Exploring Minimally Invasive No Prep Veneers: A Case Study by Dr. Jason Olitsky
Case Background:
Cristina, a 34 year old female patient came to the office for porcelain veneers. She wanted a bigger and brighter smile. She was referred by another patient who was posting about her experience at our office getting no preparation veneers and wanted to know if she was also a good candidate for the treatment.
Preparation and Veneers:
We took several pictures at her consultation appointment and evaluated the alignment, tooth size, labiodental dynamics, facial aesthetics and tooth color. When evaluating patients for no preparation veneers it is important to specifically study the tooth size and shapes as well as the lip shape and size. Patients with smaller tapered teeth that are in alignment are better candidates than people with teeth that are out of alignment. It is typical to have patients align their teeth prior to getting the treatment. Lips that are larger create a bigger frame for the teeth and can support larger teeth that still fit the frame. They also create an umbrella effect on the maxillary anterior teeth that hide the teeth and create a reduction in value to the teeth.
IO scanning was completed with an Itero and sent to the technician to create an additive design to the smile to simulate the new smile with the new restoring volume added to the teeth. This design is used to create a preview of the new smile before final analog impression are made of the teeth for the veneer fabrication.
When the patient returned to bond in the porcelain veneers, they where first tried in one at a time for fit, then all together with try-in paste. This appointment is completed with no anesthetic. The ceramist followed the provisionals very closely adding their own touches to improve the case. The patient was able to approve the aesthetics from pictures taken during try-in.
Delivery of the feldspathic restorations is performed under rubber dam isolation with care to protect the fragile porcelain from fracture during clean-up. A size 000 cord is placed to displace the gingival margin slightly and allow for ideal isolation and margin finishing post cementation.
The patient is thrilled with her new smile done with no drilling on her natural enamel!
Conclusion:
Our patients who are considering porcelain veneers are frequently concerned about the removal of healthy tooth structure that usually accompanies the treatment modality. Misunderstanding regarding no-preparation porcelain veneers less than ideal aesthetics and periodontal complications as a consequence of over contoured teeth. Despite the fact that the vast majority of patients who receive porcelain veneers today do get their teeth prepared by dentists, there are a significant number of patients who can benefit from veneer options that do not include removal of any tooth structure or at least very minimal amount of enamel contouring. The majority of instruction for porcelain veneer treatment focuses on traditional tooth preparation for delivering pressed or milled ceramics.
Since then, adhesives protocols and veneer fabrication techniques by laboratories have steered practitioners into providing minimal thicknesses to comply with the newer fabrication techniques which boast higher flexural strengths and easier fabrication by the laboratory. The downside is the increased reduction of natural tooth and potential compromise to the beauty of the final results.
Patients who are interested in pursuing porcelain veneer treatments are often times concerned about removal of tooth structure related to the treatment and would prefer to have the service done without any tooth preparation. The popularity of social media enables potential patients to get more information the procedures related to getting porcelain veneers and platforms often depict tooth over preparation as a necessary step in achieving a beautiful new smile. In the early 1980’s tooth reduction was not an issue. Feldspathic porcelain was the only modality for fabrication of porcelain veneers and enamel bonding was mandatory for retention of the restorations. Despite alternative ceramic veneer fabrication techniques ranging from printing, to pressing and milling, feldspathic porcelain fabrication methods of refractory and foil have the ability to provide the most natural looking result in the the thinnest restorations. Case selection for these types of no preparation veneers is very important to enable a successful outcome of beautiful and life-like restorations.
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