pressed leucite veneer without compromising fracturestrength. Application of layered porcelain powders ontopressed leucite veneer restorations imparts depth of colorto the laminate and seals internal characterizations toprotect them from environmental wear factors.

Patient PresentationA 45-year-old male patient presented for whitening treat-ment and desired a more uniform-shaped dentition following orthodontic correction. Preoperative analysisrevealed a Class I occlusal scheme, periodontal classi-fication I, and no preexisting anterior dental restorations.Dental history was limited to posterior occlusal fillingsand routine periodic cleanings. Following facial gener-ated treatment planning, smile analysis, and computer-generated imaging, the patient was diagnosed for 10maxillary porcelain laminate veneers and mandibulararch bleaching. The fabrication of pressed leucite porce-lain veneers using the pressing, application stain, andtranslucent impulse layering phases allowed the pre-dictable creation of a bleached appearance within theanterior restorations.

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LAYERING TECHNIQUE FORPRESSED CERAMIC LAMINATE VENEERS

John C. Schwartz, DDS*

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Figure 1A. Preoperative facial view of the existing naturaldentition. The patient desired tooth whitening and orthodontictreatment.

Figure 1B. Postoperative view following placement of thedefinitive pressed ceramic laminate veneer restorations demon-strates satisfactory tooth alignment, appearance, and form.

*Private practice, Metairie, Louisiana.

A s the success of porcelain laminate veneers con-tinues to evolve, techniques developed by anexacerbation of creativity and diligence enhance

the lifelike realism imparted by these ceramic restorations.In particular, veneer restorations fabricated with pressedleucite porcelain materials have satisfied the clinicalcriteria demanded by many contemporary aesthetic den-tal practitioners. The incorporation of the “shaded” tech-nique for the fabrication of these restorations requires theapplication of stains to the surface of the pressed ceramic,in order to precisely match the shade requested by thedentist. This technique provides the restoration with accept-able fit and marginal integrity. Since pressed leuciteceramic fabrication requires the incorporation of the “lostwax” technique, desired anatomic accuracies can bewaxed into the laminate shape. The staining techniqueis, however, limited in its ability to place internal char-acterizations within the laminate, which are necessaryto impart a lifelike realism to the prosthetic dentition.Utilizing a layered application sequence of porcelainpowder to a pressed leucite ceramic veneer, the restora-tive team can enhance the aesthetic character of the

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Figures 2A,B,C. Prior to the initiation of tooth prepa-ration, the cementoenamel junction, cervical ridge con-tour, points of concavity, longitudinal development lobes,proximal concave lines, mesial and distal line angles,incisal edge survey form, and linguoincisal anatomicform were identified. In order to ensure postoperativeanatomic accuracy and meet the minimum thicknessrequirements of pressed leucite porcelain materials, thenatural dentition were prepared using diamond burs toachieve a 1.5-mm incisal reduction, 0.7-mm buccalreduction, and a 1.2-mm vertical shoulder margin. Carewas taken to control tooth preparation of the buccal,mesial, distal, incisal, and linguoincisal surfaces andsubsequently ensure optimal biomimetic behavior of theporcelain restoration.

Figures 3A,B,C. The veneers were waxed with ivory-colored sculpting wax (Ivoclar Vivadent, Amherst, NY),and anatomic form was carefully developed. The incisalthird was waxed to within 0.7 mm of complete anatomicform in the buccolingual direction. The survey form wassubsequently waxed to within 0.5 mm of the final form,and the waxings were pressed in the desired ingots,divested, and the sprue forms were removed. An O1ingot (Opacity 1, Ivoclar Vivadent, Amherst, NY) wasselected to provide the appearance of bleached den-tition and allow sufficient light transmission. Minorshaping was performed using a carborundum stone toprepare the pressings for the layering technique. Thepressings were subsequently cleansed prior to the appli-cation of stains from the color palate.

Figures 4A,B,C. Stain application was initiated inthe incisal third, and sky blue tints were applied incisalto the dentin mamelons to enhance the effect of trans-lucency. This shade was applied towards the proximalarea to mimic the thickness of unsupported enamel, fol-lowed by the creation of a halo that extended from themesial contact point to the distal aspect using whiteshades. This halo shape was thickest at the develop-mental lobes and thinnest at the developmental grooves.A wash application of blue was applied where theenamel was thickest proximal to the mesial and distaldevelopmental lobes. In this area, enamel created anunsupported prismatic effect that was more subtle thanthe translucent zone.

Figures 5A,B,C. The blue wash was outlined withwhite to provide an encasement support effect, and bam-boo tints were placed in the center of the cervical thirdto impart a high value to the area. Bamboo, white, andcaramel effects were then combined with a glaze to pro-vide a yellow tint within the cervical third. The place-ment of these internal stains allowed the restoration tomimic the optical activity and internal characterizationscreated by the interaction of dentin and enamel.

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Address correspondence to: John C. Schwartz, DDS337 Metairie Road, Metairie, LA 70005Tel: 504-832-2043 • Fax: 504-832-2065

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Figures 6A,B,C. The creation of a bleached denti-tion in ceramic required high value white incisal shade tobe placed over the developmental lobes using a splayedbrush to add a degree of increased value to the appro-priate areas, and a low value transparent white wasplaced at the developmental grooves and the survey out-line form. The application of the high value and low valueporcelains (ie, Impulse White incisal and Impulse OpalTranslucent, Ivoclar Vivadent, Amherst, NY) constituted theImpulse layer for the bleached dentition. The applied stainswere then fired at a temperature 10° below the porcelainmaturation temperature. The translucent impulse layer wassubsequently built up using translucent powders to impartthe illusion of depth and protect the internal optical effectsagainst wear. This layer varied in thickness from approx-imately 0.2 mm to 0.5 mm and allowed the placementof surface texture without harming the staining diagram.An additive powder (Korrection Material [KM], IvoclarVivadent, Amherst, NY) was also incorporated to lowerthe firing temperature of the porcelain powder and ensurethe elimination of potential distortion in the underlyingpressing during firings.

Figures 7A,B,C. The laminate veneers were firedin the porcelain oven at approximately 20° below themanufacturer’s specified maturation temperature. Thelaminate surface texture was finished with carborundumstones and porcelain polishing wheels and points. Thesurface texture was polished prior to glazing (Cerapol,Edenta AG Dentalprodukte, Switzerland), and a lightapplication of glaze was applied to soften the surfacetexture creation during the final bake.

Figures 8A,B,C. The laminate veneer restorationswere adjusted for seating on the master model and evalu-ated to determine proper anatomy, contour, and fit prior toclinical try-in. Marginal fit of each restoration was analyzedunder a microscope, and anatomical form was evaluatedto determine the placement and location of the mesial anddistal points of concavity, as well as the location and direc-tion of the mesial, central, and developmental lobes.

Figures 9A,B,C. The definitive pressed ceramicveneers (IPS Empress, Ivoclar Vivadent, Amherst, NY)were cemented using a 36% phosphoric acid etchant,dentin adhesive (Excite, Ivoclar Vivadent, Amherst, NY),and a light-cured composite cement (Variolink II, IvoclarVivadent, Amherst, NY) material. The “Wave” techniquewas incorporated to ensure proper adhesion. Post-operative evaluation revealed a bleached appearancewith anatomic character and aesthetic optical activitywithin the restorations.

AcknowledgmentThe clinical and laboratory procedures described hereinwere performed by the author.