Solving Dilemmas in Clinical Practice

[drmithila]

 On insertion day, the veneers were tried in individually for overall fit and marginal integrity. All veneers were then tried together to be sure the contact areas were properly designed with no excess pressure that would disallow any veneer from seating properly. A water-soluble try-in gel (Prevue [Cosmedent]) was used to ascertain the shade of resin cement (Insure [Cosmedent]) used for cementation of the veneers. When Gina and I were satisfied with the preview, the veneers were removed, all try-in paste was washed out, and the veneers thoroughly cleaned. A prehydrolyzed silane ceramic primer (RelyX Ceramic Primer [3M ESPE] was brushed on the pre-etched inner veneer surfaces and allowed to dry. A thin layer of resin adhesive (Adper Single Bond Plus Adhesive [3M ESPE]) was brushed onto the silanated veneer surfaces and air-thinned. The selected shade of resin cement was placed in each veneer in an incisal-gingival direction and all veneers were placed in a covered storage container (ResinKeeper Mixing and Storage Palette [Cosmedent]) to keep the resin cement from setting prematurely.

     The temporaries were removed and the teeth cleaned with pumice (Consepsis Scrub [Ultradent Products]) in a prophy cup. Floss was used to remove any remaining prophy paste interproximally. A final surface cleaning was gently performed using a microetcher (MicroEtcher IIA [Danville]). Then, the prepared teeth were etched with a 35% phosphoric acid gel (Ultra-Etch [Ultradent Products]), rinsed, and dried. A thin layer of the resin adhesive was brushed onto the teeth, air-thinned, and cured. It is this author’s preference to insert both central incisor veneers simultaneously followed by 2 or 3 veneers at a time on one side, then the other side. Each veneer was tacked in place for 2 to 3 seconds with a halogen curing light (Optilux 501 [Kerr Demetron]), gross excess cement removed, and final curing for 60 seconds was done on each veneer. The gingival margins were cleared of any excess. 

     Because Gina had expressed a desire for "more rounded corners" while wearing her temporary restorations, the incisal angles were gently rounded with a very fine diamond (888-012VF [SS White]) and polished (Jazz P3S Porcelain & Metal 3-Step Polishing System [SS White]) to bring the porcelain back to a high luster. Her completed smile is seen in Figure 8, and even more telling are the before and after images seen in Figures 9 and 10. This case started out as a medicolegal and ethical dilemma, but ended with an excellent result that satisfied the patient, giving her a renewed sense of trust.