By: Jason Cellars DDS

We’ll begin the dialogue by strolling via how I might prep a tooth that’s in a great place and is a perfect measurement. This may take among the nuances out of the image so we are able to speak concerning the common philosophy. As soon as we have now the overall type and magnificence, we’ll take a look at the variations that may be made to the preparation which can be essential to cope with the completely different circumstance.

To wrap or to not wrap, that’s the query. This query is the place probably the most disagreement happens between beauty dentists. Wrapping is the place the preparation extends via the interproximal contact, and it’s utilized very often and has deserves. Some revered beauty dentists nonetheless use this methodology, the primary motive being that it makes seating the veneers quite simple. Whereas there’s nothing fallacious with wrapping, and has its makes use of as we’ll talk about, I don’t use in until wanted as a result of it takes away an excessive amount of tooth construction. It is very important make clear that “an excessive amount of”, is our personal opinion and philosophy. I say this as a result of the analysis reveals that wrapping your preparations doesn’t weaken the tooth or the veneer in any means and is structurally and biologically sound. That being stated, we might slightly save as a lot tooth construction as attainable. If I have been to have veneers, though they’re completely bonded, I wouldn’t need small enamel beneath. I make some extent to point out my sufferers their prepped enamel since they’ve nervousness about this, they usually at all times sigh aid once they see that their enamel are the identical aspect and nonetheless seem like their enamel. It’s comforting to know that your pure enamel are nonetheless preserved beneath so that’s what we prioritize with our prep design.

The preparation course of commences after finalizing the smile and enamel’s form and measurement. Moderately than prepping enamel primarily based on their present measurement, it’s essential to work from the ultimate desired consequence. Porcelain usually requires 0.4mm to 0.6mm facial discount and 0mm to 1.5mm incisal discount. These reductions have to be taken from the veneers’ remaining place as a result of it’s extra conservative and infrequently implies that you don’t want to remove tooth construction in any respect. Sustaining skinny facial discount permits the tooth’s pure shade to shine via, giving the veneers vitality and a life-like look. Sufficient incisal discount is necessary for incisal translucency. If no translucency is desired then no incisal discount is required, and not more than 1.5mm of discount needs to be left as a result of it would weaken the ultimate veneers.

After facial and incisal discount, a light-weight chamfer margin needs to be place circumferentially. Gingivally, we place the margin half a millimeter into the sulcus, apart from on the papilla the place I’ll depart it on the stage of the gingiva. We choose to not place the margin extra subgingival to scale back irritation. Interproximally, we push the margin to the contact level. If the enamel have a slim contact level, pushing the margin right here will break the contact simply sufficient for mild to move via, which is right for the impression or scan in addition to for the ceramist. If the enamel have a broad contact level, we depart the margin on the most facial a part of the contact level and break the contact with a sanding strip. It is very important maintain the insertion level for the prep from the facial in order that it may well stay as conservative as attainable. If you’re lowering incisally, create a pointy 90 diploma angle on the incisal palatal junction, and clean the entire facial angles.

That’s the design for a great tooth. However usually we don’t have the best gingival contour, or there’s a rotation in a tooth, or there are areas that we’re closing. With every of those variations, we have to alter our preparations accordingly:

• Gingival Contour: If the gingival contour is off, place the margin extra subgingival the place wanted so the gums can heal across the new margin. The principle place we see this are on the maxillary incisors when the zenith is just too far mesial. If so, place the mesial margin 0.5mm – like regular – and place the distal margin proportionally to that, which is able to make it extra subgingival on the distal.
• Black Triangles: Black triangles often consequence from gingival recession and generally is a massive supply of insecurity for many individuals. When black triangles exist, prolong the margin interproximally to make a wing. Wrap the wing totally interproximally, conserving the wing cervical to the contact level of the tooth. The interproximal margins must also be positioned 1mm to 1.5 mm into the sulcus to permit for a greater emergence profile.
• Diastema: When diastemas are current and there’s a full house between two enamel the interproximal preparation is prolonged interproximally on that aspect. That is the one time that we do wrap the prep, however it’s not essential to take away tooth construction, a margin simply must be created on the interproximal and the tooth must be formed so that there’s a clear path for insertion. The margins needs to be positioned subgingival within the papilla, like with black triangles, to permit for a extra pure emergence.
• Quick or Fractured Enamel: If you’re including greater than 1.5mm of size to the tooth, we don’t add the additional with porcelain. If additional size is required for cosmetics and performance, we add the size with composite, after which cut back to 1.5mm or much less and add the porcelain from there. This may give the specified size with out compromising the power of ultimate veneer and tooth.

There are extra nuances to the method and plenty of extra eventualities that want particular changes. Nonetheless, it is a common method to veneer tooth preparation and the philosophies that we use to create stunning long-lasting veneers whereas saving as a lot tooth construction as attainable. This isn’t a complete step-by-step information to take you to beauty experience, however hopefully it has clarified among the obscurities and is on the very least a great begin.

Photograph quotation
Fava, Joseph. “Porcelain Remedy: Veneers vs Jacket Crowns, the ALARA Precept for
Prosthodontics.” Oral Well being Group, 15 Nov. 2015,
www.oralhealthgroup.com/options/1003918624/attachment/fava-fig-1d/.