hi I'm dr. Michael de Tola and I'd like to welcome you to this clinical presentation today I want to
share with you a patient we treated recently his name is Chris he's gonna be a no prep veneer case
using v veneers you can see the spaces that he's got between his teeth he's a great additive type
case so this is gonna be a good chance for us to really make a overnight improvement
not even overnight I mean by the time we try in the veneers he's gonna get a chance to see what
he looks like without any spaces in there and we already tried the veneers in and Chris was
happy with how they look so we're gonna go ahead and begin the bonding procedure at this part and
you'll get a chance to see them once they are in place we're using some pumice here I like to use
preppies from Witte mix and a slow speed handpiece with a pro feet cup and we're doing this to clean
the tooth and remove le pellicle that might be on the tooth and just make sure that we have a
nice bonding surface here as we get ready to edge the enamel we don't feel the need necessarily to
use rubberdam in a situation like this as long as we're able to have good moisture control because
there is no exposed dentin which is one of the big advantages of no prep or even minimal prep
veneers you'll notice we have retractors in place these are the Seymour retractors from
discus dental and these are good no Henry tractors that do a good job of retracting both cheeks and
the upper and lower lip as well so we're gonna go ahead and rinse off the pumice at this point
and as we do that we'll make sure that we don't have any extra clumps sitting anywhere and then
we'll go ahead and dry off the teeth and I wear 4x loops high-rez loops from Oris Coptic and I'm
really still able to see any pumice that might be in or around the tooth especially around the
gingival sulcus it seems like we get some so a cotton roll does a good job of removing that we're
gonna go ahead and begin the etching procedure with a 37% phosphoric acid one of the other nice
things about no prep veneers is when you prep veneers and you have had temporaries on for a
couple of weeks the gingiva can it irritated and the acid etch can actually make the gingiva bleed
typically for no prep veneers we have very healthy gingiva because Ben no prepping and no temporaries
that have been in place and as a result we have the opportunity to go ahead and place the etch
next to some healthy gingiva so we don't have to worry about bleeding since these no prep veneers
will wrap on to the lingual surface because we are increasing the incisal edge length of all
the teeth we're gonna go ahead and use the mirror just to verify that we have in fact got the etch
onto the lingual third of the teeth it's pretty easy sometimes to to overlook that etch but we do
want to make sure we get a good bond everywhere and we should be as we're bonding to enamel the
best bond in dentistry we're gonna go ahead and rinse off the 37% phosphoric acid as you may have
noticed we have only itched the central incisor so far and as we air dry this you'll notice that
we see that frosty appearance that we're used to from the old days of bonding when we were
primarily etching enamel what we're placing here is not your typical debt and bonding agent this
is just the adhesive from the scotch bonnet is Plus kit and because we don't have any exposed
dentin we can just use the adhesive there is no need for primer so we're gonna go ahead and coat
the entire ashed enamel surface with the adhesive from the Scotch pine mulch I purpose plus system
as well as making sure we get the lingual third as well because the veneer is going to wrap over
the incisal edge as we're doing this my assistant has cleaned the veneers removed the water-soluble
try and paste from the veneers and has placed the silane for 60 seconds evaporated and then place a
layer the Scotch bond inside the veneers and air thin those as well I'm air thinning the adhesive
on the teeth right now to make sure that we don't have any pooling anywhere down by the gingival
margin or anywhere else on the tooth this really isn't as big of a problem as it is with prep
veneers because there's nowhere in the preparation for it to pool and keep the veneer from seating
once we've everything that pretty thin we're gonna go ahead and cure that depending on the thickness
of your veneers you could wait and cure it once the veneer and the cement are in place and that's
perfectly acceptable as well but having tried on these veneers already I know I'm gonna be able to
put that adhesive on cure it and go forward now we've gone ahead and placed the cement into the
veneer itself and this is insure from Cosmo dent it's a thicker near cement and I like it because
it makes cleanup a lot easier it's really nice to be able to clean it up with just something like an
explorer or just something like that the runny ER of veneer cement is the more likely it is to
get in between the teeth into the embrasures and make it very difficult to be able to remove it I'm
using an orange wood stick here typically on the incisal edge and the facial surface to make sure
that the veneer is seated all the way and again using an orange wood stick is kind of a level
to make sure the incisal edges are level as well typically with a good fit on your veneers that's
not a problem and they should fit the teeth just as well as they fit the model so as I put some
pressure on these teeth just to make sure they're down all the way my assistants gonna do a little
tack and wave which is a cure right over just as you see two passes they're at a couple seconds
each and then I go ahead and judge the viscosity of the cement and if it's still not set all the
way she'll come back in for another one and a half to second cure and you can see that as I
start to work the Explorer under this material it has gotten to its gel state which makes it very
easy to clean up at this point the thinner veneer cements tend to run everywhere and it's a little
more difficult to do it and I can see over here on the distal that it's not quite cured yet so she's
gonna give me another second and a half and two seconds and we're gonna see and that appears to
have set it up so we'll go ahead and be able to remove this in one big piece this is nice
because this is the way we're used to cleaning up crown and bridge cases when we use conventional
crown and bridge cement in this case we're doing veneers and veneer clean up is typically one of
the harder things we do in General Dentistry and this tack and wave technique of removing
this entire piece of cement at one time as we've done here really makes things a lot easier once
we remove this large piece we can then take the Explorer and go around the margins check in the
gingival embrasures as we're doing here and remove any other excess that's there but certainly the
ability to remove that large piece right at the beginning saves us a ton of time with cleanup as
we go through this we're gonna cure the lingual for again one and a half to two seconds and I'll
remove any excess that we have back there as well and once we begin to remove this excess
we've done most of the cleaning and really all that's left is for us to go ahead and clean in
approximately with some dental floss we're gonna make our first attempt to go through between the
central incisors with dental floss and we were successful that's the reason why we do the tacking
wave while we try to keep the light away from these interproximal surfaces we'd rather just cure
right at the gingival and set the cement there and not necessarily cure it in or approximately
where it's gonna be difficult to remove later and that's one of the things I like about ensure is
the fact that we are able to cure in one spot and not necessarily cure adjacent cement and as
you saw we were able to work the floss in between the two teeth it wasn't too tough on the distal x'
because we did have some pre-existing diastema once we've cleaned up the interproximal cement
and the facial and the lingual cement we're going to go ahead and do a full cure on these two teeth
again the reason we do the two central incisors first is because they're very critical to the
outcome of the case and when you're trying to see a bunch of veneers together if you do have
contact issues that makes it difficult to deal with because everything's kind of a moving target
so when I do these types of cases will put the the central incisors on first and then we'll go ahead
and place the rest of the veneers and if we have contact problems and we'll just kind of make it
up as we work our way back so at this point we're going to go ahead and match the lateral incisor
the cuspid and the first bicuspid and we're just slowly moving our way posterior we're gonna get
the second bicuspid here and then because these veneers do wrap onto the occlusal we will get
some H on the occlusal surfaces as well then we will go ahead and after waiting 15 seconds
for the edge to take place we will go ahead and rinse off all the acid etch from these teeth and
dry them and then follow the same bonding steps that we fought that we proceeded with before on
the central incisors once again we're applying the adhesive from the scotch bonnet I purposed
plus system to the etched enamel surface as you dry that @sh enamel surface you will notice the
frosty appearance that we're used to seeing and we're gonna air thin the adhesive as well
here we're using a vive stick from IVA clarviva dent to place some of the smaller veneers and
it sticks extremely well with small restorations like veneers or inlays and things like that fact
you have to hold the restoration down just to get to stick off and now that we're seeing this all
the way we take our orange wood stick and we're putting some pressure on the facial and we're
gonna place the cuspid as well with the vive stick and then I use my finger to stabilize the veneer
as we pull the vive stick off again with the vive stick you'll never worry losing a veneer because
it's got such a nice fit we're gonna go ahead and do the tack and wave again for one and a half two
seconds and after three applications of that you can see the ensure is starting to set up
and peels away very cleanly from the facial margin if we can't get the floss through which we weren't
able to do between the central and the lateral we are using a serrated strip from axis dental this
is a safe sided strip that doesn't remove on the mesial and distal but has serait shion's on it so
that you can cut through any bonded resin whether it's bonding agent or resin cement that keeps the
floss from going down of course you do have to be careful when you're using this working it back and
forth so that you don't cut the gingiva we're now placing the bicuspids into place and again
with these smaller veneers it certainly is nice to be able to use the vive sticks and then I'm just
gonna hold on to the restoration with an explorer while I pull the vive stick off the restoration
now what I'm doing here is I've got a finishing bur a fine diamond finishing bird that I'm using
to go around the margins I'm not standing on the rheostat at all so the burr is not spinning what
I find is these finishing birds work very well almost like a scalpel except it's not sharp to
go around the gingival margin and remove any small overhangs of cement that are left they really do a
great job because they're thicker than an explorer and they have an easier time they don't Bend like
an explorer and so as you use them you're able to pop that extra cement off if you do find you have
a bulky margin as long as you're in there with the bird you can go ahead and smooth that down at the
same time here we're using a 7408 carbide burr to go ahead and make any any adjustments on the back
typically what we're doing here is we're moving any excess cement at the veneer tooth juncture
and we're going in and using this to remove that and anywhere where the ceramic might be a little
thick a little over contoured or just a little bit rough we're using the 7408 to smooth that off so
that the patient's tongue won't be able to feel the transition between the veneer and the tooth
when we finish smoothing everything off on the lingual the next step is to use our articulating
paper to go in and see if we have any premature ''tis and if we do have any premature ''tis or
actually what happens more commonly as we have some excess cement that's left over when you use
a translucent resin cement oftentimes you'll have X resin cement that you didn't see on a tooth and
that ends up being your high spots so we use the 7408 to not only remove any excess cement but to
take care of any excursive areas that we want to remove from the ceramic material or in fact if we
do have an area where we do have a high spot the 7408 at relatively slow speeds does a good job of
removing ceramic material without causing a lot of the roughness that you can have with something
like a diamond if I'm going to use a diamond for this purpose I will use a very fine diamond like
a 30 micron diamond football burr now we've got our cable slow speed electric handpiece out and
with all that torque we can really get some nice polish on the veneers as we finish up here this is
the last stage of the Brassard iolite we've gone through the two previous wheels and now this is
the gray high shine wheel and we're going in at about 20,000 rpms with a ton of torque with the
opportunity to go in and really polish these up and really make them look nice you really don't
see the big difference till the very end when you actually use that gray wheel and go along there
after we finished polishing with the brass lured iolite series of wheels we're gonna go in with
product called rapid glaze and we're gonna place this on the facial surfaces of the teeth and we're
using a Nakhla brush here this is from Kerr Xavier and what this is is a aluminum oxide impregnated
brush that goes into slow speed and we're gonna use this at relatively low speed 5 to 7,000 rpms
in the beginning or reading use heavy pressure and then lighter pressure to really put a nice high
shine on the facial aspect of our ceramic veneers when we're done polishing we're gonna go ahead and
rinse off the rest of the polish from the veneers and take a look and see how they look and see if
we've got anything that needs to be touched up you can see on the before picture the big spaces
that were present before and this is one of the great times to use a no prep case when you've
got somebody who needs a little additional tooth length has some large diastema in between their
teeth because you can accomplish both those goals at the same time you notice we still have a small
black triangle at the gingival margin between 8 and 9 and that gingival embrasure and sometimes
with an Oprah case that's impossible to close a large diastema completely in fact that's a really
good job that the technician did on this case if you do want to close that completely or if that's
one of the patients requirement I would suggest you to eat prep the veneer as you prep 8/9 and
drop the margins slightly sub gingival use a soft tissue model and your technicians should be able
to close it completely this case illustrates one of the really good uses for no prep veneers the
patient came in with multiple diastema between his teeth and he could use a little extra tooth
length as well and since there wasn't a big requirement to remove any to structure this
case really didn't lend itself towards a no prep approach another one of the things that makes us a
great no prep case is the fact that we don't have many facial limiting factors and what we mean by
facial limiting factors is teeth that are sticking out towards the facial we know that when we do a
technique like this with the thin press veneers they can be pressed as thin as 0.3 millimeters but
if a tooth is already too far out to the facial adding another point three millimeters to it is
not gonna solve any problems in Chris's case none of his teeth were inclined out to the facial and
that was another good indication for using no prep veneers on behalf of all of us here at Glidewell
Laboratories thank you for your time and thank you for your commitment to quality dentistry
you