In part 1 of this series, I outlined the steps I took for a case with a patient who had interproximal spaces between many undersized anterior teeth. I paused the conversation at the diagnostic wax up and the initial reduction. Now, I’ll talk about my process from that point on.
The Porcelain Preparation & Lab Process
Transferring the diagnostic wax-up over the existing dentition allowed the preparation process to occur from the ideal final restoration position. This ensured the most uniform, consistent reduction. It also prevented both over and under reduction to existing dentition.
The transferred mock-up functioned as a laser guide for proper placement of gingival zeniths. Once the patient approved the mock up, anesthesia was given.
Once the correction of the gingival heights was completed, I placed initial reduction depth guides using a .3mm reduction bur in the gingival, middle, and incisal thirds of the teeth. Material selection and preoperative preparation color depended on the desired final shade. They determined the ideal reduction depths.
Proper case planning with a laboratory was essential to achieving an excellent result. I completed incisal reduction with a 1.5mm diamond. After this, I removed the mock up. I also finished and polished the preparations.
Due to the interproximal spaces present with undercuts on the adjacent teeth and the goal of changing the mesial/distal width, contact was broken between the maxillary anterior six teeth. I placed interproximal elbow preparations in the premolars and preserved the contacts.
Each prep should follow the papilla and extend to the proximal contact. It is crucial to rely on preparation shade tabs and photos. This is a necessary communication tool for the laboratory. That way, the correct ingot (pressed ceramics) or porcelain shades (feldspathic ceramics) could be selected. Finally, I took VPS impressions.
How do you approach a porcelain veneers case? Please let us know your thoughts in the comments!