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The Nuts & Bolts of Veneers
TODD C. SNYDER, DDS, FAACD, FIADFE, ASDA, ABAD
Accredited Fellow, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Member of The American Society For Dental Aesthetics
Diplomat of the American Board of Aesthetic Dentistry
Former Faculty, UCLA Center For Esthetic Dentistry
Speaker, Catapult Education
LEGIONpride.com, Online Training Challenge for Dentists
Entrepreneur, Software Company Owner, Author/Lecturer, Professional Race Car Driver
Todd Snyder, DDS, FAACD, FIADFE, ASDA, ABADLaguna Niguel, CA
Aesthetic Dental Designs®
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According to the American Academy ofCosmetic Dentistry 50% of patients areunhappy with their smiles and 3 out of 5people will invest in their smiles.
How Do You Get More Cases?
Business
Deliver
PATIENTS
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Business
Attract
PATIENTS
One of the most powerful & fastest tools you own to create cosmetic opportunities??
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WHITENING
Immediate Call to Action Motivator
Start Here
Over-the-Counter Teeth
Whiteners: $1.4 billion
(MSNBC) ...
(Consumer Reports).
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Opalescence GO!• Fast, Easy, Effective, Better
Experience• Convenient & affordable
professional whitening to GO• Pre-loaded, disposable UltraFit™
tray for a custom-like fit• Molar-to-molar coverage• No chair time
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Reduce or Eliminate Sensitivity
• Potassium Nitrate & Fluoride
Opalescence Go Sample Tower
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“Total annual revenue in the teeth whitening industry topped $11 billion at the beginning of
2015, with $1.4 billion spent on teeth whitening products. These figures suggest a steady annual increase in the teeth whitening market industry, which is expected to continually climb over the
next 10 years” AACD Research
So why are people willing to pay top dollar for a beautiful smile
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Diagnostic Models & Records
Silginat - Kettenbach
Counter FIT- Clinician’s Choice
Status Blue - DMG
Alginate Alternatives
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Silginat - Kettenbach
Counter FIT- Clinician’s Choice
Status Blue - DMG
Alginate Alternatives
3 Sets of Models-One is untouched for legal documentation-Second to practice preparations (It will be waxed up)-Third is a spare to practice on or make bleach trays
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Mounted and Equilibrated
Smile Design/Preparation Design:-What, Where, Why, Apply
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Veneer Preparations
• Depth Cuts
• Tooth Reduction
• Margins
• Retention Form (Line of Draw)
Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”
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Veneer Preparations
• Depth Cuts
• Tooth Reduction
• Margins
• Retention Form (Line of Draw)
Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”
Veneer Preparations
• Depth Cuts
• Tooth Reduction
• Margins
• Retention Form (Line of Draw)
Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”
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Veneer Preparations-Feldspathic Porcelain
Depth cuts of 0.2mm-0.8mm*
1.0mm-1.5mm incisal reduction*
Veneer Preparations-Pressed Ceramics
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Minimal or No Prep Veneers• Do a waxup
• Duplicate into a stone model
• Over impression of stone model w/ PVS BEADLINE TECHNIQUE or Siltech Putty
• Intraoral mockup using the over impression filled with temporary acrylic**
• Is thickness and appearance okay?• Depth cuts through over impression if necessary.
• Typically no provisionals are necessary
• No undercuts
• Color change varies based on tooth position/color
Modern Ceramics
• Stand Alone Strength Properties
• Feldspathic (80-120 mpa)
• Lithium disilicates (360-500mpa)
• Lithium silicate (373 mpa)
• Zirconia (Monolithic 640-1200 mpa+)• Layered Zirconia Feldspathic (80-120mpa)
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Incisal edge preparations
a) No incisal lengthening
b) Changing color or wear
c) Lengthening tooth
d) Interproximal
a) When to break contact?
e) When to do a crown
Veneer Preparations
Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”
labial reduction options Depth Limiting Burs - Brasseler USA
Average enamel thickness
At CEJ .3-.4 mmMiddle third .8-1.0 mmIncisal third 1.1-1.3 mm
Veneer Preparations
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Preparation Reduction• Depth reduction burs
• Safe reduction
• Lasco
Veneer Preparations
Independent Depth Cuts (Lasco Burs)
▪ Depth Cuts▪ Tooth Reduction▪ Interproximal & Margins▪ Retention Form (Line of Draw)
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Preparation
Aesthetics
Function
Bonding to Enamel
Material Options
Minimal Prep Case
Minimal Prep Case:
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Burs• Organization
• Diamonds
• Carbides
◼ K0096 Finishing Kit $126.47 each
◼ K0095 Preparation Kit
$125.47 each65
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• Bioactive flowable
• Releases Calcium, Fluoride, Phosphate ions
• Highly fracture and wear resistant
• BPA & Bis-GMA free
• Highly radiopaque
• 8 Shades A1-3.5, A4, A6, B1, BW
Cavities, Old Composite Replacements,
Undercut Block Out
Shade Assumptions
BW, B1, B2, A1, A2
Provisional Techniques
-Free hand
-Beadline Provisionals
-Putty over impression of waxup
-Premade temps?
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Review-Chief Complaint
-Occlusion
-Photographs/Imaging?
-Whiten first
-Waxup/BeadLine Provisional
-Material Selection
-Practice Preps
-Photograph Prep Shade
EMOTIONFocus on overall appearance
Stay away from little details
“Going to look & feel great”
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Minimally Invasive Veneers…. Why? Benefits??
Waxup
Mockup
Preparation
Provisional
Bonding to Enamel
Material Options
Minimal Prep Case
Beadline Provisional Mockup
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Photos for Laboratory Technician
Photos for Legality
AACD Series + Adjunct Photos
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-5 Year Long Term Provisional
-Tooth-like translucency and opalescence
-30% stronger than LuxaTemp Ultra
-Natural Fluorescence
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Simplified Provisionals**
Siltech Putty Matrix
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
Scribe a 0.5mm-1mm groove into tissue & a little on tooth
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
Shades:
B1, BL
A1,2,3, 3.5
High impact strength, flexural strength, diametrical tensile strength, and elastic modulus.
Tooth-like translucency and opalescence ensure optimal integration into the existing dentition thanks to the chameleon effect.
Natural Fluorescence
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Cosmetic Provisionals (Bead Line Technique)
No Polish Necessary if you use a good model
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
AESTHETIC TEMPORARY CEMENT
ClearTemp LC-Ultradent
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▪ 4 upper & lower trays
▪ 60 sec. @ 158°F
▪ Fast, efficient
▪ Virtually custom
▪ 30% less impression
material used
Impression Trays
HeatWave by Clinician’s Choice
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Impression Trays
HeatWave by Clinician’s Choice
Dry all teeth in arch
Place tip in most difficult area first
Keep tip on margin and immersed in material
Go around entire margin first
Next go to adjacent teeth
Then do coronal aspect of teeth
Double Mix Single Impression is the most accurate
Syringe Placement
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Panasil Initial Contact (VPS)
Kettenbach
TIP
Panasil Initial Contact
▪ Lowest contact angle of any VPS
impression material
▪ Fast set and Regular set
Kettenbach
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Hydrophilicity: angle of contact
Panasil ® = Hydrophilicity
▪ Hydrophobic water droplet ▪ Hydrophilic water droplet
Lowest contact angle of any VPS impression material
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Panasil® Initial Contact (PIC) Hydrophilicity Demo
Hydrophilicity: comparison
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co
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drop age [s]
Aquasil™ Ultra XLV(Dentsply)
Affinis™ light(Colténe)
Impregum™ Garant™L DuoSoft™(3M Espe)
Panasil® initial contact X-light(Kettenbach)
Panasil® initial contact light(Kettenbach)
Comparison of spreading behavior 30 s after mixing starts within the first 3safter applying a water drop: relative humidity 50 % - 80 %
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Hydrophilicity: comparison
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drop age [s]
Aquasil™ Ultra XLV(Dentsply)
Affinis™ light(Colténe)
Impregum™ Garant™L DuoSoft™(3M Espe)
Panasil® initial contactX-light(Kettenbach)
Panasil® initial contactlight(Kettenbach)
Contact angle after 30 min at 23°C: relative humidity 50 %
Cracked toothKettenbach
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Panasil Initial ContactKettenbach
▪ Exceptional Flow Properties▪ Exceptional Detail▪ Exceptional Performance even in a moist environment
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Panasil Initial ContactKettenbach
Kettenbach
Identium(Vinylsiloxanether-VSXE)Identium® is developed especially for the single impression technique and
combines the best of the two worlds: all advantages of conventional
polyether materials paired with those of A-silicones.
"Best of Two Worlds"
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Identium®: the Vinylsiloxanether
The best of polyether:
▪ High degree of precision
▪ Dimension stability and
▪ Detail reproduction.
▪ Well-developed flow properties
▪ Low contact wetting angle
▪ Long working time
▪ High final hardness
Identium®: the Vinylsiloxanether
▪ The best of A-Silicone:
▪ Well-developed elastic properties
▪ Resists even high mechanical stresses
▪ Optimal recovery after deformation
▪ Easy removal from mouth and model
▪ Improved patient comfort due to the absence of odor
…and taste,
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Make cases easy, make your patients happy
Make cases easy, make your patients happy
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Bite Registration Demonstration Video w/ Handout
O-Bite:
PVS bite registrations
When to use,
How to use Correctly.
Strong material
Easy to cut
Good rigidity
Fast
LuxaBite
BisAcryl material
Higher accuracy
More rigid
Use for bigger cases
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TROLLDENTAL-4.5ΜM ARTICULATING PAPER
WWW.TROLLDENTALUSA.COM
DIRECTA DENTAL
Mixed Provisionals
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• 1) Implant screw retained.
• 2) FujiCEM Evolve (RMGI Cement) #6 & #8 or Doxa Ceramir
• 3) Bisco All Bond Universal Adhesive & Choice 2 Veneer Cement
Margin Refinement
K0095 Preparation Kit (Brasseler USA)
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Types of Moisture
Saliva
Crevicular Fluid
Bleeding
Fluid/Tissue Management
Superoxol
Epinephrine
Ferric Sulfate
ViscoStat 20%
Astringent 15.5%
Aluminum Chloride
Viscostat Clear 25%
Expa-syl
Hemostasyl
Aluminum Sulfate
Tissue Goo 25%
Various Cords
Enhancing Moisture Control
Fluid/Tissue Management
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Lasers (Diodes) Fast
Hemostasis
No crevicular fluid
No cord
Better healing
Enhancing Moisture Control
Fluid/Tissue Management
A soft tissue laser incision at 1000x
magnification
Laser cut
Superficial coagulation
Heat dissipation with little/no edema
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•Invisible under restorations, yet detectable for excess removal•Beautiful esthetics, transparency•Easy one-piece removal of excess•Optimal adhesion with easy removability•Eugenol free•Not sticky•Flows and mixes easily
Laser Tissue re-contouring, Provisional & Impression
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Beadline provisionals that are locked on.
Removing provisionals that are locked on.
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REVIEW
• Full arch impression Heat Wave Tray
• Record or Diode laser
• Light & Heavy Body Impression Material
• Bead Line Provisional Technique uses no temp cement or adhesives,
mechanical retention, shrink wrapped
CEMENTATION
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-Clean Tooth
-Try-in with water soluble try-in paste, not water.
-Clean & Decontaminate
3.
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- Light-cured luting cement designed for cementation of porcelain veneers.
- Color stability.
- Corresponding try-in pastes (sold separately)
- Choice 2 is specifically formulated for color stability (Delta E <1.2**) resulting in high esthetics
-Highly filled resin cement enhances the overall strength of the restoration
-Low film thickness ensures veneers are completely seated
-Corresponding try-in pastes confirm shade selection prior to cementation
-Choice 2 cement will not change (shade shift) over time, a problem that can occur with dual-cured systems
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• Design• Power• Durability• Access• Posterior tooth• Broad Light Output Range
– 385-515nm
• Cost• Weight• 5 Year Warranty
8.
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All Steps are the SAME, Except we are using a Dual Cured Resin Cement where there is
decreased exposure from curing light because of ceramic material or thickness.
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1) Implant screw retained #7
2) Bisco All Bond Universal Adhesive & Duo-Link Universal #6, 8 & 10
3) Bisco All Bond Universal Adhesive & Choice 2 Veneer Cement #9 & #11
- Dual Cured
- Quick Clean Up
- High Conversion
- Low Film Thickness
- Radiopaque
- Available in Universal (A2) & Milky White shades
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• What is the working time of DUO-LINK UNIVERSAL?
Minimum 2 min. (includes mixing)
• What adhesive can I use with DUO-LINK UNIVERSAL?
Can be used with any – we recommend All-Bond Universal. Some manufacturer's adhesives are
too acidic to properly bond to self -& dual-cured resins. ALL BISCO manufactured adhesives
are compatible with self- & dual-cured cements. If you are using an adhesive from a different
manufacturer, please refer to their instructions for compatibility.
• Do I need to pre-treat the surfaces of my indirect restorations?
Yes. Silane should be used to prime the surface of glass ceramics. Z-PRIME™ Plus should be
used to prime the surface of metals, composites, and zirconia.
• Can I use this for all indirect restorations?
Yes, however we recommend the use of a light-cured resin cement such as Choice™ 2 for
veneer cementation to ensure shade stability.
FAQs
A Universally Simple, Universally Strong adhesive resin
cement specially formulated for cementation of ALL* indirect
restorations.
• Universal - for all cementation procedures*
• Formulated to allow for quick and easy removal of excess cement
• Easily identified on radiographs for quick and effective diagnosis
• High degree of conversion in both light- and self-cured modes
ensures a strong, long lasting restoration
• Easy to use auto-mix, dual-syringe provides a consistent mix for
immediate delivery
• Ideal for all chairside and lab-fabricated restorations
• Available in Universal (A2) & Milky White shades
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Duo-LinkUniversal Multilink NX3 XTR
Sh
ea
r B
on
d S
tre
ng
th (
MP
a)
Light-Cure SE Self-Cure SE
* It is recommended to use BISCO’s CHOICE™ 2 for veneer cementation.
SBS Competitive Comparison
Data on file. BISCO, Inc.
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Alkaline pH 8.5
Moisture Tolerant
Self Sealing
Apatite Formation
Insoluble/No Degredation
Stronger with time
Semi / Translucent
Biocompatibility-Excellent
Bioactivity-Apatite formation
No silane, conditioning, bonding
Calcium Aluminate/Glass Ionomer Hybrid Cement**
Bioactivity
A reactive bioactive system that contributes to hydroxyapatite mineralization of hard tissue through ion release and alkaline
pH.**
Calcium Aluminate/Glass Ionomer Hybrid Cement**
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Cementation Technique
Mix for 8-10 seconds
.17ml vs single cap .10ml
3-4 restorations
Calcium Aluminate/Glass Ionomer Hybrid Cement**
Lithium Disillicate (eMax)• Cleaning
w/phosphate
scavengers is not
necessary
• Silane is
contraindicated
• Tooth etching or
conditioning is not
necessary
• Bonding agent is not
needed
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Cement Selection
Three year recall data yielded no loss of retention, no
secondary caries, no marginal discoloration, and no
subjective sensitivity. All restorations rated excellent for
marginal integrity.
Cement SelectionJournal of Esthetic & Restorative Dentistry March 2015
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Simplify Cementation
-Silane is contraindicated
-Restoration does not have
to be cleaned after tryin
-Tooth etching or
conditioning is not necessary
-Bonding agent is not
needed
Technique Research/Literature**
Moisture Tolerant
No Sensitivity
Alkaline pH
Apatite Forming
Insoluble
Stronger With Time
Self Sealing
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KEY FEATURES:Tough, resilient, fracture resistant, absorbs shockInsolubleReleases and recharges calcium, phosphate and fluorideChemically bonds – Seals against microleakageNo sensitivityMoisture tolerant – Simplified technique – No etching, no bondingLight cure and self-cureAvailable in A2 and translucent shades
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Legal Documentation
Signed treatment plan
I.C. RBAs
Arbitration agreement
Driver’s License
Headshot in your office
Paid prior to starting appointment
Waxup signed off as approved
Temps signed off as approved
Final appearance at tryin approved giving consent to cement as final.
Document discussion of wearing a clear aligner or night guard and having discussed OSA. OHI. Eating and Habits.
PLAN
Who are you?
Who and What do you want?
How will you achieve it?
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Case Acceptance,Communication, Sales TrainingLearn how to help patients say yes to treatment and financing
https://www.legion.dentist/inception
• Reduce Your Stress & Build A Better Life
• Better Business & Communication Skills
• Incredible Marketing & Advertising
• Front Office Simplification
• Insurance Independence
• Office Metrics/KPI
• Responsive Websites, Social Media
• Enhance Diagnostic Skills & Procedures
• Photography
• Elective Dentistry & Sales Skills
• Cosmetic & Restorative Dentistry
• New Materials, Techniques, Technology & more..
Online Training/Mentorship For Dentists.www.Legion.dentist
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Digital Lecture Handouts
www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers
Link will be emailed to you, check your spam or junk folder.
I reward you with lots of extra free information so be sure to
get yours.
Digital Handouts
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TODD C. SNYDER, DDS, [email protected] WWW.LEGION.DENTIST
QUESTIONS?YOUR FUTURE BEGINS NOW!
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