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November 2009 | Dental Products Report The take-aways New techniques, technology, laser deliver new smile When properly planned and executed, bonding porcelain to virtually undisturbed enamel creates great results. The set-up The growing popularity in the public arena for “no prep” or “minimal preparation” smile enhancements is advocated by technological enhancements and research that per Dr. Michael Sesemann “is supportive of the fact that enamel is a cherished human tissue with unique qualities that cannot be duplicated after its removal.”1 Long-term research has demonstrated a 94% survival rate of minimally invasive porcelain veneers according to Drs. Howard Strasseler and Mark Friedman.2,3 Dr. John Calamia’s original investigation in 1983 was performed with little or no preparation and the process needed to be reversible in case it didn’t work. He also cautioned the need to avoid over contouring for periodontal purposes—even with veneers that were about 0.5 mm thick. This led to the conclusion that some slight preparation was needed to create a biological appropriate emergence profile.4 Although the thicknesses of today’s minimal veneers are closer to 0.3 mm, the additive nature of this conservative technique can still encroach on the biomimetic needs of the gingival complex5, as well as make it difficult for the ceramist to create natural anatomic contours. Fortunately, the confluence of laser technology with these new restorative methods provides a healthy adjunct to this new philosophy of care.  Refer to slideshow for figures Exam/treatment planning A 34-year-old male presented for smile enhancement. After many years of hiding his smile, he desired whiter teeth while closing the spaces. After a photographic and radiographic analysis along with mounted study models and a 5-phase exam, these observations were made: Eight upper teeth with good midline positioning; generalized diastema and prominent canines that create a slightly negative smile line; Shade A2 generally (with A3 to A3.5 in the canines); his goal shade is Chromoscope 030 (Figs. 1-2); Class III occlusion with end-to-end anterior tooth relationship and group function; no wear or muscular pathology noted; range of motion was 57 mm; T-Scan showed vertical occlusal discrepancies in the posterior teeth (Fig. 3); LED Dental’s VELscope testing yielded no pathological markers; despite less than ideal flossing and mild calculus buildup, bone levels were excellent radiographically with no soft-tissue swelling or bleeding points; biomechanical—other than a previous history of a crown restoration over an endodontically treated tooth No. 3, tooth strength was optimal; no apparent history of clenching or grinding, but abfracted lesions were noted in the bicuspid areas. After reviewing findings, an ortho treatment plan with whitening was presented as an ideal solution. Because of the length of time needed to make these changes, the patient preferred a more convenient solution. Using the profile photos (Fig. 4) the labial surfaces of the upper teeth fell inside a line connecting the vermilion borders of the lips, allowing for a proper lip comfort.7 Increasing the “volume” of tooth structure by using DURAthin veneers Case sequence Next came the following sequence: 1. The lab waxed up tooth Nos. 7-10 and 23-26; eventually tooth Nos. 5, 6, 11, 12, 21, 22, 27, and 28 will be restored as the patient’s budget allows. 2. Prophylaxis was done with aggressive homecare to prepare for temporization and restorative maintenance. 3. A Kois Deprogrammer was used to retrain muscle engrams prior to occlusal equilibration. 4. Home whitening with customized trays and Heraeus Kulzer’s Venus Smile, 16% carbamide peroxide was completed. 5. Veneer treatment with minor removal of undercuts and smoothing sharp incisal edges along with soft-tissue adjustments was done as described. 6. An “esthetic protective appliance” was placed after the veneers were placed. CONTINUED ON NEXT PAGE
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