The Nuts & Bolts of Veneers - cloudfront.net
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9/21/2021
TODD C. SNYDER, DDS, FAACD, FIADFE, ASDA, ABAD
The Nuts & Bolts
of Veneers
1
Todd Snyder, DDS, FAACD, FIADFE, ASDA, ABAD
Laguna Niguel, CA
Aesthetic Dental Designs®
doc@tcsdental.com
Accredited Fellow, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Member of The American Society For Dental Aesthetics
Diplomat of the American Board of Aesthetic Dentistry
Former Faculty, UCLA Center For Esthetic Dentistry
Speaker, Catapult Education
LEGION.dentist, Online Training Challenge for Dentists
Entrepreneur, Software Company Owner, Author/Lecturer, Professional Race Car Driver
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Traditional Veneers
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The Key to Success:
Traditional Veneers
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The Key to Success:
Diagnosis & Treatment Planning
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Do you know “THEIR” desired outcome?
You are selling the Emotion…
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What is the first thing to do for
a veneer case?
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Business
PATIENTS
Deliver
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Tip #1 Business
Attract
PATIENTS
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You, Your Message and Your Uniqueness
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Tip #2 Business
Convert
PATIENTS
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Business
PATIENTS
Deliver
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Tip #3
How Do You Get More Cases?
According to the American Academy of
Cosmetic Dentistry 50% of patients are
unhappy with their smiles and 3 out of 5
people will invest in their smiles.
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Tip
Weave Mobile App
-Same functionality on your cell phone
-From anywhere you have a wifi or cell connection.
Check it out for your self & get paid $50 for just
having a discussion with Weave.
CLICK HERE: http://try.getweave.com/automation/
$50 Gift card for doing a Demo
$500 Visa Gift card for purchasing
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Dear families, friends, and colleagues,
We trust you’ve had a wonderful summer and have been enjoying time with your family! Fall is right around the corner,
and we are coming into the busiest month of the year so if you’re hoping to get in, please call to reserve time with us
sooner rather than later.
If you haven’t already heard Dr. Snyder has opened a satellite office in Las Vegas that he goes to periodically. Rest
assured he will still be seeing patients at our Laguna Niguel office. If you’ve been thinking about improving your smile
and have been curious about what your results could look like we are offering a COMPLIMENTARY digital makeover to
our patients (valued at $140). Now is the perfect time for an upgrade and boost of confidence with the Holidays right
around the corner! Dr. Snyder has 2 cosmetic appointments available for the month of September so please contact us
with any questions and we will help you every step of the way to achieve the smile of your dreams!
We look forward to hearing from you,
Dr. Snyder & Team
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Diagnostic Models & Records
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Silginat - Kettenbach Alginate Alternatives
Counter FIT- Clinician’s Choice
Status Blue - DMG
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Silginat - Kettenbach Alginate Alternatives
Counter FIT- Clinician’s Choice
Status Blue - DMG
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3 Sets of Models
-One is untouched for legal documentation
-Second to practice preparations (It will be waxed up)
-Third is a spare to practice on or make bleach trays
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Mounted and Equilibrated
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Smile Design/Preparation Design:
-What, Where, Why, Apply
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What Records & When
Diagnostic & Prep Reduction Models
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Diagnostic Prep Guides
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Diagnostic Lab Guides
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Veneer Preparations
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Tooth Preparation
Conservative Preparations
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Veneer Preparations
• Depth Cuts
• Tooth Reduction
• Margins
• Retention Form (Line of Draw)
Images from Bruce Crispin, DDS, MS book entitled
“Contemporary Restorative Dentistry”
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Veneer Preparations
• Depth Cuts
• Tooth Reduction
• Margins
• Retention Form (Line of Draw)
Images from Bruce Crispin, DDS, MS book entitled
“Contemporary Restorative Dentistry”
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Veneer Preparations
• Depth Cuts
• Tooth Reduction
• Margins
• Retention Form (Line of Draw)
Images from Bruce Crispin, DDS, MS book entitled
“Contemporary Restorative Dentistry”
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Veneer Preparations-Feldspathic Porcelain
1.0mm-1.5mm incisal
reduction*
Depth cuts of 0.2mm-0.8mm*
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Veneer Preparations-Pressed Ceramics
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Minimal or No Prep Veneers
• Do a waxup
• Duplicate into a stone model
• Over impression of stone model w/ PVS BEADLINE TECHNIQUE or Siltech Putty
• Intraoral mockup using the over impression filled with temporary acrylic**
• Is thickness and appearance okay?
• Depth cuts through over impression if necessary.
• Typically no provisionals are necessary
• No undercuts
• Color change varies based on tooth position/color
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Veneer Preparations
Incisal edge preparations
a) No incisal lengthening
b) Changing color or wear
c) Lengthening tooth
d) Interproximal
a) When to break contact?
e) When to do a crown
Images from Bruce Crispin, DDS, MS book entitled
“Contemporary Restorative Dentistry”
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Veneer Preparations
labial reduction options
Depth Limiting Burs - Brasseler USA
Average enamel thickness
At CEJ .3-.4 mm
Middle third .8-1.0 mm
Incisal third 1.1-1.3 mm
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Veneer Preparations
Preparation Reduction
• Depth reduction burs
• Safe reduction
• Lasco
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Independent Depth Cuts
(Lasco Burs)
▪ Depth Cuts
▪ Tooth Reduction
▪ Interproximal & Margins
▪ Retention Form (Line of Draw)
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Minimal Prep Case
Preparation
Aesthetics
Function
Bonding to Enamel
Material Options
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Minimal Prep Case:
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Wax-up Case:
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Preparation Guides:
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Burs
• Organization
• Diamonds
• Carbides
◼ K0095 Preparation Kit ◼ K0096 Finishing Kit
63 $125.47 each $126.47 each
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Shade Assumptions
BW, B1, B2, A1, A2
Provisional Techniques
-Free hand
-Beadline Provisionals
-Putty over impression of waxup
-Premade temps?
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Review
-Chief Complaint
-Occlusion
-Photographs/Imaging?
-Whiten first
-Waxup/BeadLine Provisional
-Material Selection
-Practice Preps
-Photograph Prep Shade
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EMOTION
Focus on overall appearance
Stay away from little details
“Going to look & feel great”
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Minimal Prep Case
Waxup
Mockup
Preparation
Provisional
Bonding to Enamel
Material Options
Minimally Invasive Veneers….
Why? Benefits??
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Beadline Provisional Mockup
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Mockup
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Depth Cuts
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Photos for Laboratory Technician
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Provisional Restorations
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Final Restorations
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Provisionals Mimic The Final Restorations
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LuxaTemp Ultra (DMG)
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Tooth-like
Shades: translucency and
opalescence
B1, BL ensure optimal
A1,2,3, 3.5 integration into
the existing
High impact dentition thanks
strength, flexural to the chameleon
strength, effect.
diametrical tensile
strength, and Natural
elastic modulus. Fluorescence
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Simplified Provisionals**
Siltech Putty Matrix
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Cosmetic Provisionals (Bead Line Technique)
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
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Cosmetic Provisionals (Bead Line Technique)
Scribe a 0.5mm-1mm groove into tissue & a little on tooth
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Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
No Polish Necessary if you use a good model
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Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
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Impression Trays
HeatWave by Clinician’s Choice
▪ 4 upper & lower trays ▪ Fast, efficient
▪ 60 sec. @ 158°F ▪ Virtually custom
▪ 30% less impression
material used
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Impression Trays
HeatWave by Clinician’s Choice
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Impression Trays
HeatWave by Clinician’s Choice
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Syringe Placement
Dry all teeth in arch
Place tip in most difficult
area first
Keep tip on margin and
immersed in material
Go around entire margin
first
Next go to adjacent teeth
Then do coronal aspect of
teeth
Double Mix Single
Impression is the most
accurate
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Kettenbach
TIP
Panasil Initial Contact (VPS)
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Kettenbach
Panasil Initial Contact
▪ Lowest contact angle of any VPS
impression material
▪ Fast set and Regular set
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Hydrophilicity: angle of contact
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Panasil ® = Hydrophilicity
▪ Hydrophobic water droplet ▪ Hydrophilic water droplet
Lowest contact angle of any VPS impression material
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Panasil® Initial Contact (PIC)
Hydrophilicity Demo
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Hydrophilicity: comparison
Aquasil™ Ultra XLV
120 (Dentsply)
100
Affinis™ light
contact angle [°]
(Colténe)
80
60 Impregum™ Garant™
L DuoSoft™
(3M Espe)
40
Panasil® initial contact X-
20 light
(Kettenbach)
0
Panasil® initial contact light
0 0.5 1 1.5 2 2.5 3 3.5 (Kettenbach)
drop age [s]
Comparison of spreading behavior 30 s after mixing starts within the first 3s
after applying a water drop: relative humidity 50 % - 80 %
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Hydrophilicity: comparison
Aquasil™ Ultra XLV
(Dentsply)
120
100 Affinis™ light
(Colténe)
contact angle [°]
80
Impregum™ Garant™
60
L DuoSoft™
(3M Espe)
40
Panasil® initial contact
20 X-light
(Kettenbach)
0
0 0.5 1 1.5 2 2.5 3 3.5 Panasil® initial contact
light
drop age [s] (Kettenbach)
Contact angle after 30 min at 23°C: relative humidity 50 %
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Kettenbach
Cracked tooth
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Kettenbach
Panasil Initial Contact
▪ Exceptional Flow Properties
▪ Exceptional Detail
▪ Exceptional Performance even in a moist environment
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Kettenbach
Panasil Initial Contact
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"Best of Two Worlds" Kettenbach
Identium(Vinylsiloxanether-VSXE)
Identium® is developed especially for the single impression technique and
combines the best of the two worlds: all advantages of conventional
polyether materials paired with those of A-silicones.
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Identium®: the Vinylsiloxanether
The best of polyether:
▪ High degree of precision
▪ Dimension stability and
▪ Detail reproduction.
▪ Well-developed flow properties
▪ Low contact wetting angle
▪ Long working time
▪ High final hardness
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Kettenbach
Identium for single teeth
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Identium for multiple teeth
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Identium for multiple teeth
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Identium for multiple teeth
Make cases easy
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Make cases easy, make your patients happy
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Make cases easy, make your patients happy
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AESTHETIC TEMPORARY CEMENT
ClearTemp LC-Ultradent
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Mixed Provisionals
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• 1) Implant screw retained.
• 2) #6, #8, #10 Cement with Doxa Ceramir
• 3) Bisco All Bond Universal Adhesive & Choice 2 Trans Veneer Cement
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Calcium Aluminate/Glass
Alkaline pH 8.5 Ionomer Hybrid Cement**
Moisture Tolerant
Self Sealing
Apatite Formation
Insoluble/No Degredation
Stronger with time
Semi / Translucent
Biocompatibility-Excellent
Bioactivity-Apatite formation
No silane, conditioning, bonding
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Bioactivity Calcium Aluminate/Glass
Ionomer Hybrid Cement**
A reactive bioactive system that
contributes to hydroxyapatite
mineralization of hard tissue
through ion release and alkaline
pH.**
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Cementation Technique
Calcium Aluminate/Glass
Ionomer Hybrid Cement**
Mix for 8-10 seconds
.17ml vs single cap .10ml
3-4 restorations
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Lithium Disillicate (eMax)
• Cleaning
w/phosphate
scavengers is not
necessary
• Silane is
contraindicated
• Tooth etching or
conditioning is not
necessary
• Bonding agent is not
needed
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CEMENTATION TECHNIQUE
139
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Crown Retention
Results Zirconia crowns (Kg/F)
35
30
25
20
15
10
5
0
Ceramir Crown & Bridge RelyX Unicem (3M) Dyract Cem (Dentsply) Rely X Luting (3M)
Material Result (Zirconia crowns) Kg/F
Ceramir Crown & Bridge 32.1 ± 6.3
RelyX Unicem (3M) 27.8 ± 11.3
Dyract Cem (Dentsply) 12.2 ± 3.1
Rely X Luting (3M) 10.9 ± 6.5
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Cement Selection
Three year recall data yielded no loss of retention, no
secondary caries, no marginal discoloration, and no
subjective sensitivity. All restorations rated excellent for
marginal integrity.
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Cement Selection
Journal of Esthetic & Restorative Dentistry March 2015
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Technique Research/Literature**
Simplify Cementation Moisture Tolerant
-Silane is contraindicated No Sensitivity
-Restoration does not have Alkaline pH
to be cleaned after tryin
Apatite Forming
-Tooth etching or
Insoluble
conditioning is not necessary
Stronger With Time
-Bonding agent is not
needed Self Sealing
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679/21/2021
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Beadline provisionals that are locked on.
167
Removing provisionals that are locked on.
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Removing provisionals that are locked on.
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Nine Years Later
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REVIEW
• Full arch impression Heat Wave Tray
• Record or Diode laser
• Light & Heavy Body Impression Material
• Bead Line Provisional Technique uses no temp cement or adhesives,
mechanical retention, shrink wrapped
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RESIN CEMENT COSMETIC CASES….
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COSMETIC CASES….
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COSMETIC CASES….
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COSMETIC CASES….
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PROVISONALS
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PROVISIONALS
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CERAMIC TRY-IN
• Make sure it is etched properly from lab
Try-in
Decontaminate
Rinse
Prime
Cement
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Silanes
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TRYIN APPROVAL
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Uni-Etch is a 32% semi-gel phosphoric acid etchant available with
Benzalkonium Chloride (BAC) and designed for etching tooth structure
prior to bonding.
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• Light-Cured Dental Adhesive
All-Bond Universal is a universal adhesive it can be used with direct and indirect restorations and is
formulated to be compatible with light-, dual- and self-cured materials. The versatility of All-Bond
Universal makes it an indispensable part of any dental practice.
• Unique Benefits:
• Not moisture sensitive use on wet, dry or moist tooth structure
• Impressive bond strength to ALL substrates
• Use with ALL direct and indirect restorations (9/21/2021
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839/21/2021 CHOICE 2 VENEER CEMENT (BISCO) - Light-cured luting cement designed for cementation of porcelain veneers. - Color stability. - Corresponding try-in pastes (sold separately) - Choice 2 is specifically formulated for color stability (Delta E
9/21/2021
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FINAL RESTORATIONS
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859/21/2021
Who are you?
Who and What
do you want?
PLAN
How will you
achieve it?
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Business
PATIENTS
Deliver
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MARKETING
https://www.legion.dentist/singularity
204
Case
Acceptance,
Communication,
Sales Training
Learn how to help patients say yes
to treatment and financing
https://www.legion.dentist/inception
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879/21/2021
Legal Documentation
Signed treatment plan
I.C. RBAs
Arbitration agreement
Driver’s License
Headshot in your office
Paid prior to starting appointment
Waxup signed off as approved
Temps signed off as approved
Final appearance at tryin approved giving consent to cement as final.
Document discussion of wearing a clear aligner or night guard and having
discussed OSA. OHI. Eating and Habits.
206
YOUR FUTURE
BEGINS NOW!
QUESTIONS?
TSNYDER@LEGIONPRIDE.COM WWW.LEGION.DENTIST TODD C. SNYDER, DDS, FAACD
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