Clinical Continued »
little during this design process with a non-preparation veneer case. The diagnostic process becomes
even more important with these minimal preparation cases if you want to obtain predictable results. With the prepless veneer cases, I require more input from my ceramist to see if I can deliver a result that I can be proud of and that my patient is happy with. Many clinicians look at the prepless veneer as a ‘lesser’ veneer or cheaper veneer because it is not prepped. They use inferior labs or are not as concerned researching the best materials because of this. I think this is a huge mistake. Some that I have spoken to even
take alginate impressions as the master impression and pour the models up themselves and send them to the lab! When the case is returned with ill-fitting margins or compromised aesthetics, they use the prepless technique as an excuse for sub par restorations. With these prepless or minimal
prep cases, we need to have an intimate relationship with our ceramist and we have to design the case, just as we would if it was a traditional veneer case. The lab needs to give us input as to whether
Indications: 1) Colour change with uniform arch shade
2) Incisal edge wear 3) Collapsed buccal corridor 4) Small spaces or diastemas ‘Microdontia’
5) Limited tetracycline and flourosis cases
6) Direct ‘resin bonding’ or veneer replacement.
Contraindications: 1) Rotation or crowding 2) Buccal displaced teeth 3) Severely lingualized teeth 4) ‘Bell-shaped’ teeth 5) Severely discoloured teeth in relatively ideal arch position.
they can deliver acceptable results. I’ve had patients say: “I do not want my teeth prepped” and my response was: “I don’t know how aesthetic this is going to look; I think it’s going to look bulky or fake or it’s not going to be something that looks like the pictures in my reception room”. I’ve taken impressions and sent them off to the ceramist despite the fact that I didn’t think it was going to look good just to get their input. The ceramist, after reviewing the case, calls me back and says: “I can’t do this. It’s going to be bulky and ugly and because this one tooth is flared, the entire case is going to be too far facial”. This is the type of relationship and input that is so important with these cases. Although prepless veneers are not
indicated for every case or even in the majority of the cases, it certainly should be a part of every clini- cian’s restorative armamentarium. It is a great option on young adults or teenagers with micro- dontia, post orthodontics. Working with the orthodon- tist to align teeth correctly can yield excellent results. Many of these veneers are only 0.2 mm
thick, so they can look natural and not overly bulky. Currently, I am using a leucite
reinforced pressed ceramic for my prepless veneers (Emprethins), because I like the physical properties of this ceramic. The bottom line is to be educated and truly understand the indications and contraindications of this technique before attempting a case or dismissing it as not being possible.
®
David Hornbrook is speaking at The Dentistry Show at the NEC, Birmingham on 4 and 5 March 2011. To register for your free place, visit
www.thedentistryshow.co.uk/ register-IDM4
Fig 4 Patient 2 after
Fig 5 Patient 3 before
Fig 6 Patient 3 after
28 Ireland’s Dental magazine
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