Tyagi S et al. Ceramic Veneers.

International Journal of Research in Health and Allied Sciences

Journal home page: www.ijrhas.com
Official Publication of “Society for Scientific Research and Studies” [Regd.]

ISSN: 2455-7803

CASE REPORT
Esthetic Rehabilitation of Anterior Teeth by Minimum Preparation with
Ceramic Veneers: A Case Report

Shweta Tyagi1, Ajay Nagpal2, Rohit Paul3, Vinayak Singh4

1,4
Post Graduate Student, 2Reader, 3Head of Department, Department of Conservative Dentistry, KD Dental College &
Hospital, Mathura, U.P

ABSTRACT:
In present time the porcelain laminate veneers with minimal tooth preparation are more demanding and esthetically fulfilled restoration in
enhancing esthetics. Advancement in adhesive dentistry made it possible to correct shape, size, and colour of the teeth by conservative
approach. PLV are more esthetically superior, conservative and durable restoration. The present article discussing a caseof porcelain
laminate veneers in anterior teeth discoloured due to fluorosis.
Key words: Esthetic, laminates, conservative

Received: 12 June, 2019 Revised: 24 June, 2019 Accepted: 25 June, 2019

Corresponding author: Dr. Shweta Tyagi, Post Graduate Student, Department of Conservative Dentistry, KD Dental
College & Hospital, Mathura, U.P

This article may be cited as: Tyagi S, Nagpal A, Paul R, Singh V. Esthetic Rehabilitation of Anterior Teeth by Minimum
Preparation with Ceramic Veneers: A Case Report. Int J Res Health Allied Sci 2019; 5(4):62-65.

INTRODUCTION INDICATIONS
In today’s life the demand of patient for esthetic correction  Abrasion;
is increasing day by day. Earlier, the most predictable  Coronal fracture;
treatment was with full coverage crowns but it required a  Correcting tooth defects (e.g. the closure of
large amount of tooth structure loss. Introduction of acid interdentalspacing and restoration of malformed
etching by buonocore in 1955 and advancement in bonding teethwhere crowns are not indicated);
lead to the development of small particle hybrid composites  Diastema;
having high clinical performance and esthetically good to  Orthodontics (e.g. discrepancies in the size
correct unaesthetic appearance.1-3 Resin composites which andshape of teeth that are not correctable by
are used for correction of discolouration, shape and size in orthodonticsalone);
teeth, having many disadvantages like susceptible to  Tooth discoloration (especially for treatment of
discolouration, wear, marginal fractures, and limited discoloured teeth that do not respond to tooth
longevity.So, they are recommended only for short to whitening or micro-abrasion procedures);
medium term restorations.4,5 Charles pincus was the first  To adjust occlusion (e.g. realignment of in-
who introduced porcelain veneers having longer durability standing, rotated or protruding teeth).
due to its biocompatibility and non-porous in nature which
decrease plaque accumulation and enhanced healthy CONTRAINDICATIONS
gingival condition.6,7  Veneers are not indicated in heavily restored teeth,
worn teeth and any teeth with insufficient enamel

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Tyagi S et al. Ceramic Veneers.

available for bonding or teeth too weak to withstand The present article includes a case of porcelain laminate
functional forces veneers in maxillary anterior teeth region with minimal
 Labial version preparation.
 Excessive interdental spacing
 Poor oral hygiene or caries CASE REPORT
 Parafunctional habits (clenching,bruxism) A 27years old male patient reported to the Department of
 Moderate to severe malposition orcrowding Conservative Dentistry and Endodontics, with a chief
complaint of discoloured teeth in upper front tooth region
ADVANTAGES of the mouth since 10-12 months and wants rehabilitation
 Minimal tooth preparation required for the same. A detailed family history, medical history and
 Porcelain veneers are stronger and more durable dental history was obtained. In family history, none of his
than composite veneers family members had similar problem. Past dental history
 Alternative to full coverage restoration in case of and Medical history was also not relevant. Extra oral
incisal fractures or tooth examination could elicit no abnormal findings. Intraoral
 discoloration examination revealed caries i.r.t. 23, root canal treatment
 Color stability was done in 14,24,25. Maxillary anterior teeth were vital
and had no hypersensitivity. Generalized gingival
DISADVANTAGES inflammation was noted and on probing mild bleedingwas
 Time consuming found. Moderate amount of calculus was present.
 Prior to cementation they are fragile and difficultto The maxillary anterior exhibited brownish discoloration of
manipulate; the surface (Fig.1). Different types of treatment options
 Repair can be difficult; were discussed which included laminate veneers,
 Satisfactory provisional restorations can be bleaching, composite veneering. Because of its minimally
difficultto make and retain; invasive nature and excellent aesthetic qualities it was
 Some tooth preparation is usually necessary; decided to enhance her appearanceusing porcelain laminate
 Their colour cannot easily be modified onceplaced; veneers. Porcelain Laminates veneers for anterior maxillary
 They are more costly than a number of segment from canine to canine teeth was planned.Firstly
possiblealternatives; before starting the preparation for maxillary anterior teeth,
 They are technique-sensitive and time-consumingto patient was sent for the full mouth oral prophylaxis and
place; Gingivectomy was done i.r.t. 11 (Fig.2).
 There are not predictable results where the Maxillary and mandibular diagnostic casts were made.
spacesrequiring closure are too wide to be closedjust Diagnostic wax up was done. The preparation of the tooth
by increasing tooth width alone; was done. The preparation was done in two planes (cervical
 It should be aware veneers is not indicatedwhere any 3rd and incisal 3rd) by placing grooves of 0.3mm and
tooth discolouration is too severe tobe masked by a 0.5mm depth with depth orientation bur on gingival and
thin porcelain veneer and wherethickening of the incisal half respectively. The enamel was then removed
veneer would require extensivepreparation into between the grooves to achieve the required reduction in
dentin; uniform depth. A broad rounded shoulder (Radial shoulder)
 In non-vital teeth for reasons of tooth weaknessand was made as the finish line and was kept restricted to the
the possibility of subsequent, unfavourable,colour labial surface as no change of anatomy was required. The
changes, ceramic veneers are not indicated. tooth preparation distally terminated facial to the contact
area. An overlapped incisal edge preparation was selected
because it helps in the proper seating of the veneer.

(Fig.1) PREOPERATIVE Fig.2) GINGIVECTOMY i.r.t. 11

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Tyagi S et al. Ceramic Veneers.

The lingual finish line was placed approximately one fourth

the way down the lingual surface connecting the two
proximal finish lines with a round a round end tapered
diamond bur. The finishline should be minimum 1mm
away from centric contacts. The veneer extended onto the
lingual surface will enhance mechanical retention and
increase the surface area for bonding. All sharp angles of
the preparation were rounded off (Fig.3).

Fig. 6 SILANE ON VENNER

The tooth surface is first cleaned with pumice or polishing

paste and rubber cups, this is followed by isolating the
tooth by placing Teflon tape between the contacts. The
tooth surface is now first treated with 37% phosphoric acid
(Ivoclar vivadent, USA)(Fig.7) and a layer of bonding
Fig.3 TOOTH PREPARTION agent(Adper single bond 3M ESPE USA) (Fig.8) was
applied on to the tooth surface. A dual cure adhesive resin
The final impression of the preparation was made after cement (Calibra Universal, DentsplySirona, USA) is then
placing gingival retraction cord with polyvinyl siloxane dispensedand mixed. The material is loaded into
impression material (Coltene, Germany) using putty wash thelaminate taking care not to incorporate any air bubbles,
technique (Fig.4).The shade was selectedunder direct the laminate is then gently placed with little pressure till it
sunlight with VITA 3D master shade guide. Since the is completely seated till the finish line, and the excess
preparation remains in enamel, most patients will not cement is removed with a sharp instrument (Fig. 9).
require a provisional restoration. The impression was then Occlusion was carefully checked initially with centric
send to the laboratory for the fabrication of final prosthesis. occlusion and then by other excursive movements to
ensure that no contact existed on tooth-porcelain interfaces.
The patient was given all the instruction necessary for the
proper maintenance of the laminate.

Fig.4 ELASTOMERIC IMPRESSION

The cementing surface of the laminate is etched with
hydrofluoric acid 9.5%for one minute and then is rinsed
thoroughly and then gently air dried (Fig.5) and this is
followed by the application of silane coupling agent one Fig. 7 ETCHANT ON TOOTH
drop spread (Angelus, Switzerland) (Fig.6) and air blown to
evenly spread on the surface of the laminate. The laminate
is now ready for the cementation.

Fig. 8 BONDING AGENT ON TOOTH

Fig. 5 HYDROFLUORIC ACID ON VENEER

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Tyagi S et al. Ceramic Veneers.

in dentist’s armamentarium. The veneers are technique

sensitive but if used carefully and with proper knowledge
can provide the best esthetic and functional result.

REFERENCES
1. Nakabayashi N, Kojima K, Masuhara E. The promotion
ofadhesion by infiltration of monomers into tooth
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Dentistry1992; 2: 117-27.
Fig. 9 CERAMIC VENEERS LUTED 3. Pashley DH, Ciucchi B, Sano H, Horner JA. Permeability
ofdentin to adhesive agents.Quintessence Int. 1993; 24: 618-
DISCUSSION 31.
Due to the advancement in adhesive technology and patient 4. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G.
awareness towards esthetic rehabilitation now slowly The five-year clinical performance of direct composite
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patient should be informed and the veneer should be left in permanent incisors. J Am Dent Assoc. 1976; 93:790-792.
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CONCLUSION
Porcelain veneers includes minimum tooth preparation for
the correction of esthetic problems and very useful adjuncts

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