Clinical Procedure - Visit 3

Veneer Cementation

1. Try-In/Shade Selection

   1. Remove provisionals

   2. Use flour of pumice to clean all prepared tooth surfaces and wash thoroughly being careful to not induce gingival bleeding.

   3. Isolate and dry the teeth.

   4. Moisten the veneers with water and place them carefully on the prepared teeth to check fit and shade.

   5. Try-in paste can be used behind facings to check shades.

   6. If color adjustment is needed, select appropriate shade of try-in paste, apply to veneer, seat, and examine for color and fit.

   7. Clean the veneers by rinsing with water.

   8. You should verify with your laboratory technician but the veneers generally come already etched with hydrofluoric acid. Therefore a 30-second application of 37% phosphoric acid is used only for cleaning, not for etching.

   9. Rinse with water and dry.

2. Cementation

   1. Apply silane to the etched porcelain surface for 60 seconds and air-dry. This step should be repeated twice to optimize bonding.

   2. Pumice and wash the tooth preparation dry and isolate the teeth.

   3. When cementing multiple veneers, you must always start closest to the midline and work distally.

   4. Veneers are luted two at a time starting with the central incisors and continuing distally.

   5. Isolate the preparation interproximally with thin Mylar strips or Tefalon tape.

   6. Etch the preparation in the usual manner indicated by the manufacturer of the bonding agent being used and dry the area.

   7. Apply enamel/dentin-bonding system according to the manufacturer’s instructions. Sixth or 7th generations (self etching) bonding agents are not recommended for veneers only prepared into enamel. Light cure the tooth (adhesive) prior to seating the veneer.

   8. Apply unfilled resin, after primer if indicated, to the tooth surface and inside of the laminate veneer. Do not cure this layer at this time.

   9. Apply composite-resin luting cement to the veneer and gently place the veneer onto the tooth in an inciso-gingival direction. Remove excess material gently with a resin-coated brush. Make sure that cement is visible at all the margins to avoid any voids.

   10. Hold the veneer and check the gingival margin for proper seating. Then, for each of the four regions (gingival, mesial, lingual-incisal and distal) remove any additional excess. Light-cure the gingival margins first for 10 seconds, mesial, incisal and distal. After curing these four areas, cure for 60 seconds through the facial surface. Light-cure each area and margin of the veneer for 30 seconds (longer for thicker, more opaque veneers or darker shades). (Check manufacturers’ recommendations for curing time.) (Figures 7, 8 and 9)

       Figure 7.

       

       Figure 7.

       Post-veneer cementation

       Figure 8.

       

       Figure 8.

       Tooth #7 Post-veneer cementation

       Figure 9.

       

       Figure 9.

       Tooth #10 Post-veneer cementation

3. Finishing

   1. Remove gross excess using sharp hand instruments — CL carver or perio scaler. (# 12 scalpel blade)

   2. Using fine and extra fine diamond finishing burs, remove excess resin gingivally and inciso-lingually.

   3. Finish the proximals using fine strips.

   4. Proceed to the next placement.

   5. Use porcelain polishing paste to regain a smooth porcelain surface whenever necessary.

   6. Check occlusion in all excursions and adjust as needed.

4. Night Guard

   1. It is recommended post cementation to provide the patient with a soft or a soft and hard (dual) night guard. This is done to protect the veneers.