Minimal Prep. Veneers

132 Rating(s).


Posted on By Hakam Mousa In Ceramics/Veneers

Patient is 21 years old with chief complaint of diastema and dark shade of existing teeth. patient had history of orthodontics and was not willing to do it again. treatment option was to do cosmetic crown lengthening to minimise gummy smile, and place veneers to achieve best results, patient denied surgery but agreed to go for some soft tissue re contouring for # 8 and premolar area , minimal preparation of 0.3mm reduction and emax veneers were cemented.

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8 Comments

Hakam,

Given the young age of the patient , I believe a course of whitening and diastema closure with direct bonded resin would have been a much more conservative treatment option. As you know, veneers don't last for ever, fractures chipping, gingival recession and de-bondig are not un-common occurrences. In her life span she may have to do this over again more than one time.


Reply

Thank you Anoosh for the comment, its always best to be conservative, in this special case, the options were given to the patient including only composite and whitening, whitening and micro veneers interproximally, or Veneers (either composite or porcelain),we choose porcelain veneers because of colour stability and no need for maintenance to keep up the whitening effect when using bleaching option. I wanted to go for no prep. veneers, but as you can see from the pictures , this patient has gummy smile and some protrusion, i did not want to give her more buccal thickness , so i tried my best to be conservative in my preparation using 0.3mm guide bur and Emax thickness.


I think with a good cooperative patient , keeping conservative preparations within enamel, and good occlusion , veneers should last for a long time.

I agree with you , the future is for composite .

I appreciate your feedback...

Hakam


Reply

The black triangle between the centrals is due to the fact that the preps did not go back far enough onto the palatal surface. Had this been done, the small space could have been closed.


Reply

Dear Gerald,

Thank you for your feedback,
Yes this is part of the reason of the black triangle, the palatal extension was fair for this case, hiding the black triangle should been solved by keeping the preparation margin more sub gingival on the mesial (inter proximal) surface to get better emergence profile.
The limitations I faced because my patient denied crown lengthening procedure:

1- By going further sub gingivally on the mesial surface with my margin, i would of had violated the biological width when getting proximity to bone level causing future gingival inflammation and possibly bone loss.

2- By doing the mock up, I noticed that closing this space, centrals would have looked squarish , and I wanted to give my patient a more smooth, rounded pleasing angles.

Thank you Gerald again for your feedback.

Hakam


Reply

Overall a great result, I wouldn't worry as much about the little black triangle. God gave her a rather large diastema and you gave her a significant improvement. Well done.


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Thank you Richard. (:


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Many different roads will take you to Rome....to me this case seemed like one that could have been managed by Crown lengthening and frenectomy followed by Invisalign, Contouring and Bleaching. A More Minimally Invasive approach....


Reply

I agree totally with you Maurice, ideally crown lengthening to minimize the gummy smile look, and orthodontics would have been the most conservative approach, but as I mentioned for this case , the patient denied surgery and orthodontics.
we went for plan B, trying to stay as conservative as possible in preparation.... , we did whitening on lower teeth a month before placing veneers in order to have shade stability before selecting the final shade for upper veneers.

thank you again for your feedback ...

Hakam


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