|Year : 2017 | Volume
| Issue : 4 | Page : 183-188
Porcelain laminate veneers – A novel dimension to minimalism in prosthodontics: A case series
Namratha Lekshmi Jayalakshmi, Aby T Mathew, Ansu Kuruvila, Sujith Kakkadathu
Department of Prosthodontics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
|Date of Web Publication||21-Aug-2017|
Namratha Lekshmi Jayalakshmi
Pushpagiri College of Dental Sciences, Thiruvalla, Kerala
Source of Support: None, Conflict of Interest: None
The success of anterior esthetic rehabilitation depends on the resolution of initial esthetic issues, patient satisfaction, and good integration of the restoration with the surrounding tooth and soft tissues. Porcelain laminate veneers are thin facings of ceramic that have evolved since 1983 to become the esthetic alternative to full coverage restorations. By the advent of new materials and techniques based on the principles of adhesive dentistry, extremely minimal preparation with enamel preservation has improved and offered best results. This article focuses on the esthetic improvement of patients with diastema, fluorosis, and discolored teeth using porcelain laminate veneers.
Keywords: Adhesive dentistry, diastema, discoloration, fluorosis, porcelain laminate veneers
|How to cite this article:|
Jayalakshmi NL, Mathew AT, Kuruvila A, Kakkadathu S. Porcelain laminate veneers – A novel dimension to minimalism in prosthodontics: A case series. J Int Oral Health 2017;9:183-8
|How to cite this URL:|
Jayalakshmi NL, Mathew AT, Kuruvila A, Kakkadathu S. Porcelain laminate veneers – A novel dimension to minimalism in prosthodontics: A case series. J Int Oral Health [serial online] 2017 [cited 2019 Jun 17];9:183-8. Available from: http://www.jioh.org/text.asp?2017/9/4/183/213493
| Introduction|| |
Contemporary prosthetic dentistry relies on the fabrication of healthy, maintainable, esthetic, and functional prostheses. The creation of an “illusion of reality” marks the key to true success of any restoration. Porcelain laminate veneers are thin facings of ceramic porcelain affixed directly to teeth using a composite resin as bonding cement. They have adequate longevity and are one of the most conservative techniques used in esthetic dentistry.,, Laminates have evolved since 1983 to become the esthetic and conservative alternative to full coverage restorations.
In the anterior esthetic zone, porcelain laminates veneers are used to solve esthetic and functional problems. In esthetic dentistry, extremely minimal preparation preserving the enamel offer better result and are best provided by veneers. Laminates are indicated for defects of teeth with respect to color, position, and form which include stained restorations, diastema, fractures, attrition, adolescent teeth, discolorations, malformations, malpositions, root exposure erosion, or abrasion.
The present case series describes the treatment of three patients with diastema, fluorosis, and discoloration of teeth in the anterior region with thin wafers of porcelain, to provide better esthetics.
| Case Reports|| |
Case report I
A female patient aged eighteen, reported to the department, for the esthetic alteration of her front teeth. A detailed history was taken with no relevant medical history, and none of her family members had a similar problem. Previous dental history revealed that her deciduous dentition was not affected. There were no abnormal findings in extraoral examination. Intraoral examination revealed localized enamel fluorosis which involved the incisors predominantly the centrals. White opaque spots on the surface of enamel of maxillary incisors were noted. All teeth were erupted and in proper occlusion, were vital and had no hypersensitivity [Figure 1]. Treatment options such as laminate veneers, bleaching, composite veneering, and microabrasion were discussed. Due to its esthetic qualities and minimally invasive nature, it was decided to enhance his appearance using porcelain laminate veneers. Maxillary and mandibular diagnostic casts were made. After analyzing the patient's smile line, it was decided to place porcelain laminate veneers in the right and left central incisors. A slight contouring of the proximal incisal edges of the laterals were also done to aid in an esthetic smile.
Case report II
A 45-year-old female patient came to the department concerned about teeth discoloration on the maxillary front teeth. A detailed history was taken with no relevant medical history, and none of her family members had a similar problem. The patient had a history of trauma due to fall followed by discoloration of teeth. Dental history revealed that she has undergone endodontic therapy in relation to 21 and an attempted endodontic therapy on 11 which was terminated due to calcified pulp chamber and was asymptomatic for 5 years. No abnormal findings were noted in extraoral examination. Intraoral examination revealed discoloration of the maxillary central incisors. Treatment options such as all ceramic crowns, laminate veneers, bleaching, and composite veneering were discussed [Figure 2]. Due to the requirement of minimum preparation and patient's interest, it was decided to use porcelain laminate veneers. Maxillary and mandibular diagnostic casts were made. Patient's smile and anterior plane was analyzed and it was decided to place porcelain laminate veneers in the right and left central incisors.
Case report III
A young female aged 23 reported to the department, for the correction of spacing in the front tooth region. A detailed history was taken with no relevant medical history and family history. Dental history revealed that her maxillary left central incisor was extracted due to trauma. No abnormal findings were noted in extraoral examination. Intraoral examination revealed midline diastema and drifting of her left lateral incisor into the previously extracted site of the central incisor. Treatment options such as orthodontics, laminate veneers, and full coverage restorations were discussed. By taking into account the duration of treatment and minimally invasive procedure, porcelain laminate veneers were opted. Maxillary and mandibular diagnostic casts were made. After analyzing the existing space between the teeth, it was decided to prepare the maxillary left lateral incisor for receiving a laminate restoration to create the illusion of a central incisor. Smile designing was done where the left maxillary canine was slightly modified by rounding the tip [Figure 3].
Before beginning the preparation of the tooth surface, the patient's tooth color in the daylight was selected using a color scale (VİTA Toothguide 3D-Master). Depth orientation grooves were placed with wheel diamond (Shofu kit: 896) on the facial surface with 0.3 mm on the gingival region and 0.5 mm on the incisal half, rest of the tooth structure was removed using round-end tapered diamond bur. A subgingival chamfer finish line was given. Tooth preparations on the proximal areas were extended till the contact areas, not breaking the contact while maintaining a layer of enamel to support the veneer.
An incisal edge overlap preparation which provides a vertical stop was chosen so as to aid in aids in correct positioning of the veneer. Round end tapered bur was used to prepare the lingual finish line which connected the two proximal finish lines. Mechanical retention and surface area was increased by extending the preparation to the lingual surface. The preparation was refined by rounding the sharp angles [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]. After finishing preparation, occlusal contacts were checked during jaw movements. A layer of dentin bonding agent was applied to the prepared teeth surfaces after preparation. Retraction cords were removed and impressions made by putty-wash technique using polyvinyl siloxane. Temporary restorations were done with tooth-colored acrylic resin and were temporized with composite resin at three spots.
Removal of the temporization followed by cleaning and drying of the teeth were done. IPS-emax veneers were tried and gingival compatibility, contact compliance, relations, and contacts during occlusion, as well as the color and design of the restoration were checked. After the checks were complete, the veneers were etched with IPS ceramic etching gel which contained 5% hydrofluoric acid for 20 s. Veneers were washed and dried. The inner surface of veneer were coated with silane coupling agent (Monoborid-S, Ivoclar vivadent) on and allowed to dry followed by application of bonding agent. The resin layer was polymerized with light. Thirty-seven percent phosphoric acid was applied onto the teeth surface, waited for 30 s and teeth were washed, cleaned, and dried. Cotton pellets were used to avoid contamination of the lips. Tooth surface was painted with bonding agent (Adper 3M ESPE). Veneers were bonded to teeth with resin cement – dual cure (Ivoclar vivadent). Base and catalyst paste were mixed in proper proportion, and the cement was applied on the inner side of veneers. Proper positioning of the veneers on the teeth, followed by application of slight finger pressure to flush out the excess cement which was then removed using a probe. Light curing of the luting composite was done for 10 s. Polymerization started from the lingual side and moving on to the facial side for 60 s. Followed by light curing for 40 s were done on all areas [Figure 10]. Contact points and occlusion were checked to make sure no contact existed in protrusive movement between the tooth and veneer [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17].
|Figure 17: Cemented prosthesis with roundening of the left canine to create an illusion of lateral incisor - case 3|
Click here to view
The clinical success of any restoration depends on the aftercare techniques that are being followed. The patient was advised to properly maintain oral hygiene with interdental brushes and floss. The patient was advised not to bite on hard items which can lead to fracture of the restoration. Periodic recall was indicated to know the maintenance of the restoration [Figure 18], [Figure 19], [Figure 20].
| Discussion|| |
Porcelain veneers are a preferred restorative option for anterior teeth due to its minimal tooth tissue removal  and also due to the adhesive systems that enhance bonding of the thin wafers to the tooth structure. They also have their disadvantages which include precision in the laboratory work, lack of color alignment, and debonding of the restoration. Three types of incisal edge preparation have been described for porcelain veneers – window, incisal bevel, incisal overlapped, and feather preparations. The choice of the material and preparation depends on the tooth being restored, its function and esthetic demands.
Type of preparation differs at the incisal edge. At gingival third the preparation would be subgingival, middle-third the preparation requires a depth of 0.5–0.8 mm and the incisal preparation can be modified according to the esthetic demand. Adequate esthetics at the incisal third of the preparation requires 1.5–2.0 mm thickness of ceramic and can be achieved with the “overlap” type of preparation. Proximal preparation must follow the papilla and extend until interproximal contact. In all the cases, an incisal overlap preparation was being followed as they maintains a vertical stop for the restoration and also aids in the retention of the restoration.
Glass ceramics may be ideally suited, and their properties are improved by adding aluminum, magnesium, zirconica, leucite, and lithium disilicate. When flexural risk factor is present glass ceramics are preferred than flespathic porcelain because when bonding to dentin the flexion of dentin is more than enamel. Glass ceramics require more thickness of material which goes along with an increase in strength. In the above cases, pressable ceramics were used.
Sealing of the exposed dentinal tubules with a bonding agent is done after tooth preparation since better adhesion is obtained with newly prepared dentin. It protects the pulp preventing sensitivity and bacterial ingression.
Etching the ceramic surface increases the surface area and creates undercuts for retention of the resin luting cement. Adhesive cementation improves fracture resistance of the brittle porcelain. In situ ations where the preparation is more than 0.7 mm, dual-cured luting composite is advised. This is due to the lower hardness of light cure composites. Dual cure composites have initiators for both light cure and chemical cure composites. Dual cure cements have greater hardness than light cure due to their higher degree of polymerization. Cementation of the veneer is the most critical step to ensure adequate bonding and durability of the restoration. Special attention is necessary during each step in the bonding technique to obtain success.
| Conclusion|| |
Re-creating the lost esthetics in patients are the most challenging topics for contemporary dentistry. Cosmetic dentistry uses porcelain laminate veneers as an important option for correcting esthetic problems. Patients expect to restore their natural beauty while maintaining functionality and stability. The minimum preparation, esthetics, biocompatibility, effective color change, inherent porcelain strength, resistance to fluid absorption is various advantages of laminate veneers. Here, three cases of discoloration, fluorosis, and diastema are treated esthetically with veneers. However, the clinical success depends on the bonding procedure, technique and maintenance of oral hygiene by the patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Malone WF, Koth DL, Cavazos E Jr., Kaiser DA, Morgano SM. Tylman's Theory and Practice of Fixed Prosthodontics. 8th
ed. Chennai, Delhi: All India Publishers and Distributors; 1997.
Gresnigt M, Ozcan M. Esthetic rehabilitation of anterior teeth with porcelain laminates and sectional veneers. J Can Dent Assoc 2011;77:b143.
Calamia JR, Trushkowsky RD, David SB, Wolff MS. Modern concepts in aesthetic dentistry and multidisciplined reconstructive grand rounds. Dent Clin North Am 2015;59:xiii-xiv.
Lewis MW, Braxton AD, Wasson W. Prefabricated composite veneers. A conservative solution for the aesthetic zone. Dent Today 2015;34:100-2.
McLaren EA, LeSage B. Feldspathic veneers: What are their indications? Compend Contin Educ Dent 2011;32:44-9.
Magne P, Hanna J, Magne M. The case for moderate “guided prep” indirect porcelain veneers in the anterior dentition. The pendulum of porcelain veneer preparations: From almost no-prep to over-prep to no-prep. Eur J Esthet Dent 2013;8:376-88.
Bagis B, Aydoğan E, Bagis YH. Direct restorative treatment of missing maxillary laterals with composite laminate veneer: A case report. Open Dent J 2008;2:93-95.
Aykent F, Usumez A, Ozturk AN, Yucel MT. Effect of provisional restorations on the final bond strengths of porcelain laminate veneers. J Oral Rehabil 2005;32:46-50.
Hui KK, Williams B, Davis EH, Holt RD. A comparative assessment of the strengths of porcelain veneers for incisor teeth dependent on their design characteristics. Br Dent J 1991;171:51-5.
Radz GM. Minimum thickness anterior porcelain restorations. Dent Clin North Am 2011;55:353-70, ix.
Soygun K, Gülnahar E, Bolayir G. Laminate veneer-CAD/CAM: Case reports. Cumhuriyet Dent J 2014;17 Suppl 1:65-70.
Alhekeir DF, Al-Sarhan RA, Al-Mashaan AF. Porcelain laminate veneers: Clinical survey for evaluation of failure. Saudi Dent J 2014;26:63-7.
Magne P, Douglas WH. Design optimization and evolution of bonded ceramics for the anterior dentition: A finite-element analysis. Quintessence Int 1999;30:661-72.
Moraes RR, Correr-Sobrinho L, Sinhoreti MA, Puppin-Rontani RM, Ogliari FA, Piva E. Light-activation of resin cement through ceramic: Relationship between irradiance intensity and bond strength to dentin. J Biomed Mater Res B Appl Biomater 2008;85:160-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20]