Postgraduate Clinic, Faculty of Dentistry, Universidad de los Andes UANDES, Las Condes, Santiago, Chile

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1 AESTETHIC DENTISTRY ADHESIVE CEMENTATION OF PARTIAL VENEERS Eduardo Mahn 1a* 1 Postgraduate Clinic, Faculty of Dentistry, Universidad de los Andes UANDES, Las Condes, Santiago, Chile a DDS, DMD, PhD, Director of Clinical Research, Director of the Esthetic Dentistry Program Received: February 27, 2017 Revised: March 09, 2017 Accepted: April 02, 2017 Published: April 03, 2017 Cite this article: Cite this article: Mahn E. Adhesive cementation of partial veneers. Stoma Edu J. 2017;4(1):xx-xx. ABSTRACT Aim: The case presentation aim to offer a solution for aesthetically cement porcelain veneer. Summary: A case presentation with partial porcelain veneers on anterior superior central incisors is presented. The cementation technique is explained and showed in images. The advantages of the cement Variolink Esthetic for using in veneer applications are emphasized. Key learning points: For a case with partial veneers, Variolink Esthetic is an excellent choice, providing a strong cementation with aesthetic results. Keywords: porcelain veneers cementation, aesthetics, Variolink Esthetic. 1. Introduction The desire for aesthetically pleasing, minimally invasive and perfectly matching anterior restorations has existed since the beginning of dentistry. Only recently, however, has it become possible to translate this desire into reality 1. For many years, dentists were struggling with the opacity of PFM crowns before all-ceramic crowns became available. However, these ceramic materials were not resistant enough to be suitable for less invasive indications. Finally, ceramic veneers were launched 2. Veneer preparations are far less invasive than crown preparations - some preparation was nonetheless still needed. In addition, the veneers had to be designed in such a way that they covered the entire buccal surface 3. However, given the advancements in ceramic technology and the luting composites available today, it is now possible to use partial veneers and to insert them without any difficulty 4. Partial veneers are ceramic veneers that only cover that part of the tooth that is missing, broken off or abraded. As a result, the tooth warrants only partial preparation or none at all 2. This approach has become feasible for two reasons: 1. New ceramic materials are available. Dental technicians have now the option of layering any ceramic restoration. They can choose to use a fluorapatite ceramic material such as IPS e.max Ceram or to press the restoration from a highly translucent ingot such as the Opal or HT ingots of the IPS e.max Press range 5,6. 2. Luting composites have improved. A wide range of modern esthetic cements have become available. They are offered in several degrees of brightness to match them to the brightness of the natural teeth being restored with a veneer or partial veneer 7,8,9. In addition, these luting composites contain newly developed photoinitiators which improve their curing capabilities and long-term shade stability 10,11,12,13,14,15. The ceramic material selected for a restoration depends on the size of the defect and/or the optical effects and stability that the dentist intends *Corresponding author: Dr Eduardo Mahn, DDS, DMD, PhD, Director of Clinical Research, Director of the Esthetic Dentistry Program, Postgraduate Clinic, Faculty of Dentistry, Universidad de los Andes UANDES, San Carlos de Apoquindo 2200, Las Condes, Santiago, Chile. Tel: / Fax: , emahn@miuandes.cl 1

Figure 1 Preoperative situation Figure 2 Close-up of the preoperative situation Figure 3 Prepared teeth Figure 4 Selecting the shade of the luting composite: Variolink Esthetic LC in shade Warm

The layering technique is likely to be the first choice for teeth featuring multiple optical effects.

When it comes to selecting a luting material for veneers and partial restorations, Variolink Veneer from Ivoclar Vivadent is bound to be the first choice for many dentists 4.

The Effect shade concept on which the five shades of the product are based enables the dentist to adjust the shade effect of the restoration to make it appear warmer or brighter, as required 4.

The composite comprises the newly patented light initiator Ivocerin, which provides the cement with long-term shade stability 7.

2 Figure 1 Preoperative situation Figure 2 Close-up of the preoperative situation Figure 3 Prepared teeth Figure 4 Selecting the shade of the luting composite: Variolink Esthetic LC in shade Warm Figure 5 Try-in of both partial veneers Figure 6 Before seating the veneers: adjacent teeth covered with Teflon tape and separation with a Mylar strip to achieve. The layering technique is likely to be the first choice for teeth featuring multiple optical effects. If large partial veneers that do not warrant special effects but include the entire incisal edge are required, a high-strength ceramic such as lithium disilicate is a likely choice 1. When it comes to selecting a luting material for veneers and partial restorations, Variolink Veneer from Ivoclar Vivadent is bound to be the first choice for many dentists 4. Not long ago, the successor product, Variolink Esthetic, has been launched. This luting material is available in a dual-cure and light-cure version. The Effect shade concept on which the five shades of the product are based enables the dentist to adjust the shade effect of the restoration to make it appear warmer or brighter, as required 4. In addition, the shade effect can be checked prior to the final cementation with the help of try-in pastes in the corresponding Effect shades. The composite comprises the newly patented light initiator Ivocerin, which provides the cement with long-term shade stability 7. In addition, Variolink Esthetic is easy to use due to its flexible situational consistency and easy clean-up characteristics. The clinical report below describes the insertion of two partial veneers seated with Variolink Esthetic LC in the shade Warm. 2. Clinical case A 46-year-old male patient visited our practice with the request to have his 20-year-old Mirage partial veneer replaced. He was convinced that the veneer needed replacing because of the wear of the adjacent central incisor (Figs. 1 and 2). It was decided to use partial veneers to improve the situation. Figure 3 shows the preparation 2

Figure 7 Enamel etching for 20 seconds Figure 8 Followed by

Figure 9 Rising with water spray Figure 10 Applying Adhese

procedure Figure 12 Applying Variolink Esthetic LC Warm to

Figure 14 Careful removal of excess cement using a brush

max Press HT) from the lab, we used the Variolink Esthetic

Then, a Mylar strip was placed between the teeth (Fig. 6).

3 Figure 7 Enamel etching for 20 seconds Figure 8 Followed by dentin etching for 10 seconds. Figure 9 Rising with water spray Figure 10 Applying Adhese Universal bonding agent Figure 11 Close-up of the bonding procedure Figure 12 Applying Variolink Esthetic LC Warm to the partial veneers Figure 13 Seating the partial veneers Figure 14 Careful removal of excess cement using a brush performed on the teeth. Once we received the veneers (IPS e.max Press HT) from the lab, we used the Variolink Esthetic Try-In pastes to determine a matching cement shade for the final cementation. In this specific case, we achieved the best result with the shade Warm (Figs. 4 and 5). Next, the neighbouring teeth were covered with Teflon tape. Then, a Mylar strip was placed between the teeth (Fig. 6). The enamel was etched for 20 seconds and the dentin for 10 seconds (Figs. 7 and 8), followed by rinsing with water (Fig. 9). Then, Adhese Universal was rubbed in and allowed to react for 3

Figure 15 Light curing for 5 seconds from both side Figure 16 Final light curing with two Bluephase Style lights whilst cooling the teeth with water spray Figure 17 Excess removal using a scalpel

12 and 13). Excess cement was carefully removed with a brush before light curing (Fig. 14).

Figure 18 Postoperative view To save time, final curing was also conducted with the help of two Bluephase Style lights as each side had to be light cured for 30 seconds (Fig. 16).

damage to the pulp. It is therefore prudent to cool the teeth with water spray, as shown in Fig. 16. After light curing, any remaining excess cement was removed using a scalpel (blade no.

$Guess PC, Schultheis S, Wolkewitz M, Zhang Y, Strub JR. Influence of preparation design and ceramic thicknesses on fracture resistance and failure modes of premolar partial coverage restorations.$

4 Figure 15 Light curing for 5 seconds from both side Figure 16 Final light curing with two Bluephase Style lights whilst cooling the teeth with water spray Figure 17 Excess removal using a scalpel (blade no. 12) Figure 19 Close-up of the final result after four weeks 10 seconds (Figs. 10 and 11). Variolink Esthetic LC Warm was applied to the partial veneers before they were seated (Figs. 12 and 13). Excess cement was carefully removed with a brush before light curing (Fig. 14). The veneers were first illuminated simultaneously from both sides for five seconds using two Bluephase Style curing lights (Fig. 15). Figure 18 Postoperative view To save time, final curing was also conducted with the help of two Bluephase Style lights as each side had to be light cured for 30 seconds (Fig. 16). Since light curing for this length of time with two curing lights operating at a light intensity of 1,100 mw/cm² may result in a considerable heat buildup, there is a potential risk for causing damage to the pulp. It is therefore prudent to cool the teeth with water spray, as shown in Fig. 16. After light curing, any remaining excess cement was removed using a scalpel (blade no. 12) and then the surface was polished (Fig. 17). The final result after four weeks is shown in Figures 18 and Conclusions In veneer cases, especially, partial porcelain veneers, the cement Variolink Esthetic LC provides a strong luting capability, but also an excellent aesthetic result. REFERENCES 1. Guess PC, Schultheis S, Wolkewitz M, Zhang Y, Strub JR. Influence of preparation design and ceramic thicknesses on fracture resistance and failure modes of premolar partial coverage restorations. J Prosthet Dent. 2013;110(4): Murgueitio R, Bernal G. Three-year clinical follow-up of posterior teeth restored with leucite-reinforced ips empress onlays and partial veneer crowns. J Prosthodont. 2012;21(5): Vadini M, D Amario M, De Angelis F, Falco A, D Arcangelo C. No-Prep Rehabilitation of Fractured Maxillary Incisors with Partial Veneers. J Esthet Restor Dent. 2016;28(6): Alqahtani FI. Effect of newly Developed Resin Cements and Thermocycling on the Strength of Porcelain Laminate Veneers. J Contemp Dent Pract. 2017;18(3): Fradeani M, Barducci G, Bacherini L. Esthetic rehabilitation of a worn dentition with a minimally invasive prosthetic procedure (MIPP). Int J Esthet Dent. 2016;11(1): Monaco C, Cardelli P, Bolognesi M, Scotti R, Ozcan M. Inlayretained zirconia fixed dental prosthesis: clinical and laboratory procedures. Eur J Esthet Dent. 2012;7(1): Sampaio CS, Barbosa JM, Cáceres E, et al. Volumetric 4

shrinkage and film thickness of cementation materials for veneers: An in vitro 3D microcomputed tomography analysis. J Prosthet Dent. 2016. pii: S0022-3913(16)30441-3. 8.

5 shrinkage and film thickness of cementation materials for veneers: An in vitro 3D microcomputed tomography analysis. J Prosthet Dent pii: S (16) Heintze SD, Rousson V, Mahn E. Bond strength tests of dental adhesive systems and their correlation with clinical results - A meta-analysis. Dent Mater. 2015;31(4): Rosentritt M, Hmaidouch R, Behr M, Handel G, Schneider- Feyrer S. Fracture resistance of zirconia FPDs with adhesive bonding versus conventional cementation. Int J Prosthodont. 2011;24(2): Rosentritt M, Kolbeck C, Handel G, Schneider-Feyrer S, Behr M. Influence of the fabrication process on the in vitro performance of fixed dental prostheses with zirconia substructures. Clin Oral Investig. 2011;15(6): Hajtó J, Gehringer U, Özcan M. A multi-faceted treatment approach for anterior reconstructions using current ceramics, implants, and adhesive systems. Eur J Esthet Dent. 2010;5(3): Edelhoff D, Özcan M. To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation. Clin Oral Implants Res. 2007;18 Suppl 3: Review. Erratum in: Clin Oral Implants Res. 2008;19(3): King ML, Aboush YE. Effect of adhesive resin cement on design of partial veneer crowns. J Prosthet Dent. 1999;82(2): Fahl N Jr, Casellini RC. Ceromer/FRC technology: the future of biofunctional adhesive aesthetic dentistry. Signature. 1997;4(2): Liebenberg WH. Multiple porcelain veneers: a temporization innovation--the peripheral seal technique. J Can Dent Assoc. 1996;62(1): Eduardo MAHN DDS, DMD, PhD, Director of Clinical Research Director of the Esthetic Dentistry Program Postgraduate Clinic, Faculty of Dentistry Universidad de los Andes - UANDES Las Condes, Santiago, Chile CV Dr Mahn is a graduate from the University of Chile. He received the German DDS in Münster in He got his doctorate degree in He also owns a Diploma from NYU. Between 2007 and 2009 he worked for Ivoclar Vivadent at the ICDE (International Center for Dental Education). He is presently a guest lecturer at several universities and is the author from several articles in the field of Esthetic Conservative Dentistry and Implantology. Dr Mahn is presently Director of Clinical Research and the Director of the Esthetic Dentistry Program at the Universidad de los Andes, Chile. He also mantains a private practice emphasizing conservative esthetic dentistry and comprehensive implantology. Questions What porcelain was used for these veneers? qa. IPS Empress; qb. IPS e.max Ceram ; qc. IPS e.max Press; qd. IPS e.max Press HT. What cement was used in this case? qa. Variolink Esthetic LC ; qb. Variolink Veneer ; qc. Variolink Ultra ; qd. Multilink Automix. What colour of the cement was used? qa. Warm; qb. Light; qc. Warm +; qd. Neutral. What curing light was used in this case? qa. Bluephase G2; qb. Bluephase 2 Oi; qc. Bluephase Style ; qd. Bluephase Style 2 Oi. 5

Two approaches, one goal: Digital expertise versus manual skill in the fabrication of ceramic veneers

C L I N I C A L Two approaches, one goal: Digital expertise versus manual skill in the fabrication of ceramic veneers Eduardo Mahn 1 Recently developed restorative materials have opened up a myriad of