As patients get older, anterior teeth commonly show wear, chipping and discoloration. These changes are the result of a number of factors because of aging. There is increased aware- ness of these unattractive teeth and the desire to have a more youthful appearance. Because of the recent media attention to changing ones appearance with veneers, there is a much greater demand to have cos- metic dentistry done. Over the years in the practice of dentistry, I have developed products and techniques that have improved my practice significantly. I wasn’t aware that other dentists might not be as innovative. It wasn’t until I took on an associate, who had been in prac- tice for 18 years, and he informed me that these were new ideas to him as well as to other dentists he knew. I’ve done veneers for more than 25 years and developed a technique that can make a single veneer blend so naturally with the other teeth that it is undetectable. Various nuances in technique make preparing and bond- ing veneers quick and easy. I have a CEREC machine that works especially well for a single veneer. Six or eight veneers have been done on the CEREC, but it is rather time consuming. Two or three cases of the same number of teeth could have been prepared, impres- sions taken and sent to a lab in the same time frame. It is more cost effec- tive to use a lab. But you have to have the best lab available to do this if you expect perfect results. Feldspathic porcelain is the only material that will look natural. Pressed ceramics will look more opaque, somewhere between a PFM and a natural tooth. If the patient wants glaring white, then do it that way. Feldspathic porcelain can be just as white and one can adjust the color by the bonding composite used under the veneer. Very little shade adjustment can be done under pressed ceramic porce- lain. Flowable composites work the best and come in many shades, which makes shade adjustments easy. The flowable composite by Kerr has the right consistency for veneers and the company has the strongest bonding agent, called OptiBond Solo. The preparation requires only a lit- tle more than 0.5 mm of reduction so that it doesn’t go through the enamel, if possible. The bond is the best on enamel. There should be the same reduction over the total facial surface for the lab to make a perfect veneer. Cut three or four depth grooves of 0.5 mm then remove the enamel to the grooves. If instant orthodontics is the treat- ment, then some teeth may need to light to shine in between. Shield the rest of the veneers with your hand so that the light will not set any of the other composite except the inter- proximal space between veneers #5 and #6. Cure for only two seconds. Now cure the distal of veneer #5 for two seconds. Move your hands to veneers #6 and #7, shielding the rest of the veneers and holding veneer #5 and #6 in place, leave just enough room to cure the space between #5 and #6 for two seconds. Repeat the same process for the rest of the veneers, moving from #7 to #8 and so on until all of the inter- proximal spaces have been cured for two seconds each, including the distal of the last veneer on the other side. Now cure the center of each veneer for two seconds and then the lingual incisal of each for two seconds also. If cured more than this, it is very dif- DENTAL TRIBUNE | September 2010 Clinical 25A By L. Emery Karst, DDS Making a single veneer blend so naturally it’s undetectable g DT page 26A be reduced more and some maybe hardly any. Run the prep interproxi- mally from gingival to incisal to hide the margin visually, but not breaking the contact point. The gingival margin should be at the gingival crest or a little below. It should have a champher for ease of finishing precluding any chip- ping at the margin. Some dentin will show through at the gingival mar- gin because the enamel is less thick there. If there is room, insert a thin piece of gingival braid, which can be left there during the impression. Reduce the incisal about 1 mm so the finish line is on the lingual, and round the incisal-facial junction so that there are no potential fracture lines in the veneer. When the veneers come back from an excellent lab there should be little or no adjustments necessary before bonding them on to the teeth. Etch them with hydrofluoric acid gel for at least three minutes. Rinse them thoroughly then neutralize them with a baking soda slurry and then rinse them thoroughly again. Dry them with a dry air source until a chalky appearance is visible on the interior of the veneer. Ceramic primer is then applied for one minute. Dry until it is chalky again and apply another coat of ceramic primer. Leave the primer on while the teeth are etched with phosphoric acid gel for 30 seconds. Rinse thoroughly and dry the teeth and veneers until a chalky appearance shows on both. Turn the operatory light off and then apply bonding on the teeth and the veneers. Place the flowable com- posite into the veneers one at a time for the dentist to place. Place all of the veneers and be sure they are correctly situated. With two hands, hold the distal two veneers (#5 and #6) in place leaving a space only large enough for a curing Fig. 1a: Before Fig. 2a: Before Fig. 3a: Before Fig. 2b: After one veneer on tooth #8. Fig. 2b: After Fig. 3b: After