RESIN LAMINATE VENEERS

: prepared byDr.Hany KamalDr. Mohammed Harkan

: CONTENTS

:Definitions:History

Indications::Contraindications

Advantages:Dis-advantages:Dental composite:Optical properties of dental composite:Shade Selection.Pre-Operative Procedures.Tooth preparation:

:steps of composite Veneer ProceduresSuccess and Failure:Case selections:

LAMINATE: A superfacial display in multiple layers.

WHAT IS MEAN BY DENTAL VENEERS?

VENEER: A thin layer of restorative material placed over a tooth surface, to improve the aesthetics of a tooth, or to protect a damaged tooth surface and known as dental laminates.

COMPOSITE RESIN LAMINATE VENEERS :

A thin bonded Composite resin which apply to teeth to improve appearance or aesthetics of teeth. They are used to change the colour, shape, size of teeth to make them more attractive appearance..

HISTORY OF COMPOSITE VENEERS :

Veneers were invented by dentist named Charles Pincus in 1937s by attached thin labial porcelain veneers temporarily with denture adhesive powder to enhance the appearance of Hollywood Stars for close-up photographs.

1956—BIS – GMA RESIN the major advancement for strong resin, high polymerization shrinkage 8-12%.

1962 –SILANE COUPLING AGENTS INTRODUCED MACRO FILLED COMPOSITES DEVELOPED to improve mechanical properties & reduce

shrinkage1970– ACID ETCHING INTRODUCED, The second evolution of Veneers through Etching

tooth structure.1976 – MICRO FILLED COMPOSITES DEVELOPED

MID 1980– HYBRID COMPOSITES DEVELOPED + Light cure2002 – NANO FILLED COMPOSITES

INDICATIONS: -Esthetically compromised anterior teeth. - Stained or darkened teeth. - hypo calcification. - Closure of Diastema. -Peg Laterals , Chipped Teeth, Microdontia. -Rotated and mal posed teeth. -Lingual position. -Stained restoration. -foreshortened teeth. -Tooth brush abrasions.

Stained or darkened teeth.

hypo calcification.

Diastemas .

Peg Laterals , Chipped Teeth , Microdontia.

Chipped Teeth.

Rotated Teeth.

Lingual position.

Stained Restorations.

Foreshortened Teeth.

Slight Malposition midlines.

Tooth brush abrasions.

CONTRAINDICATION:

-Excessive interdental spacing . -Poor oral hygiene.

-Clenching & Bruxing -Extreme midline deviations.

-High caries index . -Extensive existing restoration.

-Posterior teeth . -Edge to edge or cross bite. -people with healthy teeth .

-Crowding with inadequate enamel present. -Periodontal disease.

-Excessive inter dental spacing.

-Clenching & Bruxing .

-Extreme midline deviations.

-Edge to edge or cross bite.

ADVANTAGES OF COMPOSITE VENEERS :1 )Esthetics.

2 )Veneers is more conservative tooth preparation. .3 )Bonded to the tooth structure.

4 )Repair potential.5 )Chair-side control of the anatomy & easy polished.

6 )low thermal conductivity.7 )Less expensive.

DIS-ADVANTAGES OF COMPOSITE VENEERS :

1 )Tend to discolor.2 )Wear out quickly .3 )Marginal staining.

4 )Shade matching difficulty .5 )Often require repair and replacement.

TUTORIAL:

WHY THE COMPOSITE VENEERS ARE REQUIRED? They are resin based dental materials with fillers of very small particles. the size filler particles is important to achieve high polish able & stain resistant Composite veneers.To achieve excellent results, Composite veneers are technically and artistically very demanding. They should be Understands dental materials very well.

HOW LONG DO COMPOSITE VENEERS LAST? The longevity of Composite veneers depends many factors:type of material and procedure in doing them.Average Composite veneers are expected to last between 5– 10 years.WHAT ARE THE ALTERNATIVES TO COMPOSITE VENEERS?

Different treatments can be suggested. For example, to close gaps and re-align teeth, Orthodontic treatment such as Invisalign can be considered.For a full Smile makeover and improvement esthetics in multiple teeth, Porcelain veneers considered.

WHAT PORCELAIN VENEERS CAN DO?

It can correct uneven or warped teeth.It can correct worn out tooth enamel.

It preserves the damaged tooth surfaces therefore reducing the need for extensive dental treatments.It corrects uneven teeth spacing and gaps.

It can also correct stained or discolored teeth.

It can controlled of the sensitive teeth.

To achieve excellent results, Composite veneers are technically and artistically very demanding. They should be Understand dental materials very well.

DENTAL COMPOSITE:Consist of (resin matrix & filler distribution) for example we needs increase modulus of elasticity + strength + decreasing shrinkage + coefficient of thermal expansion + optimum translucency filler incorporation helps in all theses things .

COMPONENTS:Organic MatrixInorganic FillerCoupling agentInhibitors & acceleratorsPigments

Resin matrix:Monomer (Bis-GMA) (bisphenol-A glyceryl methacrylate) - (UDMA) (urethane dimethacylate)

strength. &Diluent (TEGDMA) (triethylene glycol dimethacrylate) added to increase flow and handling If the composite is made up of just the resin matrix, it is called Unfilled Resin.

MATRIX Phase that a solid mass and bonds to tooth structure .

Weakest and the least wear resistant phaseAbsorbs water, stain and discolorMinimize the filler content

Silica, Carbon glass, barium glass, quartz, ceramic.Fillers are placed in dental composites to reduce shrinkage upon curing .

Physical properties of composite improved by fillers, however, composite characteristics change based on filler material, surface, size, load, shape.

The classes of composites generally based on size of filler particles

:Macro filled composites (Traditional, or Conventional composites)-first type composte appeared in 1960s

- size filler particles 8-12 m-Excessive shrinkage in composite because leave gap between tooth & composite & reducing by

increase glass filler.not polishable causing accumulation of plaque and stain & Air Bubbles on surface.

-wear is major disadvantage of macrofilled composites.NB: less acrylic & more fillers its better,but resin used to glue silica particles together, It gives un-polymerize material

-difficult handling .Hybrid composites:

-contain different particle sizes. formulated in 1980's, they include about 75% conventional size particles (1-3 micron) & about 8% sub micron size (0.2-0.4 micron)

-not retain a high polish for long, due to the tendency of the largest particles to surface but retain proper working characteristics + wear resistant because contain submicron particles which difficult to dislodge + higher density with glass particles

Inorganic Filler

placing restoration on anterior tooth. optimal choice would be hybrid for strength, when needs translucency & light transmission at incisal edge, The optimal choice micro fill or Nano fill.

Micro hybrids: -They use three particle sizes for more efficiency, and range size particles (0.6 -0.7 microns).

-greater polish ability but lower density.-achieve superior color optics by using small filler particles between larger particles, also resin hardeners, to maintain

a surface polish during prolonged function. -working characteristics as hybrid composite.

-superior esthetics especially for anterior restorations by using uniformly cut small filler particles between larger particles, resin hardeners help to maintain a surface polish during prolonged function .

-mechanical properties strong for rebuilding incisal edges on anterior teeth -particle size and esthetic qualities make them especially attractive for any anterior restoration.

Brands as Tetric Ceram, Charisma

Micro filled and Nano filled composites:

micro fillers particles smaller than 1 micron, while Nano fillers particles smaller than 0.1 micron "Nano" has come to imply the newer agglomerated micro fill composites (defined below)

the more micro sized particles composite, the more wear resistant in the mouth.Used mostly to veneer over the larger particle sized macro filled or hybrid restorations in anterior teeth to make

them more polishable .The major problem with micro filled composites that tend to be sticky on handling. Their main advantage is superior wear resistant and high polishable.

Nano Hybrid Composites:

The newest composite & becoming popular because superior esthetic & wear characteristics & high polishability & superior handling suitable for anterior build-ups The compressive and fracture strengths higher than other composites (hybrids, micro hybrids) .The mechanical properties good as hybrids and suitable for both posterior applications and excellent esthetic.TYPES:

Agglomerated, larger glass or silica of 0.4 micron, 0.5 micron-wear resistant surface

Easy handling and esthetic characteristics which acceptable for anterior+posterior restorations.Brands of nanohybrids: FiltekZ350, Tetric EvoCeram, Renamel Microfill, Hereaus Venus.

OPTICAL PROPERTIES OF COMPOSITE VENEERS:

is essential to achieve natural results with composite veneers:

Hue, the name of color which corresponds to wave length of light reflected by the teeth .the shade guide hue is listed as A1, A2, B1, etc.chroma, its intensity of color or degree of hue saturation.The “brightness”of color is represented by value, which is the third dimension of the polychromatic effectThe color of the tooth usually comes from the thicker underlying dentinthe composite material must be opaque enough to block out any undesirable shadesThe enamel layer: is color less; therefore, enamel shades of composite resin exhibit high translucency.

Renamel Microhybrid Strong and wear-resistant composite + adapts beautifully to underlying tooth structure + ideal opacity to minimize shine through.because it has great flow and a thicker oxygen inhibited layer, Renamel Microhybrid is easy to manipulate and place in thin layers.

SHADE SELECTION : -depend on variations in optical properties of new generation composite resin

veneers .

-Color varies with translucency, thickness of enamel and dentin, age of the patient. -Different color zones: incisal edge translucent than cervical which darker (enamel

thins and dentin shows through) .

-Enamel is prismatic and translucent which results in a blue gray color on the incisal edge.

-Color deviation, such as hypo calcifications, within dentin or enamel can cause further color variation .

Automated shade selection:

WHAT MAKES AN ESTHETIC SMILE:جميلة االبتسامة تجعل كيف

Lips should be symmetrical

A pleasing smile should ideally show canion to canion or premolars to premolars

SHAPE OR FORM

Feminine smile Rounded incisal

angles + open facial embrasures

Masculine smile

closed and prominent incisal

angles75 to 80% of max incisors showing, women more of their maxillary incisors

whereas men show more mandibular teeth

Symmetrical gingiva

COMMON PROBLEMS WITH GINGIVAL ESTHETIC:

-Excessive root surface exposure -Loss of papilla between teeth

-Excessive gingival display -Uneven gingival contour

HOW TO DEAL WITH THESE PROBLEMS:

For root surface exposure / loss of papillae Crown lengthening and root grafting.For excessive gingival display Excision of excessive gingiva.For uneven gingival contours Excision of excess gingiva when needed.

PRE-OPRATIVE PROCEDURE :

- Full set of radiographs is required (extra oral & intra oral), - Complete diagnosis + evaluation of the periodontal teeth of each

individual.

TOOTH PREPARATION:

LABIAL REDUCTION:

INTER PROXIMAL REDUCTION:

INCISAL EDGE REDUCTION:

LABIAL REDUCTION

Veneer Preparation is a conservative reduction of tooth structure consisting of 0.5 – 0.7 mm Labial reduction with inter-proximal finish lines facial to contact area.

Using 0.5 mm depth diamond bur, as drawn across labial surfaceFinish ling: Long Chamfer.

Place (long chamfer) angle with an obtuse cavo-surface angle

For Exposing Enamel Prism ends to margin for etching.

The gingival margin is prepared at level equal to free gingival crest (sub gingival) Tools: diamond bur cylindrical long bevel

INTER PROXIMAL REDUCTION

The preparation must be extended into embrasure areas to ensure that margins between Veneer and Un-prepared tooth are Hidden . REASONS TO BREAK CONTACTS:

-present of pre-existing restoration. -diastema closure.

-color consideration. -for proper contour .

REASONS TO NOT BREAK CONTACTS:- -improve retention.

- -Improve aesthetics .

INCISAL EDGE REDUCTIONS

3 basic preparation for composite Veneers designs: 1 -WINDOW:

Which veneer is taken close but not up to incisal edge.2-FEATHER:

Which veneer is taken up to the height incisal edge but the edges is not Reduced.

3-BEVEL:Which a Bucco-palatal bevel is prepared across full width of preparation with some reduction of incisal length of the tooth.

BASICS POINT DURING VENEER PREPARATION:

Avoid undercuts and Visualize path of insertion.Connect between depth cuts and margins, to prevent areas of stress concentration in composite through all tooth preparation free from sharp angles.All prepared surfaces should be rounded.

PREPARING FOR DIASTEMA CLOSURE:

In preparing diastema closure, inter-proximal preparation extend from the contact toward the lingual.

The greater the space to be close, the further preparation to lingual side.

Also important to extend inter proximal preparation sub-gingival to re-contour the papilla .

ENAMEL & DENTIN ADHESION:

ETCHING

Primer

ADHESIVE

ETCHING37% conc. Of phosphoric acid used.

For enamel & dentin for 15 sec and then rinsed off.1 -ETCHING ENAMEL

Affects both prism (rods) and prism periphery & transforms smooth to irregular Enamel surface.When fluid resin is applied to etched surfaceResin penetrates etched surface forms Resin tagsBasis for adhesion of resin to enamel.

2 -ETCHING DENTINAffects intertubular and peritubular dentin.Removes smear layer and exposes collagen network to achieve optimal adhesion to dentinal surface.Primer and adhesive material penetrates collagen fiber forms Hybrid layer Basis for micro mechanical interlocking bond to inter tubular dentin .

GENERATION OF BONDING AGENT:

The dental academic world tends to support (etch and rinse system).Clinicians in practice tend to support (self-etch system), probably because reducing postoperative tooth sensitivity and predictability when treating several patients at same time.

STEPS OF COMPOSITE VENEERS PROCEDURE :

-Complete diagnosis of teeth + oral hygiene individual, Document record, radiographs .-Local anesthesia (patient relaxed + reduced salivation).

-Tooth Preparation (labial, inter proximal, incisal edge preparation).-Isolation of operating site

-Check retractor - cotton rolls + Suction.

- retraction cord & Paste.-Etching Enamel & dentin for 15 sec then rinsed off then Air dry .

-Bonding agent for etched surface by Thin film layer (shiny appearance).-Separate each teeth by Celluloid strips.

-Handling composite by Applicator instrument on prepared tooth until chamfer finish line sub gingival.

-Curing composite veneers by visible light cure 20 sec per each increment layers.-Removal retraction cord for facilitates finishing composite veneers.

-An explorer used to check marginal composite veneers adaptation sub gingival.--Shaping composite veneers by finishing diamond bur, interproximal area with

finishing disc.--Additional finishing (contouring) and polishing are completed 3days later + occlusal

adjustment-Polishing tools: polishing fine disc, polishing paste, silicon rubber polishing cup .

SUCCESS OF COMPOSITE VENEERS:

Proper case selection.Conservative enamel preparation.Proper finishing and polishing.Proper shade selection.

FAILURE OF COMPOSITE VENEERS:Marginal discoloration and loss of color stability.Improper occlusion and its periodontal implication. Improper anatomical form of the veneer or fracture.Gingival  recession.

CARE FOR VENEERS:Proper care of  tooth veneers : it important for a long life, shine and aesthetics, These include maintaining oral hygiene to avoid composite veneers wearing off and giving bad look to the teeth.Maintenance of good Oral Hygiene for Tooth Veneer CareOptimum plaque removal is necessary for increasing the longevity of the tooth veneer .Proper tooth brushing and flossing  for maintaining good oral hygiene .

 

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