BONDING CERAMIC VENEERS

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1 BONDING CERAMIC VENEERS LAMINATE PREPARATION Make sure the porcelain veneers (1) have been properly etched and cleaned (no salt). Apply silane after etching of (2) porcelain or as soon as you receive the porcelain veneers. ( use a two part silane ). Allow silane in place for seconds. Use a gentle flow of air to remove the excess of silane Do not allow silane to reach the (3) facial surface of the veneer. Try silanated veneers on the cast (4) and next on teeth. Use Bite-X to identify the seating (5) interferences if the veneer does not fit. All adjustments must be done on the tooth. DO NOT adjust the inside of the veneer. 1

2 Do not use hydrofluoric acid to (6) re-etch the veneers. Place an appropriate shade of (7) luting resin in laminates. Do not use shaded try-in paste to (8) try in the veneers. Studies have shown lack of consistency between the colored try-in paste and that of luting resin. Try-in veneers on the teeth with (9) resin in place. Redirect the overlight as luting resin is very sensitive to light. Examine: (10) If color is desirable, remove, clean with acetone, and proceed to step #14. If the color is not desirable, remove veneers, wipe out resin and select another shade. If necessary, use appropriate (11) shades of tints modify the shade and enhance the esthetic outcome. 2

3 Clean try-in composite from inside (12) veneers with acetone using two separate beakers. It is not necessary to re-salinate (13) the veneers. Apply a very thin layer of porcelain bonding resin inside the veneer followed by a copious amount of the appropriate shade of luting resin. Place the loaded veneers under the cover. Note: Load 2 veneers at one time. Start with #8 and #9. Mouth Preparation for Bonding Clean the prepared teeth with (14) "oil-free" pumice. Avoid subgingival pumicing. Isolate #8 and #9 with two pieces (15) of shim stock or foil. The shim stock must remain in place until etching and priming of teeth #8 and #9 is completed. Etch enamel and dentin for (16) 30 seconds, rinse thoroughly for 10 seconds. 3

4 Use a gentle blast of air to remove (17) the excess water. Do not dry the teeth. Post-operative sensitivity as a result of over-drying has been reported in the literature. If the etched teeth are accidentally (18) over-dried, moisten teeth with water. Use a 4th generation dentin (19) bonding agent ( All-Bond 3 or All-bond Universal ) on both enamel and dentin. Paint two coats and remove the excess solvent with a gentle flow of air. Light-cure for 10 seconds. With patient in a supine position, (20) carefully place the veneers on the two centrals. DO NOT completely seat one veneer at a time Gently guide the two veneers into (21) place. Do not use hard finger pressure. DO NOT rock the veneers once they are in place. Make sure that excess resin (22) appears at margins. If not, remove veneers and add resin. 4

5 Light cure each veneer for 1 (23) second or less. Choice 2 LC is very sensitive to light. It is critical to dislodge and not (24) fully remove the excess resin particularly from the distal of the bonded veneers. Use the #12 blade to dislodge the excess resin from the labial of the veneers. It is not necessary to completely remove the excess resin at this time as it may cause dislodgement of the veneers. If hemorrhaging starts, proceed (25) quickly with curing. Light-cure each veneer for 20 seconds from facial and 20 seconds from lingual. Use the #12 blade to remove all (26) residue of resin from the facial and the distal of the bonded veneers. DO NOT remove the excess from the gingival direction as it may chip the margins of the veneers. 5

6 Note: DO NOT try to remove the (27) excess cured resin between #8 and #9 at this moment. Removal of the residue of the hardened cured resin may cause wedging and movement of #8 and #9 which will interfere with seating of adjacent veneers. Repeat procedures for two veneers (28) at a time, moving distally from the centrals. Finish the margins with a (29) finishing bur, then polish with diamond paste. Keep diamond paste off root (30) surface as it will strip cementum and cause post-bonding sensitivity Do not scratch the veneer with (31) the finishing bur. Keep the bur on the margin. Any cured resin on the facial of the bonded veneers must be removed with #12 blade. 6

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