By: Justin W. Griffin, DMD
Cosmetic & Implant Dentist
WildeWood Aesthetic Dentistry
Want to save chair-time for your next veneer case (which translates to opportunities to treat more cases, leading to greater revenue, and which also leads to happier patients—and hence more referrals, and so on and so on. It’s possible when you treatment plan appropriate cases for minimal preparation veneers. IPS e.max lithium disilicate veneers can be made with minimal-to-no preparation on the teeth. Imagine: shorter appointments; no need for anesthesia (in most cases); no need to place long-term temporaries; and esthetic treatments that are longer lasting (because the strong and flexible enamel substrate for bonding is preserved). But the most satisfying advantage of minimal preparation veneers are happier patients.
With minimal preparation IPS e.max veneers, breaking all contacts and traditional tooth reduction of 1.5 mm is history. Now, with an understanding of chewing forces and by working with an experienced laboratory that can provide minimal preparation models, dentists can treat suitable cases in as few as three appointments, each less than an hour! Appropriate cases usually become apparent during the examination and smile design phase, when the profile, lips, and biotype must be evaluated. Note, however, that 100% prep-less veneer cases are still very rare. However, if you are willing to learn, you will discover that minimal preparation veneers are indicated more often than you might think.
So what’s involved with minimal preparation IPS e.max veneers?
Many of the same treatment planning and smile design steps associated with other types of cases, including taking photographs throughout the planning and treatment sequences for assessment and verification. In this instance, during the smile analysis and diagnosis appointment—which lasted 30 minutes, it was determined that the patient had a thin biotype, spaces between the teeth, and an asymmetric gingival architecture that wasn’t ideal. A diode laser was used to minimize the gingival discrepancies and a smile design involving six veneers on teeth #6 through #11 was proposed and approved by the patient.
Based on this smile design, the laboratory (Experience Dental Lab) created a wax-up for the veneers, along with a preparation model and putty matrix reduction guide to verify adequate space for the final restorations. Provisional (more like trial) restorations were also made so that the patient could evaluate the new smile without anesthesia during the second (preparation) appointment, which lasted 45 minutes. Once the smile was approved, the provisionals were removed, the teeth were pumiced, and a final impression of the maxillary arch was taken.
In fact, the preparations were so minimal that the provisionals weren’t even needed for interim esthetics or tooth structure coverage. It’s also worth mentioning that in many minimal preparation veneer cases, the patient doesn’t wear the provisionals home.
Once the IPS e.max minimal preparation veneers were fabricated by the laboratory, the patient returned for the try-in and cementation appointment, which totaled 45 minutes. Again, there was no anesthesia needed. The veneers were tried in, and the patient had the opportunity to approve them for final esthetics. Upon patient approval, the teeth and veneers were prepared for cementation.
Readying the teeth for adhesive bonding involved pumicing the preparations; applying and rinsing a chlorhexidine scrub; etching the preparations, followed by application of a desensitizer, air drying, air blowing thin and curing of an adhesive bonding agent.
The IPS e.max veneers, which had been pre-etched at the laboratory using hydrofluoric acid etchant, were silanated to increase bond strength. A transparent shade of Variolink Esthetic adhesive cement was placed into the intaglio aspect of the veneers, which were then seated into place and tack cured. After excess cement was removed from the margins and interproximally, the veneers underwent a final cure, and the patient’s bite and contacts were adjusted and polished.
Traditional veneers would have required a 1.5-hour preparation appointment, along with at least two appointments involving anesthetic injections, time spent removing the provisionals, with likely subsequent gingival displacement, and possible inter-appointment provisional adjustments. The time saved is tremendous, the patient satisfaction (with future referrals) is priceless, and the bond strength and durability is greater - with minimal preparation veneers.
IPS e.max Smile
BONUS VIDEO: Dr. Michael DiTolla - IPS e.max Clinical Research