Kumar et al.

Veneer in Restorative Dentistry

REVIEW ARTICLE

Veneer in Restorative Dentistry

Neeraj Kumar1, Sanjeev Srivastava2, Dipak SP Majumdar3 and Kapil Loomba4

fractured malformed or discolored teeth has been a perplexing

ABSTRACT problem for dentist, in past few years a conservative approach
to improve the esthetic appearance has led widespread use
Aim: To discuss the development of veneering system of the veneering system. Typically, veneers are made of chair
from initial porcelain to composite resin and ultimately to side composite, processed composite, porcelain, or cast
cad -cam system. ceramic materials.
Summary: The demand for the tooth color restorations
and a more attractive smile has now passed the boundaries Perfect smile improves the self-confidence, personality, social
of exclusive practitioners, specialist and the esthetic life and have psychological effect on improving self-image
centers to all over the world. As esthetically pleasing with enhanced self-esteem of the patient. Improvement of
restorations of young fractured malformed or discolored smile makes us gratifying and opens door in the new
teeth has been a perplexing problem for dentist, in past dimension of dental treatment using veneers. As we are in the
few years a conservative approach to improve the esthetic new era of resin bonded porcelain (ceramic and esthetic
appearance has led to widespread use of the veneering dentistry), this review article enlights and emphasize upon
system. Typically, veneers are made of chair side composite, newer information regarding materials, methods and
processed composite, porcelain, or cast ceramic materials. techniques regarding veneers.
Thi s review art icle discusses t he i ndicatio ns,
HISTORY
contraindications and development of veneering system
over the years. Porcelain veneers were introduced by Dr Charles Pincus in
Keywords: Porcelain veneers, laminate, CAD/CAM. Hollywood in 1930s, to enhance an actor’s appearance for
close-ups in movie industry. Dr Pincus attached these thin
INTRODUCTION veneers temporarily with a denture adhesive powder.1

The demand for the tooth color restorations and a more In 1955, Buonocore’s research into the acid-etch technique
attractive smile has now passed the boundaries of exclusive provided a simple method of increasing the adhesion to enamel
practitioners, specialist and the esthetic centers to all over surface for acrylic filling materials2. His discovery was quickly
the world. As esthetically pleasing restorations of young followed by Bowen’s work with filled resin. Only in 1970s,
however, with introduction of visible-light cured composites,
did the dentist have the necessary working time to properly
Dr Neeraj Kumar has done his graduation (BDS) shape direct composite laminate veneers. In the 1970s, Faunce
from College of Dental Sciences, Manipal in 2002 described a one-piece acrylic resin prefabricated veneer as
and postgraduation (MDS) from A B Shetty MIDS an improved alternative to direct composite resin bonding.3,4
Mangalore in 2008. He is currently working as senior These veneers were primed with ethyl acetate or methylene
lecturer in Azamagarh Dental College. chloride liquid and luted to the etched tooth with a composite
resin.

Department of Conservative Dentistry & Endodontics, 1Azamagarh The concept of laminate veneers although existing long back,
Dental College, Azamagarh, 2Sardar Patel PG Dental & Medical Health got surface in 1975 by Rochette who introduced the use of
Sciences, 4 Saraswati Dental College & Hospital, Lucknow (UP),
3
Department of Dentistry, Govt. Medical College & Hospital, Agartala,
silane coupling agent with porcelain laminate veneers of
India. repairing fractured incisors.5 Then the popularity of porcelain
Address for Correspondence: laminate skyrocketed in 1980s partly because o f its
Dr Neeraj Kumar, Department of Conservative Dentistry conservative nature and the dental researches in the etched
& Endodontics,1Azamagarh Dental College, Azamagarh,
Contact: +91 9450540189, E-mail: njmahe98@gmail.com.
technique and new bonding methods.
Date of Submission : 09-03-2012
Reviews Completed : 26-04-2012 In the 1983- Porcelain as a material for veneering was first
Date of Acceptance : 28-04-2012 reported by Horn, using commercially available porcelain.6

Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1 17
Veneer in Restorative Dentistry Kumar et al.

In the 1983, Horn advocated the use of a light-curing resin 4. Marginal integrity and discoloration were worse when
luting agent for efficacy and convenience. the restoration margin was within dentin.

In the 1983, Simonsen and Calamia demonstrated that etching 5. The weak link in bonding PLVs was the dentin resin
of the internal surface of the porcelain veneer allowed the cement bond.
veneer to be retained on etched tooth enamel better than
composite resins or acrylic resin.7,8 6. The wearing time had a significant influence on the
porcelain surface, marginal integrity, and marginal
In the 1984, study done by Calamia revealed the enhancement discoloration.
of the etched porcelain/luting resin bond by chemical means
through pretreatment with silane.9 7. Papillary bleeding on probing and recession increased
when the preparatio n margins were l ocat ed
1986- Nicholls J.I. showed that tensile forces are primarily equigingivally or subgingivally. 16
responsible for dislodgement of esthetic veneers that are
cemented with microfilled resins.10 Overall the esthetic results over an extended period remain
excellent, as did patient’s acceptance.
1987- Heymann HO demonstrated a clinical technique of
indirect composite resin veneers11 2000- Peumans m et al stated that an optimal bond was
obtained if the preparation was located completely in enamel,
1988 - Reid J.S. did a study on tooth color modification and if correct surface treatment procedures were carried out and if
po rcel ain veneers and found a method whereby t he a suitable composite luting agent was selected. They also
appearance of a discolored tooth could be improved not only concluded that the major shortcoming of porcelain veneers
by masking the discoloration but also by producing a more was the relatively wide marginal discrepancy. 17
natural result.12
2001- Hager Bertil, Agneta Oden, Bernt Anderson et al
1989- Graber A. David compared direct composite veneer DESCRIBED the use of Procera All ceram laminates for patients
versus etched porcelain laminate veneers. He concluded that with discolored teeth.18
the etched porcelain restoration, in future would replace direct
bonding composite restoration in most clinical situation. 2004- Magne pascal demonstrated novel porcelain laminates
preparation approach driven by a diagnostic mock-up. 19
1991 - Herbert Victor Exner investigated the predictability of
colour (hue value and chroma) on cervical surfaces, body 2005-George P. Cherukara, Graham R. Davis, Kevin G.Seymour,
surfaces and incisal surfaces of ceramic veneers and the extent Lifong Zou, DayanandaY.D.Samarawickrama did a study to
to which laminates may be shade adapted by use of tints and assess the effectiveness of 3 clinical techniques, namely,
opaquers on the fitting surfaces.13 dimple, depth groove, and freehand, in producing an
intraenamel preparation. Within the limitations of this pilot
1991 - Rada E. Robert and Betty Jean Jankowski described study, the 3 different techniques tested did not differ
porcelain laminate veneer provisionalization using visible light significantly in conserving enamel.20
cure acrylic resin.14
2006- Zarone, Ettore Epifania, Giuliana Leone, Roberto
1997- Rouse S. Jeffrey discussed the interproximal extension Sorrentino, Marco Ferrari, demonstrated that chamfer
of full veneer and traditional veneer preparations.15 preparation is recommended for central incisors, whereas the
window preparation showed better results for canines.21
20 00-Dumfahrt Herbert and Herbert Schaffer did a
retrospective evaluation after one to ten years of service of 2006-Barghi et al did a study on effects of porcelain leucite
porcelain laminate veneers (PLVs). This study covered a content, types of etchants, and etching time on porcelain-
period from 14 months to 127 months and evaluated 191 PLV composite bond strength and they concluded that
restorations with a mean wearing time of 55.6 months. They
concluded that: 1. Gel hydrofluoric acid etchant provided higher porcelain-
composite bond strength than did the liquid etchant.
1. The survival probability of PLVs was 97% at 5 years
and 91% at 10 ½ years. 2. Proper etching of porcelain for boning depends on the
leucite content of the porcelain as well as the type of
2. The failure rate increased when the finish line was within etchant used.
an existing filling and/or when the veneer was partially
bonded to dentin. 3. Presence of additional leucite crystals may affect the
time required for proper etching of porcelain. 22
3. Occlusion played a major role in most failures.

18 Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1
Kumar et al. Veneer in Restorative Dentistry

2007- Sailer I et al compared color stability of three veneering full veneers are done, care must be taken to provide proper
ceramics for zirconia frameworks. Three veneering ceramic physiological contours, particularly in the gingival area, to
compared were Initial (GC), Triceram (Esprident) and Cercon favor good gingival health. One veneer has been lost and
Ceram S (DeguDent).They concluded that all 3 ceramics met severe gingival irritation exists around the remaining
the esthetic demands only to a limited extent. Triceram allowed overcontoured veneers.
to be the most predictable result in terms of color stability. 23
Partial veneer
Porcelain has long history in the dental field. It is one of the
most esthetically suitable and biocompatible material available. Full veneers can be accomplished by a direct or an indirect
Porcelain abrasion and stain resistance are excellent and well technique. When a small number of teeth are involved or
tolerated by gingival tissues. Thus it makes porcelain laminate when the entire facial surface is not faulty (partial veneers),
veneers superior to other veneering systems. directly applied composite veneers can be completed for the
patient in one appointment with chair side composite. Placing
A veneer is a layer of tooth colored material that is applied to direct composite full veneers is very time consuming and
a tooth for esthetically restoring localized or generalized labor intensive. However, for cases involving young children,
defects or intrinsic discolorations.24 a single discolored tooth or when economics or patient time
are limited precluding a laboratory fabricated veneer the direct
Constructing a veneer (without regard to the material) and
technique is a viable option.
bonding it to etched tooth structure is referred to as
“laminating” (Faunce FR). 3 Veneers also can be divided into two categories based method
of fabrication
The laminate veneer is a conservative alternative to full
coverage for improving the appearance of an anterior tooth 1. Directly fabricated composite resin veneers (i.e. free
(Horn HR).25 hand placed), and
A porcelain laminate veneer is an extremely thin shell 2. Indirectly fabricated veneers, such as preformed
of porcelain applied directly to tooth structure (McLaughlin laminates or laboratory-fabricated acrylic resin,
G). 26 microfilled resin, or porcelain veneers.
There is little difference between a laminate and veneer. In
Direct Veneers:24
general terms, a laminate is done to maintain the color, where
as a veneer is made to change the color. In esthetic dentistry, Buonocore’s research of the acid etch technique in 1955,
laminates are used to restore the original color of the tooth, combined with Bowen’s later use of filled resins, provided
whereas veneers are used to change the original color of the the technology enabling mechanical bonding between etched
tooth to make it look more natural.27 tooth and filled resins (direct bonding). Although these were
major breakthroughs in dental research by the early 1960s,
Types of Veneers 24 little esthetic use was made of this bonding technology of
nearly a decade. This was partially due to the limitations of
Veneers can be divided into two categories based tooth
the available self-curing resins, which did not allow sufficient
preparation
working time for the dentist to recreate a labial surface before
1. Partial veneers the composite resin chemically cured itself.

2. Full veneers The introduction of light cured composite resins in the early
to mid 1970s allowed the dentist greater flexibility. The
Indications 24 advantages of visible light cured composite resins, such as
greater working time and improved chemistry, versus the self-
Partial veneers and Full veneers cured composite resins, marked the entrée into the next
generation of esthetic materials. Visible light cured composite
Partial veneers are indicated for the restoration of localized
resins were replacing self-cured composite resins by the late
defects or areas of intrinsic discoloration. Full veneers are
1970s and were preferred for esthetic anterior restorations.
indicated for the restoration of generalized defect or areas of
intrinsic staining involving the majority of the facial surface Direct acid etched bonding proved to be advantageous, yet a
of the tooth. However, several important factors including susceptibility to stain, poor wear resistance and lack of natural
patient age, occlusion tissue health, position and alignment fluorescence spurred the continued search for improved
of the teeth and oral hygiene must be evaluated prior to materials.
pursuing full veneers as a treatment option. Furthermore, if

Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1 19
Veneer in Restorative Dentistry Kumar et al.

Indirect Veneers: A composite is a system composed of a mixture of two or

more macromolecules, which are essentially insoluble in each
The idea of restoring teeth for esthetic purposes became more other and differ in from. Examples of natural composite material
widely accepted by the dental community as new esthetic are tooth enamel & dentin matrix is made collagen with
restorative techniques and material became available. Faunce hydroxyapatite crystals acting as fillers.
described a one-piece acrylic resin prefabricated veneer as
an improved alternative to direct acid etched bonding. By Composition
using, a chemical primer applied to the veneer and a composite
to lute the veneer onto an etched tooth, both a chemical and  Resin matrix/binder- BIS-GMA o r urethane
mechanical bond contributed to the attachment. It was more dimethacrylate
stain resistant than composite resin veneers, but numerous  Filter Quartz colloidal silica or heavy metal glasses
preformed acrylic resin laminates suffered from delamination
at the laminate/composite interface, usually due to the weak  Coupling agents – Organoslianes
chemical bond. Like composite resins, they also exhibited  Hydroqu inone inhibi tor to prevent i mmat ure
poor resistance to abrasion. polymerization
The inherent advantage to laboratory-fabricated veneers is  UV absorbs to improve color stability
the anatomical accuracy. Laboratory formed acrylic resin  Opacities e.g. Titanium dioxide & aluminum oxide
veneers and laboratory formed microfill resin veneers offer a
smooth surface, good masking ability, and very little finishing,  Color pigments to match tooth color
if they are completed properly. However, porcelain laminates
can surpass their esthetics, strength, and longevity. Types

Based on curing Mechanisms

Advantages of Indirect Veneers Over Direct Veneers
1. Chemically activated
Indirect veneers require two appointments but typically offer
numerous advantages over directly placed full veneers. First, Alfa camp (VOCO)
indirectly fabricated veneers are much less technique
sensitive to operator ability. Considerable artistic expertise  Two paste system; base and catalyst paste supplied in
and attention to detail are required to consistently achieve small jars or syringes.
esthetic and physiologically sound direct veneers. Indirect
veneers are made by a laboratory technician and are typically  Po wder liquid syst ems; po wder(ino rganic
more esthetic. Second, if multiple teeth are to be veneered phase)supplied in jars and liquid (BIS-GMA) diluted
indirect veneers u sual ly can be pl aced much mo re with monomers in bottles.
expeditiously. Third, indirect veneers typically will last much 2. Light Activates
longer than a direct veneer, especially if made of porcelain or
pressed ceramic.  Hercentile (kerr)
 Heliomolar (Vivadent)
Contraindications for Veneer placement
3. Dual Cured
 Teeth with defective enamel formation
 Auto polymerizing + photo cured
 Teeth having insufficient crown material
Based upon size of filler particles
 Young permanent teeth
Conventional 8-12mm
 Teeth exhibiting severe occlusal wear patterns, due to
Para-functional habits Small particle 1-5mm
 Severe periodontal involvement and severe crowding Microfilled 0.04-0.4mm
 Poor oral hygiene Hybrid 1-0mm

Veneering Materials CEROMERS

Composite Resins The term ceromer stands for ceramic optimized polymer and
was introduced to describe composite Tetric ceram.This
It is a tooth colored restorative system developed in late 1950’s co nsists o f barium glass (<1mm)Sphero idal mixed
& early 1960’s It is basically a resin, which has been oxide,Ytterbium trifluoride & silicone in dimethacrylate
strengthened by adding silica particles.

20 Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1
Kumar et al. Veneer in Restorative Dentistry

monomers (BIS-GMA) & urethane dimethacrylate by a HYBRID TYPE:

polymerization of C=C of the methacrylate.Ceromers combine
the advantages of ceramics & composites. Newly developed processed composite colloidal silica, offers
a significant improvement in bond strength. This type of
Properties similar to ceramics composite contains particles of barium glass, which is soft
radio-opaque filler; it can be sandblasted and etched in the
i) Durable esthetics with enamel like translucency and lab. With a mild concentration of (9%-10%) of hydrofluoric
fluorescence acid to produce numerous areas of microscopic undercuts,
ii) Abrasion resistance & enamel like hardness. similar to those formed with etched enamel.By producing a
surface capable of micromechanical bonding, “etched
Properties similar to composites: composite” veneers can be strongly bonded to enamel.They
can be replaced or repaired easily with chairside composite.
i) Ease of final adjustment.
ii) Excellent polish ability. Indications:
iii) Effective bond with luting composite. For placement in children and adolescents as interim
iv) Low degree of brittleness. restorations until the teeth have fully erupted and achieved
their complete clinical crown length.
v) Possibility of repairing restorations in the mouth.
For placement in patients who exhibits significant wear of
Commercial name – Tergis. their anterior teeth due to occlusal stress.
Indirect veneers are made of:
II) Porcelain Veneer28
i) Processed composite
ii) Porcelain Feldspathic porcelains contain a variety of oxide components,
including SiO2 (52-62 wt%), A12O3 (11-16 wt%), K2O (9-11
Indirect veneers are attached to the enamel by acid etching wt%), Na2O (5-7 wt%), and certain additives, including Li2O
and bonding with either a self-cured, light cured or dual cured and ZrO2. These ceramics are called porcelains because they
resin bonding material. contain a glass matrix and one or more crystal phases. They
cannot be classified as glass-ceramics because crystal
1) PROCESSED COMPOSITE VENEERS: formation does not occur through controlled nucleation and
crystal formation and growth.
Composite veneers can be processed in a laboratory to achieve
superior properties. Using intense light, heat, vacuum, There are four types of veneering ceramics. These include (1)
pressure, or a combination of these, cured composites can be low-fusing ceramics (feldspar-based porcelain and nepheline
produced that possess improved physical and mechanical syenite-based porcelain); (2) ultra low-fusing ceramics
properties compared to traditional chairside composites. (porcelains and glasses); (3) stains; and (4) glazes (self-glaze
Indirectly fabricated composite veneers offer superior shading and add-on glaze). The particle type and size of crystal
and characterizing potentials well as better control of facial particles, if present, will greatly influence the potential
contours. abrasiveness of the ceramic prosthesis.

MATERIALS: Classification of All Ceramic Systems used as Veneering

Materials 29
MICROFILL COMPOSITES
1. Conventional powder slurry ceramic
Most processed composit es presently are microfi ll i) Optec HSP – Leucite reinforced porcelain.
composites. Although significant advantages exist over direct
composite veneers, indirect veneers made of processed ii) Duceram LFC – Hydrothermal low fusing ceramic.
microfill composites possesses limited bond strength because 2. Pressable Ceramic
of the reduced potential to form a chemical bond with the
bonding medium because laboratory processing results in a i) IPS Empress
greater degree of polymerization resulting in fewer bond ii) Optec Pressable Ceramic
sites.Consequently, they should not be used in areas of high
occlusal stress. 3. Castable Ceramic
i) Dicor
ii) Cerapearl

Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1 21
Veneer in Restorative Dentistry Kumar et al.

4. Machinable Ceramic Disadvantages:

i) Cerec Vitablocs Mark I & II These are no clinical studies that the material is less abrasive
ii) Celay blocks than feldspathic porcelain.
iii) Dicro MGC 2) Pressable Ceramic – IPS Empress Injection Moulded
Glass / Leucity Reinforced Hot Pressed Glass Ceramic
5. Infiltrated Ceramic
i) In-Ceram Wohlwend et al first described this System in 1989.This is
precerammed glass reinforced with leucite that prevents glass
1) Conventional Powder Slurry Ceramic propagation without diminishing its translucency.It is
available in the form of ingots, which are heated and injected
I. OPTEC HSP: Leucite Reinforced Porcelain under pressure and temperature into a mold created by a lost
wax technique. It is less susceptible to fatigue failure.
Lencite porcelain is commercially available as optec
HSP.These porcelains contain dispersed leucite (potassium Flexural strength is higher than Dicor and conventional
aluminium silicate) crystals in a glassy mix.They have a high porcelain.
tensile strength rendering porcelain to be stronger compared
to conventional feldspathic porcelains. The leucite and glassy Advantages:
components are fused together during the baking process at a) Potential to fracture under high stress.
10200C. The build up, condensation and curing is done using
the powder slurry technique on a special semipermeable die b) Need for special equipment (pressing oven and die
material. material).
3) Castable Glass Ceramic:
Advantages:
i) DICOR:
i) Lack of met al o r opaque substru cture, good
translucency. A glass ceramic is a material that is formed into the desired
shape as a glass and subsequently heat treated to induce
ii) Moderate flexural strength, higher than conventional
partial devitrification or crystallization.This conversion
feldspathic porcelain.
process, which involves crystal nucleation and growth is
iii) Ability to be used without special lab. Equip. referred to as ceramming and is accompanied by a small and
controlled volume change.The crystalline particles, needles
Disadvantages: or plates formed during the ceramming process constitutes
i) Margin inaccuracy caused by porcelain sintering a ceramming network which increases strength of material by
shrinkage. interrupting crack prepagation.

ii) Potential to fracture at increased loads. COMPOSITION:

iii) Increased leucite content may cause high in vitro wear The glass ceramic material is composed of SiO2, K2O, MgO,
of opposing teeth. Mg F2, Al2O3 .The fluoride acts as a nucleating agent and
improves the fluidity of molten glass.
II. Duceram LFC – Hydrothermal Low Fusing Ceramic
After ceramining, the material is approximately 55% crystalline
It is composed of an amorphous glass containing hydroxyl and contains tetrasilicic fluoride crystals (K2MgsSi8 O2oF)
ions. The restoration from Duceram LFC is made in two layers. which closelyresemble mica.Addition of 2.5% lithimm fluoride
The base layer is Duceram metal ceramic (a Lucite containing to the embedment material may promote crystallization of mica
porcelain), which is placed in a refractory die and baked at and increase toughness of glass ceramic.
9300C. The second layer Duceram LFC is applied over the
base layer & baked at 6600C. Advantages:
Advantages: i) Excellent marginal fit.

a) Greater density, high flexural strength, greater fracture ii) High strength.
resistance than feldspathic porcelain. iii) Surface hardness and occlusal wear similar to enamel.
b) No special lab equip or techniques are required for iv) Can produce wax patterns precisely by using lost wax
fabrication process. technique.

22 Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1
Kumar et al. Veneer in Restorative Dentistry

ii) Cera Pearl 5) Computer Assisted Restorations

Composition: Currently, the CEREC system (Sieman’s corporations,

charolette, NC) is a computer assisted design comuter assisted
Cera Pearl is composed of CaO, P2O5, MgO, and SiO2 manufacture (CAD/CAM) ceramic reconstruction with a laser
imaging camera that reconstructs the tooth preparation in
CaO (45%) and P2O5 (15%) are the main constituents in glass three dimensions. The operator can program the design and
formation and hydroxyapatite crystals. the computer directs the milling machine in the appropriate
MgO (5%) helps in formation of hydroxyapatite crystals. fabrication of the restoration.

SiO2 (34%) with P2O5 forms the matrix and regulates thermal Advantages
properties.
Computer assisted system eliminate the problems that arise
Advantages: for the indirect fabrication technique employed.

i) Biocompatible Disadvantages

ii) Young’s modulus, tensile strength and compressive High cost and inabilit y to bui ld layers of colo r and
strength are higher than conventional porcelains. translucency.

4) Machinable Ceramic: Examples – lava (3M USA), Procera (Sweeden)

These products are supplied in the form of ceramic ingots in 6) ART GLASS
various shades and with the hel p of a machi ne are
Polymer glass material.
fabricated.The fabrication process involves exposing a
ceramic ingot to a machining apparatus, which produces It offers the esthetics and longevity of porcelain but is tougher
desired contours. This is followed by occlusal adjustment, and more flexible.It can be easily adjusted or repaired
polishing, etching and bonding to the tooth. intraorally with any hybrid composite. It is color stable, plaque
Various types of ingots used are: repellent and offers perfect esthetics and margins.

a) Cerec Vitablocs Mark I Current materia ls for c eramic laminate vene er

restorations: 30
b) Cerec Vitablocs Mark II
c) Dicor MGC Fracture Toughness and Relative Optical Properties

d) Celay.

Material Flexural Opacity/ Translucency

Strength
(MPa)
Slip-Cast Alumina Ceramics (In-Ceram, Vita Zahnfabrik, Germany) 630 high/low
High-Alumina Reinforced (Sintered) Ceramics (Procera-Sandvik, 600 high/low
Stockholm, Sweden)
Leucite-Reinforced Ceramics
(Empress 1, Ivoclar-Vivadent, Lichtenstein) 180 moderate/moderate
(Cerpress SL, Leach and Dillon, Cranston, RI) 180 variable (high/low)
Feldspathic Ceramics 90 low/high
(Creation, Jensen Industries, New Haven, CT)
Synthetic Low-Fusing Quartz Glass Ceramics (HeraCeram, Heraeus- 120 very low/very high
Kulzer-Jelenko, Arrnonk, NY)

Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1 23
Veneer in Restorative Dentistry Kumar et al.

REPAIR OF VENEERS24 of the resin-bonding agent. Chairside composite material is

then added, cured, and finished in the usual manner. Large
Failures of esthetic veneers occur because of breakage, fractures are best treated by replacing the entire porcelain
discoloration, or wear. Consideration should be given to veneer.
conservative repairs of veneers if examination reveals that
the remaining tooth and restoration are sound. It is not always Faulty veneers in metal restorations17
necessary to remove all of the old restoration. The material
most commonly used for making repairs is light cued Faulty acrylic resins veneers on gold crown after long years
composite. of service need replacing because of wear and discoloration.
The teeth are cleaned with slurry of pumice and the shade
Veneers on tooth structure selected before isolation by cotton rolls and retraction cords.
With superficial wear or staining, part of the old restoration
Small-chipped areas on veneers can often be corrected by (silicate cement, acrylic or composite) can be left to achieve
recontouring and polishing. When a sizable area is broken, it some masking of the underlying metal. All of the old resin
can usually be repaired if the remaining portion is sound. material is removed with an appropriate instrument such as a
No. 1558 carbide metal cutting bur. Both preparations are
Direct composite veneers accomplished together. The outline of each preparation is
For direct composite veneers, repairs ideally should be made extended gingivally by removing some of the gold. The
with the same material that was used originally. After cleaning operator should endeavor to create a chamfered finish line.
the area and selecting the shade, the operator should roughen Retention is placed with a No. 33 ½-carbide bur in selected
the damaged surface of the veneer and/or tooth with a coarse, areas in the metal along the line angles approximately 0.25 mm
rounded end diamond instrument to form a chamfered deep.
cavosurface margin. For more positive retention, mechanical Although the preparations are done simultaneously, it is
locks may be placed in the remaining composite material with usually better to place the veneers one at a time. A light cured
a small round bur. An etching solution is applied to clean the composite is recommended because of the extended working
prepared area, which is then rinsed and dried. Next, a resin- time. Polyester strips are placed between the proximal surfaces.
bonding agent is applied to the preparation (existing The preparation is cleaned with acid etchant for 30 seconds,
composite and enamel) and polymerized. Chair side composite then rinsed and dried to remove debris and obtain a clean dry
material is then added, cured, and finished in the usual manner. surface. The acid is used only to clean the surface, not to
etch the metal. Wedges placed in the gingival embrasure may
Indirect processed composite veneers help to establish proper contour of the matrix. A masking
Indirect processed composite veneers are repaired in a similar material (opaquing resin) is artfully placed with a small brush
manner. over the metal areas of the preparation by applying and
curing successive thin layers. Adhesive resin lines containing
Porcelain veneers 4-META, capable of bonding to metal, also may be used to
achieve additional retention and to achieve some masking.
However, in order to repair porcelain veneers, a mild These materials should be placed directly over the prepared
hydrofluoric acid preparation, suitable for intraoral use, must metal surface. Manufacturer’s instruction should be followed
be used to etch the fractured porcelain. Hydrofluoric acid closely to ensure optimal results with these materials, as they
gels are avail able in approximatel y 20 % bu ffered are quite sensitive to proper technique.
concentration, which are intended for intraoral porcelain
repairs. Although caution still must be taken when using Next, a small amount of composite material (gingival shade) is
hydrofluoric acid gels intraorally, the lower acid, concentration placed at the cervical area with a hand instrument, adapted
allows for relatively safe intraoral use. Full strength with the time of a No. 2 explorer, and cured with visible light.
hydrofluoric acid should never be used intraorally or etching New material of the preselected lighter shade is added to
porcelain isolation of the porcelain veneer to be repaired restore the middle and incisal portions. A small brush is helpful
should be accomplished with rubber dam to protect the in smoothing the surface and obtaining the final contour
gingival tissues from the irritating effects of the hydrofluoric before curing. Finishing is delayed except for removing any
acid. The manufacturer’s instructions must be followed excess contour at the mesiofacial embrasures.
regarding application time of the hydrofluoric acid gel to
Evaluation of the width of the teeth can be achieved with a
ensure optimal porcelain etching. A lightly frosted appearance
Boley gauge or another appropriate caliper. The second
similar to that of etched enamel should be seen if the porcelain
preparation is cleaned and died before the opaque or adhesive
has been properly etched. A silane-coupling agent may be
liner is added. Composite material is inserted and cured as
applied to the etched porcelain surface prior to the application

24 Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 1
Kumar et al. Veneer in Restorative Dentistry

described for the first veneer. The retraction cords are removed 10. Nicholls J.I. 1986: “Esthetic veneer cementation”. JPD. 56(1),
9-12.
and both restorations are finished together to obtain
symmetrical contours. 11. Heymann HO, Indirect composite resin veneers: clinical
technique and two- year observations, Quintessence Int;
18(2):111-118.
CONCLUSION 12. Reid J.S. 1988 : “Tooth color modification and porcelain
veneers” Quintessence International 19(7), 476-481.
New emerging concepts in esthetic dentistry with regards to
13. Herbert Victor Exner 1991 : “predictability of color matching
materials technology and public awareness have made and the possibilities for enhancement of ceramic laminate
veneers on demand. It has been less than a decade since the veneers”. JPD 65, 619-622.
phenomenon of fusing porcelain directly to tooth was first 14. Rada Robert E. and Betty Jean Jankowski 1991 : “Porcelain
described in 1980s since then the growth and development in laminate veneer provisionalization using visible light curing
this field has been nothing short of humungous. Yet, because acrylic resin”. Quintessence Int. 22, 291-293.
the science is still in its infancy cautions is required. The 15. Rouse Jeffrey S. 1997: “Full veneer versus traditional veneer
preparation: A discussion of interproximal extension J Prosthet
average dentist has a tendency to think only in terms of Dent. 78(5), 544-549
articulation also and function with a little thought to esthetics. 16. Dumfahrt Herbert 1999: “Porcelain Laminate Veneers, A
We should always keep in mind that we are dealing with retrospective evaluation after 1 to 10 years of service Part I –
organs, which can change an individual’s entire visual Clinical Procedure. The International Journal of Prosthodontics
personality. A captivating smile showing an even row of 12(6), 504-511.
natural gleaming white teeth is a major factor in achieving 17. Peumans M et al. Porcelain veneers: A review of the literature,
journal of dentistry 2000; 28:163-177.
that elusive dominant characteristic called personality. The
18. Hager Bertil, Agneta Oden, Bernt Anderson and Lars Anderson
objective of cosmetic dentistry must be to provide the
2001: “Procera All Ceram Laminates: A clinical report”. J
maximum improvement in esthetic with the minimum trauma Prosthet Dent. 85(3), 230-233.
to the dentition. There are a number of procedure that begin 19. Magne pascal, Novel porcelain laminate preparation approach
in approximate the ideal parameter of cosmetic dentistry, most driven by a diagnostic mock-up. J Esthet Restor dent2004,
notably that of porcelain laminate veneers. 16(1):7-18.
20. George P. Cherukara et al 2005: Dentin exposure in tooth
Porcelain veneers are a useful adjunct to the armamentarium preparations for porcelain veneers: A pilot study. J Prosthet
of the dentist to help in the management of aesthetic problems Dent 94:5
in patients, both young and old. Care needs to be taken during 21. Fernando Zarone et al : Dynamometric assessment of the
mechanical resistance of porcelain veneers related to tooth
tooth preparation and particularly during the luting phase to
preparation: A comparison between two techniques. J Prosthet
ensure maximal results are obtained for the patient. Dent 2006,95:5.
22. Barghi et al,Effects of porcelain leucite content, types of
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