Conservative Porcelain Veneer: Step by step protocol for ideal preparation

Abstract

Since the 1930s laminate veneers have been commonly used to improve appearance of teeth, but they did not become popular until enamel etching and porcelain surface treatments made them more clinically predictable in the 1980s.1 Over the years, they have been indicated to modify the color, shape, length and alignment of teeth to improve their esthetic appearance. Contraindications include severely discolored teeth and lack of enamel remaining to support the restoration.3 Treatment planning is the first step to ideal veneer preparation, which involves determining the incisal edge position, shape and proportions of the teeth being restored. This information is obtained form the diagnostic wax-up and subsequent esthetic mock-up. Veneer preparations often follow one of two common reduction patterns: conservative or standard. The difference between the two being the amount of tooth structure removed. The conservative approach involves reduction of 0.3 mm gingival third, 0.5 mm middle third, and 0.7 mm incisal third; or no reduction may be required. The standard preparation typically follows a reduction pattern of 0.8 mm gingival, 1.0 mm middle, and 1.2 mm incisal. Incisal reduction can be characteristic of either technique to allow room for the addition of incisal effects such as halo and translucency. In order to ensure porcelain veneers have the maximum lifetime expectancy, it is imperative to have preparations entirely in enamel. Bonding porcelain veneers to enamel increases their fracture strength. 2 Based on the best available evidence the ten year survival rate for porcelain veneers is at around 95% if bonded to enamel.1 Maxillary midline diastemas (MMD) are present in 28% of the population, and 87.5% of females with a midline diastema are dissatisfied and seek treatment.3 This clinical report focuses on the clinical management of a maxillary midline diastema (MMD) with porcelain veneers through a conservative preparation and incisal reduction.