How to place porcelain veneers with minimal preparation
Dr. Ross Nash outlines how he enhanced one patient’s smile with a minimally invasive technique.
A young woman presented with a desire to enhance her smile.
Figure 1 shows her smile before treatment. A retracted view illustrates that she had developmental enamel defects that resulted in decalcified surfaces (Fig. 2). Some areas had white spot lesions and others had brown areas where the white spots had incorporated stain over time. The incisal view in Figure 3 shows well-aligned teeth. Clinical and radiographic examination revealed excellent dental health with no periodontal disease or caries.
The patient communicated that whitening procedures she had tried were not successful and actually made the appearance worse by causing the white spots to stand out more. My experience tells me that white spot lesions such as these are often near the surface of the enamel and enameloplasty can sometimes remove them. However, the teeth actually appear a darker color due to less coverage of the underlying dentin. Resurfacing of the tooth surface is desired in many of these cases. It can be accomplished with direct composite resin veneers or indirect composite or ceramic laminates.
While direct restorations can usually be accomplished at a lower cost to the patient, it requires the clinician to have artistic abilities. By using an indirect process, an artist can be chosen by the dentist. I have found that a ceramic laminate routinely outlasts my direct or indirect composite veneers by a factor of two and resists stain better. Preparation for these thin veneers can be minimally invasive and usually does not require temporary restorations.
The patient chose 10 porcelain laminates for her smile makeover.
Up next: Dr. Ross demonstrates how to place restoration veneers