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Teach Me Ideal Dentistry for Veneers
Learn from Townie favorite, John Nosti, who answers this plea.
Dentaltown.com > Message Boards > Cosmetic Dentistry > Cosmetic Dentistry > Teach Me Ideal Dentistry for Veneers
NY sent
Member Since: 10/10/05
Post: 1 of 33
What is considered ideal dentistry when it comes to doing a veneer case? No shortcuts.
Let’s say the case is going to be premolar-to-premolar, upper and lower, and the patient is very
particular and discerning.
Here’s what I remember about veneers from dental school and GPR:
•
Preps should be kept minimal compared to when prepping for an all-ceramic crown;
preps can stay entirely in enamel if possible.
•
Something about a wax-up before and lab-fabricated temps after you do your preps.
•
Patient wears the temps for a few weeks. All changes are made in the temps until the
patient and doctor are happy, then the final porcelain restorations are ordered.
•
Patient can be sent to the lab for the tech to better create the proper shade for the
restorations.
•
Final restorations are sometimes cemented with temp cement for a period of time
before cementing with permanent cement but I don’t remember why. ■
OCT 31 2013
vomer6
Member Since: 10/15/03
Post: 2 of 33
Much different for me:
•
Long discussion as to patient’s desires where I show pictures of veneer cases all with
different objectives and outcomes.
•
Discuss costs. If patient wants to proceed, take impressions and get a wax-up deposit.
•
Review wax-up with patient, duplicate wax-up to make a pressure form and make a
clear PVS. Try in pressure form.
•
Prep all teeth, verify and use pressure form to check for clearance by “relining” pressure form with light PVS.
•
Use clear PVS of wax-up to make temps.
•
Verify orientation, length and that all is good.
•
Explain temps to patient and make sure we are still on same page.
•
Bond veneers on about 10 days later, clean and floss every contact.
•
Bring back patient after a week and check everything.
The above has worked well for many cases. ■
OCT 31 2013
John Nosti
Member Since: 02/23/04
Post: 3 of 33
All ceramic crowns can be minimal prep as well. Always design your case prior to prepping.
Why? You are restoring all the teeth in the smile (maxillary 10). This decision is yours and the
patients. Preferably you place temps that mimic the finals in color, size, shape and function.
Negative on the fifth point you have. If you temp cement porcelain veneers, good luck with
ever permanently cementing them considering that they will have little to no strength without
bonding them in place, and are likely to fracture or simply fall out. Check out this great article
on veneers: [Editor’s note: Go online to view this link.] ■
OCT 31 2013
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cosmetic
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Brandon Piper
Member Since: 02/10/07
Post: 4 of 33
Just out of curiosity, have you done a veneer case? I can’t imagine anyone temp cementing
porcelain veneers. They have to be silanated and bonded, or they wouldn’t make it through the
patient’s first meal. I highly recommend John Nosti’s detailed posts about veneers and smile
design. Great info there. ■
OCT 31 2013
NY sent
Member Since: 10/10/05
Posts: 6 & 7 of 33
I am an orthodontist so I will be doing zero cases in the future. I did a case when I was a
GP. So I was wrong about the cementing veneers with temp cement, don’t remember where I
got that. I used to work for a GP who did very nice restorative work but not large 20-unit type
veneer cases. He used to send the patients that he knew would be difficult about shades to the
lab to get perfect shade matches, so that’s where I got that idea. However, he was sending them
to match #4 and #5 PFMs to the existing natural dentition, so I guess that is a different situation
than 10 veneers in an arch.
Good point about the silane step. Forgot about that. I am asking these questions because
I would like to sound more knowledgeable than Dr. Google when confronted by patients or
parents about restorative stuff.
How do you make the temps? Thanks for the list of steps you use. ■
OCT 31 2013
austindoc2
Member Since: 05/15/03
Post: 10 of 33
I used to free hand them into place, just using a very, very small dot that was etched and
bonded. The interprox undercuts also held the temps in place. I would then use a diamond and
flex discs to shape and polish the temps to where I thought the patient wanted them. ■
OCT 31 2013
DoctorEd
Member Since: 09/21/02
Post: 11 of 33
I remember when residents were not accepted to specialty programs unless they had practiced
general dentistry for at least three years. I do not do any orthodontics. I have been impressed
with the bracket and adhesive technology over the past 10 years. Is there any way to temporary
cement a bracket to “test drive” it’s position? ■
OCT 31 2013
austindoc2
Member Since: 05/15/03
Post: 12 of 33
DoctorEd
Member Since: 09/21/02
Post: 13 of 33
Elmers glue? ■
OCT 31 2013
Seriously Michael. One of the most distressing problems I see with orthodontic treatment
is when brackets are removed. I have had many patients come back with “divots” in the facial
enamel when brackets have been removed with pliers. It is very upsetting. Is the solution to
bond facial composite restorations after the damage or remove the brackets carefully with a
handpiece? Most offices delegate this procedure to an assistant. Scary IMO. ■
OCT 31 2013
NY sent
Member Since: 10/10/05
Posts: 16 & 17 of 33
I don’t know what it was like before, but for at least the last 10 years since I got in, ortho has
always favored the “fresh” graduate. The majority of programs really didn’t care that much if
you had GP experience or not.
All brackets are “temporarily” cemented. They have to come off at some point, whether it
is three days or three years later. Though I feel like you are asking this question with sarcasm
rolled in...
I haven’t worked in an office where they use the adhesive removal pliers that are scraped
along the tooth to remove the adhesive, but I still see them sold in the catalogs. Even if the
assistants remove the brackets with a debonding plier, I always sit down to use the handpiece to
polish and remove the adhesive.
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I used to work in an office where one male assistant started trying to use the handpiece
himself and I always had to run over and tell him to stop and take over. I had worked with
this assistant for two years and he didn’t used to try to use the handpiece, so something was
off. Turns out he was working in an office where the assistants were using the high speeds to
remove the adhesive, so he thought it would be OK to do it where I worked as well. Now that
is scary. ■
NOV 1 2013
DoctorEd
Member Since: 09/21/02
Post: 18 of 33
I have seen that too, Michael. Assistant with a high-speed drill! When using a debonding
plier have you ever seen some enamel come off with the bracket? I have and that is what I was
talking about. It has been several years since I saw this. The newer bonding agents are probably
designed not to bond as tenaciously to prevent this. ■
NOV 1 2013
austindoc2
Member Since: 05/15/03
Post: 19 of 33
E d, I have never seen this. I did ortho in my practice for the last few years and never had
any issues of the enamel popping off. I guess it could happen, but I never saw it. ■
NOV 1 2013
NY sent
Member Since: 10/10/05
Post: 20 of 33
There are two different pliers we are talking about here:
1. Debonding plier — this one is used first, it fits around the bracket on the gingival and
occlusal. A little bit of pressure is applied and the bracket comes right off, usually at the bracketadhesive interface, leaving the adhesive behind on the tooth. About 2 0+ years ago, there
was a worry that when debonding ceramic brackets, the bracket would debond at the adhesive-enamel interface and enamel would come off with the adhesive. This might still happen,
but I think it’s uncommon. I have removed many ceramic brackets and not had one where the
enamel broke off. If anything, the ceramic bracket shatters first, and then I have to sit down
with a high speed and diamond bur and remove the rest of the hard ceramic, and then switch
burs to remove the softer adhesive.
2 . Adhesive removing plier — this is the one I have not seen used in any office I work in,
but I think they were used more regularly in the past in the “ orthodontists never use high speed
handpiece” offices. I still see this plier sold in catalogs. This is the plier that is going to cause
possible damage to the enamel if the operator is not careful. The plier is scraped along the
tooth to scrape the adhesive off. If you scrape too hard, the enamel gets gouged. ■
NOV 1 2013
PD3
Member Since: 11/01/06
Post: 22 of 33
Sadly I have seen many young teens just out of ortho with bur marks all over the teeth!
Seems resin cements are great for ortho and bad for teeth. ■
NOV 1 2013
austindoc2
Member Since: 05/15/03
Post: 24 of 33
Dentists in a hurry. They should be called on the carpet for this. ■
NOV 1 2013
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Teach Me
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