramic veneers should not be a dogmatic procedure where all prepara-
Nasser Barghi, Bruce Crispin, Lee Culp, CDT
tions are done exactly the same way. The translucency of this conserva- DDS DDS, MS
tive category of restoration offers the advantage of assisting in the final
esthetic match by allowing natural tooth color to pass through. At times,
however, this translucency can also be problematic, especially when try-
ing to cover discolored teeth, and must be compensated for. In addition,
variations in the functional demands of individual patients will require
modifying the preparation design. For optimal adhesion, it is always
desirable to keep the preparation in enamel, but sometimes this is not
possible because of many factors. Analysis of these factors and justifica- John Kois, Gerard Kugel,
tion must be carefully considered before preparation. Finally, the restora- DMD, MSD DMD, MS
tive material should not require excessive tooth reduction just to satisfy
fabrication criteria.
Dr. Kois and Mr. McGowan have successfully researched the subject
and written an excellent article on it for this issue of Esthetic Technique.
They discuss how and why each zone of the tooth is prepared to meet the
biological requirements of the tooth. In addition, they show how function,
dentofacial parameters, and periodontal concerns will often require mod- Howard
Edward A. Larry Rosenthal,
ifying the preparation criteria and design. Optimal results are achieved by McLaren, DDS DDS Strassler, DMD
treating each patient individually and not dogmatically treating everyone
the same way. This article clearly describes and defines a philosophical
and technical approach that allows for the most esthetic and conservative
results when using adhesive ceramic restorations.
Dental Learning Systems would like to thank Brasseler USA for
sponsoring this clinical series.

Best regards, Douglas A. Thomas F.

Terry, DDS Trinkner, DDS

Dental Learning Systems Co., Inc.,

is an ADA Recognized Provider
Academy of General Dentistry Approved
Bruce J. Crispin, DDS, MS National Sponsor. FAGD/MAGD Credit
Director, Esthetic Professionals 7/18/1990 to 12/31/2002
Woodland Hills, California

Publisher and President, Daniel W. Perkins; Vice President of Sales and Associate Publisher, Anthony Angelini; Senior Managing Editor, Allison W. Walker; Associate Editor,
Projects, Lisa M. Neuman; Projects Director, Eileen R. Henry-Lewis; Copy Editors, Barbara Marino and Susan Costello; Design Director, Jennifer Kmenta; Circulation Manager,
Jackie Hubler; Northeast Regional Sales Manager, Jeffery E. Gordon; West Coast Regional Sales Manager, Michael Gee; Executive and Advertising Offices, Dental Learning
Systems Co., Inc., 241 Forsgate Drive, Jamesburg, NJ 08831-1676, Phone (732) 656-1143, Fax (732) 656-1148.
Postmaster: Send address changes to Contemporary Esthetics and Restorative Practice®, Attn: Data Control, One Broad Avenue, Fairview, NJ 07022-1570. Send correspond-
ence regarding subscriptions or address changes to Data Control, One Broad Avenue, Fairview, NJ 07022-1570, or call (800) 603-3512. Periodicals postage paid at Monroe
Township, NJ 08831, and at additional mailing entries.
Contemporary Esthetics and Restorative Practice® (ISSN 1523-2581, USPS 017-212) is published 12 times a year by Dental Learning Systems Co., Inc., 241 Forsgate Drive,
Jamesburg, NJ 08831-0505. Copyright © 2001 by Dental Learning Systems Co., Inc./A division of Medical World Communications, Inc. Printed in the USA. All rights reserved.
No part of this issue may be reproduced in any form without written permission from the publisher.
Contemporary Esthetics and Restorative Practice® is a trademark of Dental Learning Systems Co., Inc. Medical World Communications Corporate Officers: Chairman/CEO,
John J. Hennessy; President, Curtis Pickelle; Chief Financial Officer, Steven J. Resnick; Chief Operating Officer, Melissa J. Warner; Vice President of Manufacturing, Frank A. Lake
BPA International Membership Applied for October 1998.

The Esthetic Technique™ series is made possible through an educational grant from Brasseler USA,
Inc. To order additional copies call 800-926-7636, x180. D450
Diagnostically Generated Anterior
Tooth Preparation for Adhesively
Retained Porcelain Restorations:
Rationale and Technique
John C. Kois, DMD, MSD
Steve McGowan, CDT
ABSTRACT
A diagnostically based protocol for anterior
tooth preparations for adhesively retained
porcelain restorations offers dentists and labo-
ratory technicians new options to approaching
these restorations. Rather than designing a
preparation and restoration based more on the
needs of the products used than on the preser-
vation of the remaining tooth structure, practi-
tioners can enhance the predictability of these
restorations by concentrating simultaneously
on three distinct zones of the tooth (incisal,
middle, and cervical) and four diagnostic cate-
gories (periodontal, biomechanical, functional,
and dentofacial). The result of following the
technique presented in this article is achieving
an individualized design that offers a pre-
dictable option with minimal risks to the
remaining tooth structure.
Figure 2—
Radiograph
of teeth Nos.
7 through
10 shows
large endo-
dontic ac-
cess open-
ing and fill
in tooth No.
8, which is
Figure 1—Preoperative facial view a high bio-
of teeth Nos. 7 through 10 shows sig- mechanical
nificant discoloration and incisal risk.
edge fracture on tooth No. 8.
ESTHETIC TECHNIQUE
John C. Kois, DMD, MSD
Private Practice
in Fixed Prosthodontics
Tacoma, Washington
Steve McGowan, CDT
Kenmore, Washington
LEARNING OBJECTIVES
After reading this article, the reader should be able to:
• explain how a diagnostically based rationale
will enhance the predictability of anterior tooth
restorations.
• identify the three distinct zones of anterior tooth
preparation.
• discuss the tooth reduction considerations and
margin design for each zone.
A
lthough technically demanding and product
dependent, porcelain laminate veneers offer a
predictable option for creating a successful
restorative treatment that also preserves a maximum
amount of tooth structure.1-5 The risk of failure, howev-
er, has been shown to increase when primarily bonding
to dentin rather than enamel, when the functional rela-
tionships are not managed properly, or when the tooth
structure to be restored is very dark.
Concepts of anterior tooth preparation for these
restorations continue to evolve, creating confusion
among restorative dentists and laboratory technicians.
Figure 3—Preoperative facial view,
“envelope of function” reveals no
mobility, minimal wear, and low
functional risk.
VOL. 1, NO. 2, 2001 3
 Figure 4—Final tooth preparation
on No. 8. There is excessive reduc-
tion of the incisal edge on the mesial
(dictated by fracture), butt-fit mar-
gin design, and a more excessive
cervical reduction (0.7 mm)
because of the high dentofacial risk
and low periodontal risk.
Figure 7—Final view in occlusion.
The veneer on tooth No. 8 is adhesive-
ly retained primarily to enamel,
which is not perfect esthetically.
However, max- imum preservation of
tooth structure for a predictable long-
term result was accomplished.
Unfortunately, this confusion
tends to result based more on the
needs of new and innovative prod-
ucts, which is commercially bias-
ed, rather than on concern about
remaining tooth structure.
In contrast, a rationale that is
diagnostically based provides the
opportunity to create a framework
of understanding that will enhance
the predictability of these restora-
tions in tandem with the improve-
ments and benefits from new tech-
nologies. To create a restoration
that exceeds our patients’ expecta-
tions with minimal compromise to
remaining or existing tooth struc-
ture, the parameters of anterior
tooth preparation are focused on
three distinct zones: incisal, mid-
dle, and cervical.
Within each zone, the tooth
4 VOL. 1, NO. 2, 2001
Figure 5—Laboratory communica-
tion photograph includes shade tabs
for value and supports high dentofa-
cial risk.
Figure 8—Preoperative facial view
of teeth Nos. 7 through 10 shows
hopeless prognosis for tooth No. 8
and discolored interproximal com-
posites.
preparation is generated by simul-
taneously understanding the bio-
mechanical behavior of the tooth
structure, functional requirements,
dentofacial parameters, and the
periodontal concerns of the
patient. Therefore, the ultimate
design of the tooth preparation is
minimized by the needs dictated by
P
orcelain laminate
veneers offer a
predictable option for
creating a successful
restorative treatment
that also preserves a
maximum amount of
tooth structure.
Figure 6—Preoperative facial view
of teeth in occlusion.
Figure 9—Preoperative incisal view
of functional relationship shows
slight malposition of teeth Nos. 9
and 10; low functional risk.
product thickness and maximized
to benefit the final restorative
result (Figures 1 through 7).
I NCISAL ZONE
Representing the initial starting
point, restoration of the incisal
zone is based primarily on the func-
tional and esthetic requirements of
the individual patient. If the incisal
edge position is correct in the face
and in harmony with the smile, no
vertical tooth reduction is neces-
sary. This, unfortunately, does not
provide the laboratory technician
any flexibility to modify shape,
position, or incisal translucency.
Vertical reduction is not desirable,
however, if the functional risk is
high. If functional risk is low, the
dentist has more flexibility to
develop incisal reduction based on
ESTHETIC TECHNIQUE
 Figure 10—The Brasseler tooth
preparation kit systema includes all
of the burs necessary for tooth
preparation and insertion of indi-
rect restorations.
esthetic dentofacial veneers (Fig-
ures 8 and 9).
Reduction Considerations
Ideally, the vertical incisal
reduction is 2.0 mm from the
desired position, where it does not
create a biomechanical compro-
mise to the remaining tooth struc-
ture. It also offers minimal func-
tional risk to the porcelain extend-
ing beyond the incisal edge, and
gives the laboratory technician
esthetic options to alter tooth
form and build incisal effects in
the porcelain. In addition, strict
guidelines about not reducing the
incisal zone more than 2 mm verti-
cally as discussed in previous arti-
cles are not supported by clinical
findings. Unsupported vertical
incisal porcelain even greater than
4 mm is predictable if the
Key: Develop optimal incisal
position for esthetics
and function
Objective: 2.0-mm vertical
reduction
a
Brasseler USA®, Savannah, GA 31419; 800-841-4522
ESTHETIC TECHNIQUE
Figure 11—Facial view of tooth
preparation technique for adhesive-
ly retained porcelain restorations.
Step 1, incisal zone. Incisal edge
reduction depth cuts with a 330 MW.
angle of anterior guidance and
envelope of function are con-
trolled (Table 1).
T
he parameters of
anterior tooth
preparation are focused
on three distinct zones:
incisal, middle, and
cervical.
Margin Design
Most practitioners recommend
a lingual chamfer margin design,
which is acceptable, although it is
not ideal.6 It appears more prudent
to develop a butt margin design
incisally, with its lingual compo-
a
Brasseler USA®, Savannah, GA 31419; 800-841-4522
TABLE 1—I NCISAL ZONE
Margin Design: Butt
Lingual finish line
in enamel
Instrumentation: 330 MWa
KS 0 Mediuma
KS 7a
Figure 12—Facial view, step 1,
incisal zone. Gross reduction using
a KS 7a bur.
nent in enamel and its facial axial
line angle rounded. This allows the
technician an opportunity to blend
the porcelain so that the outline of
the preparation will never be visi-
ble facially. In addition, the techni-
cian and dentist will then have mul-
tiple paths of insertion, for simplic-
ity (Figures 10 through 13).
M IDDLE ZONE
The key concern for this zone
is performing minimal facial
reduction that retains tooth struc-
ture comparable to the retained
enamel to optimize the limitations
of composite technology. This will
provide a unique blend of stiffness
vs flexibility and preserve the bio-
mechanical behavior of the origi-
nal tooth.7-12 Unfortunately, this
must be balanced by the need to
create sufficient porcelain thick-
Consider Alteration of Incisal Zone
Reduction When:
Example 1 Use less reduction if:
Low-risk dentofacial
High-risk function
Example 2 Use more reduction if:
High-risk dentofacial
Low-risk function
VOL. 1, NO. 2, 2001 5
 Figure 13—Facial view, step 1,
incisal reduction complete. Note
that the vertical reduction is slight-
ly less than the ideal 2 mm because
of the need to increase the length of
the final result based on dentofacial
parameters.
ness, which is required for opti-
mum esthetic development.
R estoration of the
incisal zone is
based primarily on the
functional and esthetic
requirements of the
individual patient.
The mean facial enamel thick-
ness in the middle zone is 0.8 mm to
0.9 mm.13 Therefore, while facial re-
duction less than this amount is
desirable, maintaining the thickness
of porcelain less than this amount
Key: Maintain enamel
Minimal structural
compromise
Objective: 0.5-mm to 0.6-mm—
normal-colored teeth
reduction
0.7-mm to 0.9-mm—
darker-colored teeth
reduction
Bevel facial incisal edge
Proximal finish lines in
enamel
6 VOL. 1, NO. 2, 2001
Figure 14—Lateral view, step 2,
middle zone. Facial reduction depth
guide using a KS 0 medium bur.
Note that this is approximately half
the 1.0-mm diameter.
will create many challenges for the
laboratory technician and elimi-
nate options for any core-support-
ed systems.
Reduction Requirements
To maintain enamel facially
and recreate the original biome-
chanical behavior of the tooth, a
0.5-mm to 0.7-mm reduction is
ideal. Interproximal finish lines
should be terminated in enamel to
minimize microleakage, and all
sharp corners should be eliminated
to minimize stress concentration in
the porcelain as well as seating
concerns for the restoration. Based
on functional relationships, as
much lingual enamel as possible
TABLE 2—M IDDLE ZONE
Margin Design:
Option 1 Maintain contact point if no
proximal restorations
Option 2 Open contact point if pre-
vious caries restorations
or to change tooth form
Instrumentation:
KS 0 depth guide ≈ 1/2
Diameter 0.5 mm
KS 7—gross reduction
KS 0—complete remaining
preparation
Figure 15—Facial view, step 2.
Completion of facial depth guide
using a KS 0 medium bur. Note that
this step does not include the cervi-
cal zone.
should be preserved to minimize
opposing wear. Dentofacial para-
meters contribute to significant
concerns based on a preference
for using only a clear resin-luting
agent to develop imperceptible
restorations.
For normal-colored teeth pro-
viding 1 or 2 levels of shade change
(ie, A3 to A1), reduction require-
ments of 0.5 mm to 0.7 mm are suf-
ficient. However, for tetracycline-
stained or very dark teeth, the max-
imum reduction of 0.8 mm to 0.9
mm is more prudent.
As usual, and especially in
these situations, the individual tal-
ents of the laboratory technician are
far more important than the specif-
Consider Alteration of Middle Zone
Reduction When:
Example Dark-colored tooth
High-risk biomechanics
High-risk function
High-risk dentofacial
Use 0.6-mm to 0.7-mm
facial reduction
ESTHETIC TECHNIQUE
 Figure 14—Lateral view, step 2,
middle zone. Facial reduction
depth guide using a KS 0 medi-
um bur. Note that this is
approximately half the 1.0-mm
diameter.
ic brand of porcelain used. An un-
derstanding of layering techniques,
fluorescence, and optical properties
of the materials used is essential.
In addition, the clinician must
decide whether to maintain or elim-
inate the proximal contact from a
dentofacial perspective. This deci-
sion may be based solely on the
need to alter the tooth form or
shape. This allows proper space
distribution and the creation of
teeth in proper proportion. From a
biomechanical perspective, previ-
ous proximal restorations will
Key: Preserve enamel
Esthetics requirements
Objective: 0.3-mm reduction
requirement for normal-
colored tooth
0.6-mm to 0.9-mm
reduction for dark- to
very dark-colored teeth
ESTHETIC TECHNIQUE
Figure 15—Facial view, step 2. Figure 16—Lateral view, step 2,
Completion of facial depth guide middle zone. Gross reduction using
using a KS 0 medium bur. Note that a KS 7 super-coarse bur.
this step does not include the cervi-
cal zone.
necessitate more significant reduc-
T
tion to allow the finish line location
that terminates on enamel lingually he key concern
(Table 2). for the middle zone
is performing minimal
Margin Design facial reduction that
The facial incisal aspect of the
preparation must be rounded and
retains tooth structure
beveled slightly to create an invisi- comparable to the
ble transition of porcelain to the retained enamel.
incisal edge and to eliminate stress
concentration and seating con-
cerns. All other aspects maintain a CERVICAL ZONE
butt type of finish line (Figures 10 The key concerns in this zone
and 14 through 17). are similar to the middle zone
TABLE 3—CERVICAL ZONE
Margin Design: Consider Alteration of Cervical Zone
Option 1 Supragingival margin Reduction When:
location Example 1 High-risk periodontal
• Normal tooth color High-risk dentofacial
• Minimal change in tooth Low-risk biomechanics
form Low-risk function
Option 2 Intracrevicular location Axial reduction 0.3 to
• Dark color 0.9 mm
• Change shape Intracrevicular margin
• Close gingival embrasures location
May be primarily in
Instrumentation: dentin
KS 0 Example 2 High-risk biomechanics
High-risk function
Low-risk function
Low-risk periodontal
0.3-mm supragingival
margin location
Will be in enamel
VOL. 1, NO. 2, 2001 7
 Figure 17—Facial view, step 2,
middle zone. The facial reduction is
complete.
except that the enamel is only 0.3
mm to 0.4 mm thick. In addition,
the periodontium complicates the
management. The preference to
maintain enamel, control color,
alter tooth form, minimize flex-
ure, and preserve biologic width
combine to provide additional
unique challenges to the labora-
tory technician and clinician.
T
he individual
talents of the
laboratory technician
are far more important
than the specific brand
of porcelain used.
Reduction Requirements
To preserve enamel, ideal
reduction should be no more than
0.3 mm to 0.4 mm. This minimizes
microleakage resulting from more
predictable enamel bonding and
minimizes the biomechanical com-
promises to the remaining tooth
structure. This is especially critical
with endodontically treated teeth.
The larger the access opening and
the greater the removal of internal
tooth structure, the more critical the
concerns for cervical reduction.
This is especially a concern for a
high-risk functional patient where
tooth flexure is potentially greater.
Biomechanically and function-
ally, the minimal cervical reduction
8 VOL. 1, NO. 2, 2001
Figure 18—Occlusal view, step 3,
cervical zone. Reduction with KS 0.
Previous restorations were removed.
The implant healing abutment is
visible on tooth No. 8.
requirements are often at odds with
the dentofacial concerns. When the
teeth are normal color, a 0.3-mm
reduction remains ideal for the
porcelain to perfectly blend in, cre-
ating the contact lens effect. This is
only true, however, with clear lut-
ing cement. Unfortunately, when
teeth are darker than A3 and the
requirements for the patient dictate
using A1 or B1 shades, more reduc-
tion is necessary. As a general
guideline, an additional 0.2 mm of
reduction is necessary for each
additional shade change.
Obviously, these increased
reduction requirements compro-
mise the biomechanics and func-
tional concerns of the teeth.
Therefore, the dentist must decide
where to develop the most appro-
priate compromise. The priority in
this decision is dictated by the indi-
vidual tooth and patient concerns,
not by the needs of the restorative
material (Table 3).
Margin Design
From a periodontal perspec-
tive, supragingival margins are
ideal. Concepts of intracrevicular
tooth preparation have been previ-
ously discussed14,15 and are not any
different for these restorations.
From a biomechanical perspective,
the actual configuration of the fin-
ish line exhibits little influence on
stress variation in the porcelain.
The most significant factor in mini-
mizing marginal failure is ultimate-
Figure 19—Occlusal view, step 3,
cervical zone. Reduction is complete
and all restorations are replaced.
Note that all margins terminate in
enamel.
ly the luting layer (Figures 10, 18,
and 19).16,17
B ased on functional
relationships,
as much lingual enamel
as possible should be
preserved to minimize
opposing wear.
SUMMARY
This article presented a diag-
nostically generated protocol for
anterior tooth preparation for
adhesively retained porcelain
restorations. This approach elimi-
nates a standardized design based
solely on the requirements of
restorative materials. By shifting
the focus to three distinct zones of
the tooth and four diagnostic cate-
gories of periodontal, biomechani-
cal, functional, and dentofacial
parameters, the clinician can cre-
ate an individualized design.
Therefore, this design is determined
based on the need to minimize risk
in the highest risk categories. With
this approach, we can achieve the
best possible result with minimal
risks to the remaining tooth struc-
ture and the best chance for longevi-
ty (Figures 20 and 21).
REFERENCES
1. Peumans M, Van Meerbeek B,
Lambrechts P, et al: Five-year clinical
performance of porcelain veneers.
ESTHETIC TECHNIQUE

Figure 20—Facial view of teeth Nos.
6 through 11, at time of delivery from
the lab. The implant restoration on
tooth No. 8 was fabricated with a
custom abutment and the metal-
ceramic crown was veneered with
Duceram®,b to match the adjacent
feldspathic Duceram® veneers.
(bDucera Dental GmbH and Co, KGJ, Germany)
Quintessence Int 29(4):211-221, 1998.
2. Dumfahrt H: Porcelain laminate
veneers. A retrospective evaluation after
1 to 10 years of service: Part 1—Clinical
procedure. Int J Prosthodont 12(6):505-
513, 1999.
3. Dumfahrt H, Schäffer H: Porcelain lami-
nate veneers. A retrospective evaluation
after 1 to 10 years of service: Part II—
clinical results. Int J Prosthodont
13(1):9-18, 2000.
4. Nattress BR, Youngson CC, Patterson
CJ, et al: An in vitro assessment of tooth
preparations for porcelain veneer
restorations. J Dent 23(3):165-170, 1995.
5. Friedman MJ: A 15-year review of porce-
Figure 21—Facial view of teeth Nos.
6 through 11, final result. Note
adhesively retained porcelain
restorations on teeth Nos. 6, 7, 9, 10,
and 11. The implant-retained
metal-ceramic crown on tooth No. 8
was completed simultaneously.
lain veneer failure: a clinician’s observa-
tions. Compend Contin Educ Dent
19(6):625-638, 1998.
6. Castelnuovo J, Tjan A, Phillips K, et al:
Fracture load and mode of failure of
ceramic veneers with different prepara-
tions. J Prosthet Dent 83(2):171-180, 2000.
7. Magne P, Kwon KR, Belser UC, et al:
Crack propensity of porcelain laminate
veneers: a simulated operatory evalua-
tion. J Prosthet Dent 81(3):327-334, 1999.
8. Magne P, Douglas WH: Cumulative
effects of successive restorative proce-
dures on anterior crown flexure: intact
versus veneered incisors. Quintessence
Int 31(1):5-18, 2000.
9. Magne P, Versluis A, Douglas WH: Effect
of luting composite shrinkage and ther-
mal loads on the stress distribution in
porcelain laminate veneers. J Prosthet
Dent 81(3):335-344, 1999.
10. Magne P, Douglas WH: Porcelain
veneers: dentin bonding optimization
and biomimetic recovery of the crown.
Int J Prosthodont 12(2):111-121, 1999.
11. Magne P, Versluis A, Douglas WH:
Rationalization of incisor shape: experi-
mental-numerical analysis. J Prosthet
Dent 81(3):345-355, 1999.
12. Magne P, Douglas WH: Rationalization
of esthetics restorative dentistry based
on biomimetics. J Esthet Dent 11(1):5-
15, 1999.
13. Ferrari M, Patroni S, Balleri P:
Measurement of enamel thickness in
relation to reduction for etched lami-
nate veneers. Int J Periodontics
Restorative Dent 12(5):407-413, 1992.
14. Kois JC: Altering gingival levels: the
restorative connection, part I: biological
variables. J Esthetic Dent 6(1):3-9, 1994.
15. Kois JC: New paradigms for anterior
tooth preparation: rationale and tech-
nique. Contemporary Esthetic Den-
tistry 2(1):1-8, 1996.
16. Tjan AH, Dunn JR, Sanderson IR:
Microleakage patterns of porcelain and
castable ceramic laminate veneers.
J Prosthet Dent 61(3):276-282, 1989.
17. Troedson M, Derand T: Effect of margin
design, cement polymerization, and angle
of loading on stress in porcelain veneers. J
Prosthet Dent 82(5):518-524, 1999.

Dental Learning Systems Co., Inc., is an ADA Recognized Provider

Academy of General Dentistry Approved National Sponsor

FAGD/MAGD Credit
7/18/1990 to 12/31/2002

WARNING: Reading an article in Esthetics Technique™ does not necessarily qualify you to integrate new techniques or procedures into your practice. Dental Learning Systems
expects its readers to rely on their judgment regarding their clinical expertise and recommends further education when necessary before trying to implement any new pro-
cedure.
The views and opinions expressed in the article appearing in this publication are those of the author(s) and do not necessarily reflect the views or opinions of the editors, the
editorial board, or the publisher. As a matter of policy, the editors, the editorial board, the publisher, and the university affiliate do not endorse any products, medical tech-
niques, or diagnoses, and publication of any material in this journal should not be construed as such an endorsement.

ESTHETIC TECHNIQUE VOL. 1, NO. 2, 2001 9

 CE QUIZ
Dental Learning Systems Co., Inc., provides 2 hours of Continuing Education credit for those who wish to
document their continuing education endeavors. Participants are urged to contact their state registry boards
for special CE requirements.
To receive credit, complete the enclosed answer form, include a check for $14, and mail both in the enve-
lope provided.

1. The parameters of anterior tooth 6. The mean facial enamel thickness in the
preparation focus on which zone? middle zone is:
a. incisal a. 0.1 mm to 0.2 mm.
b. middle b. 0.5 mm to 0.7 mm.
c. cervical c. 0.8 mm to 0.9 mm.
d. all of the above d. 1.1 mm to 1.4 mm.

2. Within each zone, the tooth preparation 7. For tetracycline-stained teeth, the
is generated by understanding the: maximum reduction of how many
a. chemistry of composite setting. millimeters is more prudent in the
b. chemistry of etching. middle zone?
c. biomechanical behavior of tooth a. 0.3 mm to 0.5 mm
structure. b. 0.5 mm to 0.7 mm
d. requirements of the porcelain. c. 0.8 mm to 0.9 mm
d. 1.1 mm to 1.3 mm
3. The ultimate design of the tooth
preparation is minimized by the needs 8. To preserve enamel in the cervical zone,
dictated by product thickness and the ideal reduction is no more than:
maximized to benefit: a. 0.1 mm to 0.2 mm.
a. new bondable porcelain. b. 0.3 mm to 0.4 mm.
b. shade-sensitive luting composite. c. 0.5 mm to 0.6 mm.
c. the ultimate restorative result. d. 0.7 mm to 0.8 mm.
d. reduction of laboratory costs.
9. In general, how many additional
4. The incisal zone is the initial starting millimeters of reduction are necessary
point and is based primarily on the for each additional shade change?
functional and esthetic requirements a. 0.1 mm
of the: b. 0.2 mm
a. individual patient. c. 0.3 mm
b. skill of the practitioner. d. 0.4 mm
c. available shades.
d. available stains. 10. The most significant factor in
minimizing marginal failure is the:
5. Unsupported vertical incisal porcelain a. luting layer.
even greater than 4 mm is predictable b. porcelain structure.
if which of the following is controlled? c. dentin smear layer.
a. bonding thickness d. bonding temperature.
b. angle of anterior guidance
c. cuspid disclusion in lateral
d. etching time

10 VOL. 1, NO. 2, 2001 ESTHETIC TECHNIQUE

 PREP STEPS
Adjusting and Polishing of Porcelain and
Polymer Glass Restorations

Figure 1—The 6942-200 diamond Figure 2—Occlusal adjustments are Figure 3—Secondary anatomy is
coarse-grit disc is used to quickly cut made using the sintered-diamond refined with a sintered-diamond
and contour interproximal surfaces. football instrument (7379M.023). instrument.

Figure 4—Porcelain is polished Figure 5—The wet glazed look results Figure 6—The gray Dialite point is
with the Dialite blue coarse polish- from polishing porcelain with the used to high shine porcelain.
ing point. Dialite blue coarse wheel polisher.

Adjusting and contouring techniques to achieve
maximum esthetics and optimum function of
porcelain or polymer glass restorations:
• Adjusting and contouring porcelain extraorally: Sintered
diamonds are preferred over diamond-coated instru-
ments. Sintered-diamond instruments are solid diamond-
particle throughout and cut smoothly but never leave
black marks on porcelain.
• For interproximal definition and contouring of splinted
units, use the 6942-200 diamond disc. The coarse-grit disc
has a thin 0.15-mm profile to quickly cut and contour
interproximal surfaces (Figure 1).
• For emergence profile and reflective contours, use invert-
ed-cone sintered diamonds (large: 7928.11.080, medium:
7928.11.029, and small: 7928.11.018). Work the rotating
instrument away from the margin and at a very slow
speed to protect the margin integrity.
• Occlusal adjustment and secondary anatomy refinement:
The sintered-diamond football instrument 7379M.023 in
either friction grip or straight handpiece is designed to
adjust occlusal surfaces. To define the triangular fossa
and replace secondary anatomy in the now-functional
area, use small and medium inverted sintered diamonds
(Figures 2 and 3).
• Incisal adjustment: The diamond disc 952-140 is available
in friction grip, right-angle latch, and straight handpiece
for quick precise adjustment of incisal edges of porcelain
crowns or veneers. This disc features an autosafe chuck-
ing center to stop rotation if the disc becomes engaged in
contacts.
Polishing ceramic and polymer glass restorations:
The following steps will return to porcelain the wet
look of the glazed porcelain before adjustment.
• Polish porcelain with Brasseler USA Dialite polishers;
begin with the blue coarse wheel, points, or discs to smooth
scratches or further reduce the surface (Figures 4 and 5).
• The pink or medium-grit Dialite further prepares the sur-
face for final high shine. Speed range of 3,000 rpm to
7,000 rpm provides optimal polishing while maintaining
long instrument life.
• The gray Dialite (wheel, point, or cup) high shines the
porcelain, returning the natural wet look (Figure 6).
• Dialite diamond-impregnated polishers are autoclavable
and available in latch shank for intraoral use.
• For final polishing of textured and/or faceted surfaces,
the Truluster Polishing Kit is recommended. The use
of diamond paste and brushes does not remove surface
texture.
• For polishing polymer glass, which is less dense than
porcelain, the Ceroshine Kit provides a diamond paste with
a specific particle range suitable for polymer glass.
Included in the kit are scotch brite wheels, goat-hair brush-
es, a chamois wheel, and a cotton buff.

This information is provided by Brasseler USA.

ESTHETIC TECHNIQUE VOL. 1, NO. 2, 2001 11