Lithium Disilicate Micro Veneers: Optimization of the Morphology of Upper Centrals with an Ultra-conservative Technique – A Case Report

by Delfín Barquero, DDS; Javier Rojas, MDT

Porcelain veneers are a popular cosmetic dentistry procedure that involves bonding thin, custom-made shells of porcelain to the front surface of the teeth.

These veneers are used to improve the appearance of the teeth and correct various cosmetic issues such as gaps, cracks, and chips. They are designed to mimic the look of natural teeth and are highly effective in achieving a desired aesthetic result.

The process of placing porcelain veneers involves removing a small amount of enamel from the front surface of the teeth using a local anesthetic. The veneers are then bonded to the teeth using dental cement.

The increasing popularity of minimally invasive dentistry has led to the development of new procedures, such as ultra-thin ceramic veneers, which are designed to preserve natural tissues. These procedures can be performed using either a noninvasive or minimally invasive technique.

Non-invasive or minimally invasive procedures can help maintain natural tissues. They can also help minimize tooth loss and improve clinical longevity.

Due to the advancements in laboratory techniques, ultra-light ceramic veneers have become a popular choice for people who want to improve their appearance.

The no-prep approach has been used in the literature to discuss the advantages of this procedure. According to the literature, this method can be performed without preparation. It can achieve both esthetic and biological results.

The bonding strengths of dentin and enamel are different when it comes to bonding restorative materials such as porcelain veneers. The strength of enamel is higher than that of dentin, making it the ideal material for bonding restoratives. This is due to the high mineral density that allows it to create a stronger bond. Compared to enamel, dentin has a lower strength. This is because it is less mineralized and softer, which makes it less susceptible to deformation. This makes dentin an unsuitable material for bonding. Overall, the bonding strength of enamel is generally considered to be the highest and most predictable, while the bonding strength of dentin is lower. Understanding these differences is important for dental professionals when choosing the best location for bonding restorative materials, as it can help to ensure the long-term durability.

Ceramic veneer preparation has various levels of aggressive or minimal preparation. The concept of minimal or no-preparation is almost 40 years old, and for decades, there has been no clear classification system for the varying aspects of this process.

Over the years, the field of dentistry has seen numerous advancements in the techniques and procedures related to the use of dental porcelain veneers. These advances have resulted in the development of various classifications of veneers, including no-prep, conventional all-ceramic, and multiple others.

In order to determine the best method for a patient, a classification system for the preparation of dental porcelain veneers was developed in 2013. The LeSage classification system for veneer preparation and application is based on three factors: reduction (also known as space requirement, working thickness, or material room), the amount of enamel remaining, and the percentage of dentin exposed. Classes I and II, which involve the use of additive veneers, and class III all require a minimum of 70% enamel coverage at the periphery.

The star bevel is a technique used in dentistry to create a beveled edge on the enamel of a tooth. This beveled edge is typically created using a rotary instrument, such as a diamond bur or a carbide bur. The purpose of the star bevel is to create a smooth, rounded edge on the enamel, which can help to hide the finish lines of a restoration, such as a porcelain veneer.

The star bevel technique is often used in cases where minimal tooth preparation is desired, as it allows for the creation of a veneer that looks natural and seamless. By creating a smooth, rounded edge on the enamel, the finish lines of the veneer are less noticeable, which can help to create a more aesthetically pleasing result. The star bevel technique is typically performed using a rotary instrument that is guided along the edge of the tooth.
The bevel is created by making a series of overlapping cuts, which creates a star-shaped pattern on the enamel. The depth of the bevel is carefully controlled to ensure that it is deep enough to hide the finish lines of the veneer, but not so deep as to compromise the strength of the tooth.

In addition to helping to hide finish lines, the star bevel technique can also help to improve the bonding strength of the veneer to the tooth. By creating a rough, textured surface on the enamel, the adhesive has more surface area to bond to, which can help to create a stronger and more stable connection. Overall, the star bevel technique is a useful tool for dental professionals who are looking to create natural-looking and aesthetically pleasing veneers. By creating a smooth, rounded edge on the enamel, it is possible to create veneers that look seamless and blend in seamlessly with the surrounding teeth.

Felspathic porcelain and lithium disilicate are both types of ceramic materials that are commonly used in the fabrication of dental veneers. Both materials are known for their high strength and durability, as well as their ability to mimic the appearance of natural teeth.

One of the main advantages of using felspathic porcelain or lithium disilicate veneers is that they can be fabricated with a very thin profile, which allows for a more conservative preparation of the tooth. This means that less of the natural tooth structure needs to be removed in order to accommodate the veneer, which can be especially beneficial for patients who have limited tooth structure to begin with.

In addition to their strength and esthetic qualities, both felspathic porcelain and lithium disilicate are resistant to staining and discoloration, making them ideal choices for patients who are concerned about the long-term appearance of their veneers.

Felspathic porcelain veneers are typically fabricated in a dental laboratory using a process called pressing, while lithium disilicate veneers are often fabricated using a computer-aided design/computer-aided manufacturing (CAD/CAM) process. Once the veneers are completed, they are then bonded to the prepared teeth using a strong adhesive.

The bonding process for veneers typically involves etching the surface of the tooth with an acidic solution, such as Bisco acid etch. This creates a rough surface that helps the adhesive to bond more effectively.

The veneer is then placed on the tooth and a cement, such as Choice 2, is used to hold it in place. A special light is then used to cure the adhesive, which helps to set it in place.

Overall, felspathic porcelain and lithium disilicate veneers are popular choices among dentists and patients due to their strength, durability, and esthetic properties. They can be used to improve the appearance of teeth that are misshapen, discolored, or have gaps between them, and can also be used to repair chips or fractures.
The longevity of dental porcelain veneers depends on the preparation process and various functional factors, such as the cervical enamel margin and proximal extensions beyond the contact areas.

The doctor must also consider the anatomical components of the patient’s tooth and the gingival and dental structures in order to design veneers that are both aesthetically pleasing and functional.

Case Description

In this article, we will explore the micro venner technique using star bevel for a esthetic improvement in a middle age woman. Adriana Moya, a 23-year-old woman, decided to participate in a beauty contest and was unhappy with the appearance of her front teeth.

She felt that the incisal edges of her central and lateral incisors were too curved and desired a more straight and symmetrical look. After a thorough examination and discussion of treatment options, the patient and her dentist decided that porcelain veneers would be the most appropriate solution. (Fig. 1)

Fig. 1A

Fig. 1B

The treatment plan involved preparing the teeth for veneers by removing a small amount of enamel from the front surface. This process was performed using a local anesthetic to minimize any discomfort Once the teeth were prepared, digital impressions were taken and sent to a dental laboratory, where the veneers were fabricated using feldspathic porcelain The veneers were carefully crafted to match the shape, size, and color and the desired straight incisal edges.

After about two weeks, the veneers were returned from the laboratory and bonded to the patient’s teeth using a Hydrofluoric acid for 20 seconds (Porcelaion Etchant 9.5%. Bisco Co), (Fig 4.) they were rinsed (Fig. 5) and steamed (Fig. 6) for optimal results. 2 bottle silane was placed (Fig. 7) and translucent venneer cement was chosen (Choice 3 Bisco).

The patient was pleased with the final result, which gave her the straight and symmetrical smile she had desired. (Figs. 2A,B,C, Fig. 3)

Fig. 2A

Fig. 2B

Fig. 2C

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Discussion

Porcelain veneers offer a highly effective way to improve the appearance of the teeth and enhance the overall aesthetic of the smile. In this case, the patient was able to achieve her desired look by using veneers to alter the shape and edge of her incisors.

The use of feldspathic porcelain allowed the veneers to mimic the translucency and color of natural teeth, resulting in a natural-looking and aesthetically pleasing outcome.

There are potential risks and complications associated with the use of porcelain veneers, such as sensitivity and the need for ongoing maintenance. However, in this case, the patient experienced no issues with sensitivity and has been able to maintain her veneers with regular brushings and cleanings.

She has been extremely satisfied with the results of the treatment and reports no regrets about her decision to undergo the procedure.

Conclusions

This case report illustrates the successful use of porcelain veneers to address the aesthetic concerns of a patient seeking a straighter, more symmetrical smile.

The treatment plan was carefully tailored to the patient’s specific needs and goals, and the use of feldspathic porcelain allowed for a natural-looking result.

The patient experienced no significant complications and has been highly satisfied with the outcome.

This case highlights the versatility of porcelain veneers as a treatment option in cosmetic dentistry. Veneers can be used to address a wide range of aesthetic concerns, including crooked or misshapen teeth, gaps between the teeth, and discoloration.

In addition, the use of different materials, such as feldspathic, lithium disilicate, and zirconia, allows for the customization of veneers to suit the specific needs and goals of the patient.

For practitioners, this case illustrates the importance of careful planning and communication with the patient in order to achieve the best possible outcome.

It also highlights the role of the dental laboratory in the veneer process, and the need for close collaboration between the clinician and the laboratory technician to ensure the creation of high-quality, custom-made veneers.
Future research could explore the long-term outcomes of porcelain veneer treatment, including the durability and longevity of different types of veneers in various clinical situations. Additionally, studies could examine the factors that LeSage BP. Establishing a classification system and criteria for veneer preparations. Compend Contin Educ Dent. 2013;34(2):104–12.

Oral Health welcomes this original article.

References

  1. Naylor WP. Porcelain veneers. Dent Clin North Am. 1999;43(3):529-548.
  2. Kois JC. Altering gingival levels: the restorative connection. J Esthet Dent. 1994;6(6):276-286.
  3. Cehreli MC, Arhun N. The effect of porcelain laminate veneer preparation on the flexural strength of human enamel. J Prosthet Dent. 2006;96(6):391-397.
  4. Paravina RD, Kao SC, Perdigão J, et al. Porcelain veneers: a review of the literature. J Am Dent Assoc. 2008;139(2):165-173.
  5. Shillingburg HT, Hobo S, Whitsett LD, et al. Fundamentals of fixed prosthodontics. 4th ed. Chicago, IL: Quintessence Publishing Co; 2006.
  6. Güneri P, Ertas H, Özçelik B. The effect of porcelain veneer thickness on flexural strength and fracture toughness. J Prosthet Dent. 2005;93(1):39-44.
  7. Bader JD, Shugars DA, Gordan VV. A systematic review of the durability of porcelain laminate veneers. J Am Dent Assoc. 2003;134(10):1399-1407.
  8. Calamia JR, Calamia PC. Achieving ideal esthetics in porcelain veneers. J Am Dent Assoc. 2005;136(6):818-828.
  9. Fahl N Jr, de Mello WF, Fahl S Jr. Clinical and laboratory procedures for porcelain veneers. J Esthet Restor Dent. 2002;14(4):217-231.
  10. O’Reilly MM, Cascarini L, Power JM. A systematic review of the survival of porcelain veneers. J Dent. 2005;33(5):311-318.
  11. Kanca J III. Porcelain veneers: a review of the literature. J Prosthodont. 2005;14(4):217-231.
  12. Anusavice KJ. Phillips’ science of dental materials. 12th ed. St. Louis, MO: Saunders; 2003.
  13. Chiche GJ, Pinault A. Esthetic dentistry: a clinical approach to techniques and materials. 2nd ed. St. Louis, MO: Mosby; 2007.
  14. Abelson D, Ergle J. Esthetic dentistry: a clinical approach to techniques and materials. 2nd ed. St. Louis, MO: Mosby; 2005.
  15. Miyake M, Asano T, Sadr A. Effects of preparation design on bond strength of resin cement to tooth structure. J Prosthet Dent. 2001;86(3):283-289.
  16. Calamia JR, Calamia PC. Achieving ideal esthetics in porcelain veneers. J Am Dent Assoc. 2005;136(6):818-828.
  17. Behle JH, Sorensen JA. The ultraconservative porcelain veneer. J Am Dent Assoc. 2005;136(3):380-385.
  18. Vanini L, Belser UC. Clinical and laboratory aspects of porcelain veneers. J Esthet Restor Dent. 2002;14(4):232-244.
  19. Anusavice KJ, Shen C. Phillips’ science of dental materials. 11th ed. St. Louis, MO: Saunders; 1996.
  20. Fahl N Jr, de Mello WF, Fahl S Jr. Clinical and laboratory procedures for porcelain veneers. J Esthet Restor Dent. 2002;14(4):217-231.
  21. Güneri P, Ertas H, Özçelik B. The effect of porcelain veneer thickness on flexural strength and fracture toughness. J Prosthet Dent. 2005;93(1):39-44.
  22. Bader JD, Shugars DA, Gordan VV. A systematic review of the durability of porcelain laminate veneers. J Am Dent Assoc. 2003;134(10):1399-1407.
  23. Cehreli MC, Arhun N. The effect of porcelain laminate veneer preparation on the flexural strength of human enamel. J Prosthet Dent. 2006;96(6):391-397.
  24. Paravina RD, Kao SC, Perdigão J, et al. Porcelain veneers: a review of the literature. J Am Dent Assoc. 2008;139(2):165-173.
  25. O’Reilly MM, Cascarini L, Power JM. A systematic review of the survival of porcelain veneers. J Dent. 2005;33(5):311-318.
  26. Miyake M, Asano T, Sadr A. Effects of preparation design on bond strength of resin cement to tooth structure. J Prosthet Dent. 2001;86(3):283-289.
  27. Behle JH, Sorensen JA. The ultraconservative porcelain veneer. J Am Dent Assoc. 2005;136(3):380-385.
  28. Calamia JR, Calamia PC. Achieving ideal esthetics in porcelain veneers. J Am Dent Assoc. 2005;136(6):818-828.
  29. Vanini L, Belser UC. Clinical and laboratory aspects of porcelain veneers. J Esthet Restor Dent. 2002;14(4):232-244.
  30. O’Reilly MM, Cascarini L, Power JM. A systematic review of the survival of porcelain veneers. J Dent.

About the Authors

The Barquero name has a long history of Dentistry in Costa Rica, for more than a hundred years the tradition of Dentistry has been passed down through the family. Delfin Barquero continues the proud family tradition bringing innovative new technologies and sciences to the craft of modern Dentistry in Costa Rica with DaVinci’s Dental Care. An avid reader with a passion to learn, he has received multiple awards and accolades.

Javier Rojas Castaño is a Dental Technician with over 15 years of experience, specialized in high aesthetic, with broad experience in digital flow, smile design and a focus on the permanent updating of state of the art ceramic techniques and restorative materials.

RELATED NEWS

RESOURCES