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Inside Dentistry

February 2013, Volume 9, Issue 2
Published by AEGIS Communications


Affordable Highly Esthetic Veneers

With milled composites, dentists can offer patients an esthetic, durable, and affordable restorative option.

By Tony Soileau, DDS

Patients often desire nothing more than a straight, white smile but, in many cases, the cost of creating that beautiful smile may be out of reach. Porcelain veneers created by a master ceramist look amazing, but the ceramist has to charge a premium—which means the dentist must also charge more to make a profit. This can drive the cost too high for many patients.

However, new milling materials are increasing options for both labs and dentists with in-office CAD/CAM systems. Techno­logical advances in these materials offer ways for the dental profession to find the right balance of esthetics, efficiency, and afaffordable.fordability. One good example is the new milled composite material, 3M™ ESPE™ Lava™ Ultimate Restorative (3M ESPE, www.3MESPE.com). With this material, which is available both through laboratories and as a block for in-office systems, dentists can achieve a lifelike result that is both efficient and 

This milling material is a “resin nano ceramic.” It does not need an additional firing step, and it also mills faster than other materials, making it more efficient for dentists with in-office CAD/CAM systems. Restorations made with this material can be polished in just a few minutes, and can also be adjusted and repaired intraorally with composite restorative.

With fast milling, familiar composite handling, and a good range of shades to choose from, this milling material gives dentists a helpful tool for maximizing efficiency with CAD/CAM systems, and for offering affordable restorations to patients. This case demonstrates the use of this block material for a case in which esthetics were paramount.

Case Report

A 21-year-old patient came to the office seeking a brighter and fuller smile (Figure 1). The patient was a successful contestant in beauty pageants, so esthetics were even more of a concern than for a typical patient. The patient also had a very tight budget. After discussing several options, a treatment plan was developed to restore the patient’s smile with six composite veneers. Using Lava Ultimate restorative would give this patient the results she wanted and still keep the cost within her budget.

Shade BL1 was selected (Figure 2). Im­pressions were taken and a wax-up was developed by the doctor and approved by the patient. At the preparation appointment, topical anesthetic was delivered for placement of the retraction cord. The cord (Ultrapak® 000, Ultradent Products, Inc., www.ultradent.com) was placed using a hemolytic agent (ViscoStat® Clear, Ultradent) as a lubricant. The cord was placed at the beginning of the appointment in order to allow for better retraction at the time of impression-taking, as well as easier preparing.

The teeth were then minimally prepared with coarse and fine diamonds (856LC and 856LF diamond burs, Axis Dental, www.axisdental.com) and the existing composite was removed (Figure 3). With very smooth preparations, it is easier to create very thin veneers. Diamond strips (Perforated Diamond Finishing Strips Medium Grit, Axis Dental) were used to slightly break the contact between the teeth in order to facilitate increased accuracy of the impression. The diamond strips were placed through the contact only once so as not to create an open contact. The minimal preparations were then rinsed and inspected. Only 0.3 mm to 0.5 mm of tooth structure was removed along with the old composite.

Impressions were then taken using 3M™ ESPE™ Imprint™ 3 VPS Impression Material, and temporaries were placed (Luxatemp® Fluorescence, Zenith Dental, www.dmg-america.com) using a matrix made from the wax-up. The flash was then cleaned up using 12-fluted carbide burs (TDF-9UF finishing carbide, Axis Dental) and polished with diamond paste (Zircon-Brite, Dental Ventures of America, Inc., www.dentalventures.com).

The impression was then scanned using a CAD/CAM system (E4D Dentist System, D4D Technologies, www.e4dsky.com), and the Lava Ultimate veneers were designed and milled from BL1 blocks (Figure 4 and Figure 5).

The veneers were then removed from the block with a diamond disk (D805EF-160 Diamond Disk, Axis Dental), and the sprue was removed with heatless stone wheels (GF703-HP100 stone wheel, Axis Dental). The veneers were then tried on a stone model for accuracy of fit and contacts. Each veneer was then individually shaped, anatomy developed (M842R-018HP lab diamond, Axis Dental), and smoothed (P344 CeraGlaze® pre polisher, Axis Dental) (Figure 6).

The veneers were polished to a glaze shine using a diamond paste (Zircon-Brite) and Robinson wheels.

At the seating appointment, retraction was again placed and removed after 3 minutes. The veneers were tried in and approved by the patient. The teeth were etched for 15 seconds (Ultra-Etch®, Ultradent), rinsed, primed (Optibond™ Solo Plus, Kerr Corporation, www.kerrdental.com) and cured for 10 seconds each (Figure 7 and Figure 8).

A layer of bonding agent (Optibond) was applied to the internal surface of each veneer and cured for 3 seconds. Resin cement (NX 3, Kerr) was then loaded into the veneers, which were seated on the teeth, beginning with the centrals and working outward until all veneers were seated (Figure 9). The excess cement on the facial and lingual surfaces was then removed with cotton rolls, and the veneers were inspected for proper seating. The cement was spot-cured for 3 seconds on each tooth. The excess cement was then removed from between the teeth with floss and a 12b scalpel. The veneers were then cured for 20 seconds each to fully cure the cement. Finishing burs (TDF-9UF finishing carbide, Axis Dental) were used to remove the remaining cement, refine the margins, and adjust the occlusion.

Figure 10 shows the addition of two additional veneers on the first premolars. The patient was so pleased with the result of the original six veneers that she returned the following week for two more veneers to complete her smile.

Conclusion

Today, milled composites make providing patients with beautiful and affordable smiles more achievable than ever. Milled composites give the patient an affordable option with beautiful, long-lasting results. This material also provides the dentist with a profitable option that takes little chairtime compared to free-handing composite veneers. With a highly esthetic, durable and repairable material, dentists can offer patients a cost-effective restorative option that will serve them well in the long term.

About the Author

Tony Soileau, DDS
Private Practice
Lafayette, Louisiana


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Image Gallery

Figure 1 Preoperative photograph. The patient wanted a brighter, fuller smile.

Figure 1

Figure 2 Preoperative photograph with the desired shade tab.

Figure 2

Figure 3 Initial preparation with a coarse
diamond.

Figure 3

Figure 4 Lava Ultimate restorative veneers designed on E4D software.

Figure 4

Figure 5 Lava Ultimate restorative veneers milled out.

Figure 5

Figure 6 Shaping and anatomy refinement of veneer.

Figure 6

Figure 7 Etchant was applied in a spot and spread over the preparation.

Figure 7

Figure 8 Primer was applied.

Figure 8

Figure 9 Placement of all veneers prior to curing.

Figure 9

Figure 10 The final product: a full, bright smile.

Figure 10