Biomimetic Ceramic Veneers

Abstract
Initially developed to make full crowns, the full ceramic has revolutionized cosmetic
dentistry.Clinicians and technicians have quickly understood that this material can also give
an optimum contribution also for minimal invasive therapy. Many of our colleagues have
developed techniques to make veneers obtaining results which were unthinkable only little
time ago. In this article, the author is showing his technique to make veneers obtaining
excellent results and preserving as much as possible the tooth structure.

Keywords: Minimally invasive, Esthetics, Ceramic veneers, Refractory material.

A 25 year old healthy male came to the dentist's office with aesthetic concerns and wanted
to have a more confident smile. The case was referred to the lab for preoperative
evaluation (Figure 1) .
The patient presented with diastemas in the upper arch and also had some concerns about
a few fine white bands on his teeth (Figure 2) .

Diagnosis
Taking into consideration the patient's expectations and also clinical examination the
following diagnosis was made:
1. Diastemas present between 11, 12, 21 and 22.
2. Few hypo-plastic patches present in the incisal and body area of the incisors.
Treatment Options
1. Bonding with composite resin to close gaps on central and lateral incisors.
2. Ceramic Veneers with layering technique on central and lateral incisors.
3. All ceramic crowns on lateral and central incisors (over-treatment).
Bonding has become very predictable and with many shades available, it is possible to layer
and make restorations life like. It is also the most conservative of the options
present. Traditionally composites are known to discolor while ceramic restorations don't and

also do not present with the same optical qualities as feldspathic ceramics. 1 The patient
also had concerns about white patches on his teeth that was difficult to address with just
bonding composite resin in the area of the diastemas.
Preparing crowns was an option but considering the result desired and the age of the
patient it was a rather invasive option.
Ceramic veneers present the most aesthetic option to treat the condition that the patient
presented with. They are minimally invasive when compared to crowns, have better optical
qualities compared to bonded resin and also have a better biological response of the tissues
than around composite resins.
Treatment Plan
All relevant photographs were taken.
After receiving study models a wax up was done for 11, 12, 21, 22 (Figures 3,4) .
Patient was called to the lab to review the wax up and to get his approval.
Shade selection was done in the laboratory at this stage.
Preparation guides were made to assist the clinician in ideal tooth reduction for the
case (Figure 5) .

Clinical Steps
Local anesthetic was administered to the patient and preparations were done with the help
of preparation guide made in the laboratory 2 (Figures 6-9) .
Addition silicone impression was made after adequate and necessary gingival tissue
management. 3
Template provided, based on the wax up was used to fabricate temporary veneers. They
were spot etched and bonded on the incisors.

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11

12

13

Laboratory Steps
1- Impression was poured with Type IV gypsum ( Fuji Rock GC ) using a vacuum
mixer (Figure 10) .
2- Individual dies were made from this model giving a conical shape to simulate root with
two lateral slots.
They will be used for the final fitting of the veneers. The margins were coated with a
hardener (Margidur, Benzer)(Figure 11) .
3- They were then duplicated using high-quality laboratory silicone and poured two
times (Figure 12) .
First pouring with a refractory die material (GC CeraVest) and the second with Type IV
gypsum ( Fuji Rock GC ) to use for the preliminary fitting of the veneers.
4- The two major advantages of this cast are:
a. Stone dies and refractory dies can be inserted and interchanged, due to the identical
design of their root portions, which have the same anti-rotation grooves.
We can shape the veneer respecting the soft tissue and give the right space for papilla.
5- The refractory dies were treated with dehydration (Figure 14) and then margins have
been marked with a special pencil that is resistant to firing. A fine-grain porcelain paste
(Connector paste) was applied 1mm apical to the margins and fired (970 C for 1 minute).
b.

This step is repeated until we obtain a smooth surface.

6- The ceramic build-up ( Creation, Klema ) started with the application of dentin
powders (Figure 15) using the base shade dentin and several shades with higher chroma in
the cervical area and higher value in the incisal area(Figures 16,17) .

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18

19

20

21

22

23

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27

29

26

28

 Before

After

This basic form has been reduced, especially in the incisal and proximoincisal level to give
space for other powders.
7- Pure enamel is placed at the mesial and distal aspects of the incisal edge. Their exact
position and length are guided by the palatal silicon index.
A palatal incisal wall is made from the placement of other vertical enamel increments.
The lifelike appearance of this wall is achieved by alternating enamel powders with various
translucencies and chroma.
8- On this incisal wall (through infiltration) I placed some dentin powders modified with
intensive stains. Other internal effects within the incisal edge have been infiltrated with
fluorescent and non-fluorescent stains (Figure 18).
Photos of the patient teeth served as a guide to define accurately these distinct internal
characteristics and effects.
9- The facial surface has been completed with a combination of other translucent and
opalescent Different combinations of shaded enamels were applied alternately in tiny
vertical increments (Figures 19,20) . Then it was placed in the furnace for the first firing.
After Firing
1. It was necessary to make a correction firing covering with translucent and opaque
enamel applied alternately in vertical increments and placed in the furnace for the second
firing.
2. After contouring, diamond-silicon wheels were used for mechanical polishing.
3. Glazing was carried out.
4. Highly reflective surfaces were finally achieved with pumice and calcium carbonate using

brushes and felt tips at different rotating speeds.

5. The refractory die has been removed by sandblasting with 50-?m glass beads.
The veneers were adapted accurately using a stereomicroscope at 10x magnification (Figures
21-23) .
The Laboratory work was then sent to the Dentist for cementation (Figures 24-26) .
The veneers were cemented following a standard protocol of Bonding and were polished
thereafter.
The patient made a follow up appointment at the laboratory where the final pictures were
made (Figures. 27-29) .
Conclusion
Ceramic veneers which are fabricated using a layering technique with all protocols being
followed during the course of treatment offer patients a very natural and esthetic result.

Acknowledgement
We thank Dr. Souheil Husseini for his collaboration.
References
1. Meijering AC, Roeters FJ, Mulder J, Creugers NH. Patients' satisfaction with different
types of veneer restorations. J Dent. 1997;25:493-7.
2. Gurel G. The Science and Art of Porcelain Laminate Veneers. Quintessence. 2003;7:246.
3. Azzi R, Tsao TF, Carranza FA Jr, Kenney EB. Comparative study of gingival retraction
methods. J Prosthet Dent.1983;50:561-5.
4. Horn HR. Porcelain laminate veneers bonded to etched enamel. Dent Clin North
Am. 1983;27:671-84.