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The Nuts & Bolts of Veneers
TODD C. SNYDER, DDS, FAACD
Accredited Fellow, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Member of The American Society For Dental Aesthetics
Former Faculty, UCLA Center For Esthetic Dentistry
LEGIONpride.com, Online Training Challenge for Dentists
Todd Snyder, DDS, FAACD, FIADFE, ASDALaguna Niguel, CA
Aesthetic Dental Designs®
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According to the American Academy of Cosmetic Dentistry 50% of patients are
unhappy with their smiles and 3 out of 5 people will invest in their smiles.
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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Over The Counter Whitening
Whitening
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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
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Opalescence Go Sample Tower
“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
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So why are people willing to pay top dollar for a beautiful smile
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Cosmetic Alterations
• How many of you want to buy something sight unseen?
• How many of you want to experience something first before investing?
• Your patients are no different!
• They are concerned about how it will look and feel. They want to be excited and happy!
• Don’t Just Tell…..Show & Tell!
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The Key to Success:
VisualizationWhat is the patient’s perception or desired outcome in their mind to create the EMOTION and DESIRE?
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• Designed for dentistry
• 8 modes
• 12 Megapixels
• Dental cropping and grid lines
• Large LCD touchscreen
• Water and chemical proof
• Durable rugged Exterior***
• Fast autofocusing & anti-shake capabilities
• Held with one hand – weighs only 1lb
• Compatible with the Eye-Fi X2 card –
Immediately upload images onto PC, iPad,
Tablet or Smartphone
EYESPECIAL C-III (SHOFU)
MAGNIFICATION RANGE• Chose the magnification ratio/range by rotating the dial key
• Icons to help you determine and select the range properly
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STANDARD MODE
EDIT & DRAW FUNCTION ON THE
EYESPECIAL C-II
• Edit functions are ideal for
patient education
• Under the Menu key you can:
• Draw on images to show
areas of focus
• Rotate the image
• Protect the image against
being deleted
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WHITENING MODEFOR SHADE COMPARISON BETWEEN BEFORE AND AFTER WHITENING
• Similar to “Low-glare” mode but with lower light intensity
• Reduces glare and emphasizes the surface texture and shade
• Delegated Whitening & Imaging Assistant
Upper arch whitened
Lower arch not whitened
ISOLATE SHADE MODEFOR OPTIMAL SHADE MATCHING
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EyeSpecial C-III
Quadrant Dentistry
35mm Pro
EyeSpecial C-III35mm Pro
Cosmetic Dentistry
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EyeSpecial C-IIIKodak DCS-N
Cosmetic Dentistry
What do they want or envision?
Look at books or your cases.
Bring in examples of smiles.
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Everyone has an opinion & priorities
How WHITE?
Translucency?
What Texture?
Color Transitions
What about example
pictures?
◆ Are they relevant and
realistic?
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REALISTIC
Photographic Manipulation
• Cosmetic “Imaging” Software• SmileFy app• PreVue app• SmileVision• DentalGPS• DSD
• Digital Agents• Virtual Smiles ($125/image)• DreamSmiles (<$4000 a year?)
• Ivoclar/Kapanu?
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Why Does this Work?
✓Creates awareness
✓Suggests the possibility
✓Promotes discussion
✓Provides bridge to clinical evaluation and
presentation of options
✓Creates EMOTION and DESIRE
Digital Smile Mockup
-is a proven practice building program that can:
Dramatically increase your patient’s interest in a smile
transformation
Remember, 50% of your patients want to improve their
smile
The goal is to help them visualize themselves with an
improved smile
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When you hand a Digital Simulation to your patient, you plant a seed of what is possible, a constant reminder of what their potential new smile can be. They can show it to their friends and family, you can put a copy in their chart for follow-up, have them hang it on their refrigerator...!
VIRTUAL SMILES©
• Tooth shape
• Length, width, & style #
• Tooth color
• Translucency, effects
• File Format
• Paper
• CD
• Flash
• Logo & Office Info
• Smile Simulations
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SMILE DESIGN SOFTWARE VS DRAG AND DROP SMILE GALLERY?
Overall Feel
Appearance…what is it? who decides, Dentist? Ceramist? Patient? Combined effort?
THEIR DECISION √
BUT YOU HAVE TO GUIDE THEM
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The Key to Success:
Traditional Veneers
Diagnosis & Treatment Planning
The Key to Success:
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Traditional Veneers
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You are selling the Emotion…
Do you know “THEIR” desired outcome?
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• There never seems to be enough of it…
• It has to be built into the schedule or out source to employee
• Take the time to huge profit
• Know what the case is going to entail ahead of time
• What is the patients Chief Complaints?• Pick 3 to address
• Why do they have these problems?
• Are they going to drive you crazy?
Time
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• Immediate Smile Change Consultation?
• Can they come back in a week?
Time (CONSULTATION)
OR
-Patient wants to fix the small
lateral incisor
-No tooth reduction
OPPORTUNITY
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Beadline Provisional Mockup
Beadline Provisional MockupBeadline Provisional Mockup
Diagnostic Models with a waxup are duplicated. Special over impression is created and used to deliver temporary mockup
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LISTEN For Yourself
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Show & Sell Possibilities..
COSMETICChanges
3 out of 5 • Patient came in to fix small lateral incisors
• Wants “Absolutely” no tooth reduction
• What drives him?• Appearance
• No Tooth Reduction
• Emotion
• Desired Outcome…. Feel Better, more confident?
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Results
Confidence, Dating,Work,Emotional Goals
Cosmetic Dentistry
• Do YOU WANT more Cosmetic Cases?
• Patients desire a change• But don’t know what they want (typically)
• What are their Chief Complaints (pick 3)
• Why?
• And What will that accomplish? Reasoning behind Tx.
• Always look at the big picture
• Take photos
• Write down where they can see their Chief Complaints• Signature on waxup
• Signature on provisionals
• Signature for final cementation approval
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Free TIPS on my Instagram Story
2 New Smile TIPS coming soon!!
How Do We Create The
Intraoral Mockup?
• First take an impression of teeth with a material that allows you multiple repours.
• Want one original model
• One model for laboratory
• Extra model if you need bleach trays or practice preparations
• Photos
• Facebow
• Horizontal Plane Indicator
• Teeth that are too far facial will remain untouched. When photos are taken they will be less obvious.
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Final Impression
• Pack #00 ReCord
• Take final impression with light body PVS (Affinity) and heavy body PVS (Affinity) tray material
• Use a custom HeatWave Tray
Final Impression
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Final Impression
Final Impression
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Final Impression
REVIEW
• Existing In Office Patients (3 out of 5) want to fix their SMILES!
• Shade Evaluation every exam & everyone in Hygiene Department
• Website, Social Media Accounts all setup and posting RELEVANT content
• Photos of everyone to send home (possibly with imaging) GET A CAMERA
• Take a photo and do a Cosmetic Simulation/Mockup
• Instant visualization through software on an iPad or possibly internet
• Instant Composite Mockup in the dental chair
• Take an impression and have lab do a waxup to facilitate a Beadline
Provisional Mockup (reduced fee or no fee agreement with lab)
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Diagnostic Models & Records
Silginat - Kettenbach
Counter FIT- Multipurpose Replication Silicone
(Clinician’s Choice)
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Counter FIT- Multipurpose Replication Silicone
(Clinician’s Choice)
Silginat - Kettenbach
Wear Facets & Interferences
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
—MEG BIRAM
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TRAIN
Are you confident in creating beautiful outcomes on anterior teeth quickly &
easily? IF NOT, PRACTICE!
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Tooth Size Averages
2nd Premolar 1st Premolar Canine Lateral Incisor Central Incisor
6.6mm 7.1mm 7.6mm 6.6mm 8.6mm
7.7mm 8.6mm 10.6mm 9.8mm 11.2mm
Width
Length
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0.6-1-1.68
Golden Proportion Measurement.
SculptPad (Ivoclar)
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• Practice Preparations
• Waxup
ADDITIONAL TOOLS
◆ Panadent: Multi Purpose Ruler
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◆ Erskine: Dentagauge 1 & 2
ADDITIONAL TOOLS
What Records & WhenDiagnostic & Prep Reduction Models
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Diagnostic Guides
Diagnostic Guides
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No Preparation Veneers
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
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Tooth Preparation Conservative Preparations
No Prep Case: 1
• Angulation of teeth
• Spaces
• Lingually positioned
• Lack of lip support
• Thinned enamel
• Fuller smile
• Microdontia
• Chairside Mockup**
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Mockup & prep-Minimally invasive
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Mockup & prep
Mockup & prep
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Mockup & prep
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Preparations141
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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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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)
Incisal edge preparations
a) No incisal lengthening
b) Changing color or wear
c) Lengthening tooth
Veneer Preparations
Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”
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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
Preparation Reduction• Depth reduction burs
• Safe reduction
• Lasco
Veneer Preparations
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Independent Depth Cuts (Lasco Burs)
▪ Depth Cuts▪ Tooth Reduction▪ Interproximal & Margins▪ Retention Form (Line of Draw)
Burs• Organization
• Diamonds
• Carbides
◼ K0096 Finishing Kit $126.47 each
◼ K0095 Preparation Kit
$125.47 each
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Preparation
Aesthetics
Function
Bonding to Enamel
Material Options
Minimal Prep Case: 2
Minimal Prep Case:
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Wax-up Case:
Preparation Guides:
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Disposable Single Use Diamonds-medium or coarse grit
Offer not valid for previous purchases or in conjunction with any other offer.
Free Pack of NEODiamonds
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• Photomed (818) 908-5369
SHADE SELECTION
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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
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EMOTIONFocus on overall appearance
Stay away from little details
“Going to look & feel great”
Minimally Invasive Veneers…. Why? Benefits??
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Beadline Provisional Mockup
Mockup
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Depth Cuts
Photos for Laboratory Technician
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Provisional Restorations
Final Restorations
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Provisionals Mimic The Final Restorations
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Complex Positioning &
Gingival Tissues: #8Aesthetics
Tissue Problems
Poor Function
No TMJ Problems
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Incisal position
Gum height
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2-4 mm
10-12 mm
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Instant Ortho/Un-Rotating Teeth
• Do initial workup
• Diagnostic preps
• Diagnostic waxup
Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”
◼ Sequence
– Reduce all excess tooth structure
– Ideal reduction
– Margin placement
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Cementation**
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Selection Process
◦ Open Bite Trays
Plastic-full or quadrant
Metal-full or quadrant
Custom Trays
Non-perforated or perforated (metal or plastic)
Rigidity can eliminate tray distortion and rebound
Spring back after impression is possible with plastic
Cross arch stabilization
Ideal occlusal stops for proper model articulation
Able to recreate excursive movements if mounted on a
semi or fully adjustable articulator.
Potential for errors & adjustments are low
Impression Trays
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Custom trays create more
ideal placement
Thinner material creates
less distortion
USE TRAY ADHESIVES for
all open bite trays, not just
custom trays.
Only negative is time
Impression Trays Selection Process
Custom Tray
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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
Impression Trays
HeatWave by Clinician’s Choice
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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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Simplified Provisionals**
Siltech Putty Matrix
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Duplicate waxup model in stone
Scribe a 0.5-1mm line with a sharp instrument into the
model where the tissue and tooth come together.
Provisionals (Bead Line Technique)
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Duplicate model with a fast setting polyvinyl impression material.
I have used light and medium body washes with a heavy body tray
material.
Provisionals (Bead Line Technique)
Provisionals (Bead Line Technique)
The scribed line creates the Bead Line in the over impression of the cast.
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The Bead Line in the over impression creates pressure along the tissue
and preparation margin. This causes a thin cut or separation of the
acrylic flash from the provisionals for easier clean up.
Provisionals (Bead Line Technique)
Typically the excess acrylic can be removed with fingers, a spoon or discoid instrument. Minimal
to no effort is required to remove excess flash. If a void or a margin is exposed simply fill the
void with a flowable. Etching and a bonding agent are not required as the flowable will adhere to
the air inhibition layer of the temporary acrylic and you do not want to adhere to the tooth.
Provisionals (Bead Line Technique)
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The Bead Line Provisional Technique creates less work and risk of damaging tissues and tooth
structure. Typically the process takes 5-10 minutes to make provisionals. Consepsis (Ultradent)
can be placed on the teeth and dried prior to fabricating provisionals.
Provisionals (Bead Line Technique)
-Visalys (Kettenbach)
-TempSmart (GC America)
-Inspire (Clinician’s Choice)
-ExperTemp (Ultradent)
Provisionals
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Cling 2 (Clinician’s Choice) for all my full crowns & bridges,
retentive inlays & onlays.
My Favorite Temporary Cements
ClearTemp LC (Ultradent)
For either veneers or thin
anterior cosmetic restorations
-Aesthetics
-Function
-Gingival Embrasures
-Excess cement
-Patient homework & questions
Post-Op Check
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From Imaging & Diagnostic Wax-up the entire case was duplicated
(Clinician’s Choice)Affinity Impression Materials
▪ Light Body
High Flow
Regular Flow
▪ Monophase
▪ Heavy Body
▪ InFlex
▪ Quick Bite
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Impressions & Provisional Tips
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25% aluminum sulfate (will not oxidize & turn black)
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Heat Wave custom tray & Affinity impression
Inspire Bead Line Provisionals
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Provisionals (Temp Tray, Template) Clinician’s Choice
• Utilize an accurate preliminary over impression
• Maintain over impression
• Template 30s working time / 30s setting time
Inspire (Clinician’s Choice)40 second working time
Removal time of 1:30-2:30 minutes & total cure 4:30 minutes. Cut sooner.
4 available shades (B1, A1, A2 and A3.5) provide ideal translucency & fluorescence
High flexural and compressive strength
Elastic Modulus (3136 MPa)
Great polish
Provisionals
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Cling 2 for all my full crowns & bridges, retentive inlays & onlays.
My Favorite Temporary Cements
ClearTemp LC (Ultradent)
For either veneers or thin
anterior cosmetic restorations
is a zinc-oxide non-eugenol, automix temporary cement with a unique polycarboxylate resin
The addition of polycarboxylate optimizes adhesion, soothes the tooth, and provides an
excellent seal, while allowing the material to be easily removed from the tooth preparations
when desired.
Cling 2 (Clinician’s Choice)
30 second working time, 60-90 second set time
Good adhesion, easy removal
Low film thickness
Excellent marginal seal
Biocompatible – protects the gingival tissue
Resists forces of mastication
2 year shelf life
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Another Case Of The Week
Another Case Of The Week
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▪ Heat Wave Thermoplastic
Tray
▪ #00 Record
▪ Tissue Goo if necessary
▪ Bite Registration
▪ Photograph
▪ Inspire Temporary
▪ Cling 2 Temp Cement
Another Case Of The Week
Utilize an accurate preliminary over impression
Maintain over impression
Check contacts and occlusion
Place temp cement only on margins
Do not fill temp with cement
Or vent holes
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Photography to check color match
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REVIEW
• Full arch impression Heat Wave Tray
• Record or Diode laser
• Light & Heavy Body Impression Material (Affinity)
• Bead Line Provisional Technique (Inspire) uses no temp cement or
adhesives, mechanical retention, shrink wrapped (using Template)
Simplified Provisionals**
Siltech Putty Matrix
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Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Cosmetic Provisionals (Bead Line Technique)
Cosmetic Provisionals (Bead Line Technique)
Scribe a 0.5mm-1mm groove into tissue & a little on tooth
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Cosmetic Provisionals (Bead Line Technique)
Cosmetic Provisionals (Bead Line Technique)
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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)
Cosmetic Provisionals (Bead Line Technique)
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Case #4: Single Tooth Aesthetics
Veneers
Function
Gingival Bonding
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Remove old restorations & repair abfraction lesions on cervicals
• Stump Shade (dehydration factor)
Base Shade
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• Contact lens effect
• At or above gingiva
• Masking tooth or color changes
• At gingiva, then place cord and
reduce another 0.3-0.5 mm
Veneer & Crown Margin Placement
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Impressions
Facebow & Wax Bite Registration
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Provisionals
Free Hand Provisionals
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ULTRADENT• Nanohybrid
• Superior handling
• High polishability & gloss retention
• Exceptional wear
• Unique syringe design
• Intuitive shade offering
Free Hand Provisionals Example
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• Materials
• Rigid Bite Registration
• Light and Heavy Body
Prefabricated Over Impression
AESTHETIC RESIN TEMPORARY CEMENTS
• Materials
• Bifix Temp-VOCO
• TempBond Clear-Kerr
• ClearTemp LC-Ultradent
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Before & After Photos
Mixed Provisionals
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Waxup, Reduction Guides &
Temporaries (Case 6)
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Preparation Guides
Preparation Guides
A-TYPE PREP
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Removing provisionals that are locked on.
Removing provisionals that are locked on.
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Nine Years Later
QUESTIONS?
Red Blood Cells 2 – 5um
200-500nm
Human Hair 60 –120um
6,000 – 12,000nm
?
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Shimstock & Articulating Paper
What do you use…..
.…and why?
Parkell Accufilm II is 21µm for
dentistry
Great Lakes articulating
ribbon 12µm
8µm Almore Shimstock foil
8µm articulating paper??
Shimstock & Articulating Paper
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What do you use…..
.…and why?
8µm articulating paper
Available in blue
And red too!
TrollDental-8µm Articulating Paper
TIP
Booth # 573
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RESTORATION PLACEMENT?
• Bonded
• Margin placement
• Moisture Control
• Technique Sensitive
• Materials
• Self Adhesives
• Bonding agent (TE or SE) & luting resin
• Cemented
• Margin placement
• Moisture Tolerant
• Retention Required
• Materials
• RMGI
• Ceramir
Cement Selection
RESIN CEMENT COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
PROVISONALS
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PROVISIONALS
CERAMIC TRY-IN
• Make sure it is etched properly from lab
• Ceramic Primer prior to try-in (unless using Ceramir)
• Ultrasonic with ethanol after try-in
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BONDS WITH OR WITHOUT HF
ACID ETCHING
THE “NO-WATER” SILANE w/ MDP
INSTANT ACTIVATION
LESS DEGRADATION
(More Stable 2 Year Shelf-Life)
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Silanes
Universal Adhesives (w/MDP)
Silane Primer + MDP
Organo-Phosphate Monomer (MDP)
Silane Primers
A disadvantage of many other silane products is that they are pre-
hydrolyzed.
Another disadvantage is some require the use of Hydrofluric Acid
etching and sometimes in addition to Micro-Etching. The new
Monobond Plus requires HF and Micro-Etching as well as 60 minute
activation time period.
TRYIN APPROVAL
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3 VITA® shades
2 chromatic shades
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LITHIUM DISILICATE & SILICATE, LEUCITE AND FELDSPATHIC
RESTORATIONS
IS AN ADHESIVE CEMENTATION
SYSTEM THAT IS EASY-TO-USE,
EFFICIENT AND HIGHLY
EFFECTIVE
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FINAL RESTORATIONS
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Veneer Finishing System
Send CONTACEZ to 24587 to request a sample.Using the code SNYDER20 on their website will get attendees 20% off their next order!
ContacEZ Restorative strip system
• NEW Gold Narrow Strip 0.10mm single sided medium diamond grit Sub Gingival Trimmer w/ Blank Clear Gateway
• Black Diamond Strip 0.06mm fine diamond single sided
• Orange Serrated Diamond Strip 0.05mm extra fine diamond single sided
• White Serrated Strip 0.035mm
• Blue Serrated Strip 0.065mm
• Gray Final Polishing Strip 0.05mm ultra fine diamond single sided
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ContacEZ IPR Optional Strips
• Clear IPF Single Sided Opener 0.10mm med-fine diamond
• Cyan IPR Single Sided Widener 0.12mm med-coarse diamond
• Purple IPR Super Widener 0.25mm
coarse diamond
• Brown IPR Mega Widener 0.30mm coarse diamond
• More efficient than Halogens
• Halogen produces light from 370 to 800 nm then filters out all
but blue light in 400-500 nm range
• Longer lasting / Cordless / Batteries
• Faster curing (5 seconds)
• Smaller in size/lighter
• Less heat
BENEFITS OF LED LIGHTS
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Comparisons - Lights
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VALO DELIVERS
Access to the curing site = Energy to the resin
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Machined from Aerospace Aluminum
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• Design• Power• Durability• Access• Posterior tooth• Broad Light Output Range
– 395-480nm
• Cost• Weight
TIP
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You don’t want to miss what I am going to present in the coming months!!
Watch these Social Media Channels. Watch the Instagram Stories or Facebook Posts
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TODD SNYDER(949) 643-6733
www.aestheticdentaldesigns.comwww.drtoddsnyder.com
www.toddsnyderracing.com382
