Prepless Veneers

Part 5 - Cleaning up your final DURAthins.

Instructors:

Dr. Dennis Wells, DDS 

Dr. Dennis Wells, DDS

Dennis J. Wells, DDS, founder of the Nashville Center for Aesthetic Dentistry, is a graduate of Harding University and the University of Tennessee Dental School. He received his accreditation with the American Academy of Cosmetic Dentistry (AACD) in 1994, and has since served as an examiner for the AACD accreditation process.

Once all of the excess cement is cleaned satisfactorally, then the whole case is preliminarized.

Then we are going to use the precision floss and then gently pass floss through each one of these contacts. You know there is an element of this type of dentistry that is really hard to teach, the rules, you know dentist like to have, well you do this and then you do that, they like the cookbook format, we all do. But this is a great situation where passing the floss through here was probably not the right thing to do. Many times passing the floss through will pull that cement a little bit away from the margin and it’s real easy to pass once they’re cured, it’s real easy to pass something through here. Now we probably caused more harm than good but in many cases it works out well.

So once we have carefully cleaned all of the excess cement to our satisfaction, then of course we are going to preliminarize the whole case and we just have been very careful through this process. Again, not to elicit any hemorrhaging and problems with the tissue and we have tried to be certain that we have not disturbed the cement margin interface there that we have been able to clean the excess away where we know that we can do a nice speedy job on the clean up and still accomplish the goals we are looking for aesthetically.

Ok, so now we’re applying our glycerine to manage the oxygen inhibited layer and we’re going to do real deep and intense puliminarzation now and then we will begin our final clean up. So once we have puliminarized the case completely and we are down to doing some clean up and cement removal. First, I start with just a scaler and do any gross clean up there and then we are going to come back in just a moment and use a 12 fluted carbide bur which will work real well to go in and clean up the cement without putting undue scratches or compromises on our tooth or ceramic. One thing that I would love to point out is that right after we just do a gross clean up with a scaler and we come around and feel these margins contrary to what one might think since there is no margin or preparation for the ceramist to build to, you might think that there would just be this gigantic ledge or certainly a margin that we would not be happy with. But the fact of the matter is that the way that these are made, I can go in and feel the margins and they do not feel distinctly different from a conventional veneer case that I just cemented. And then once we are through with the marginal finishing procedure then they will actually be just the same if not even not a little bit better marginal interface and emergence profile than with conventional veneers.
So here is a close-up and I’m actually running my explorer down these margins after just the rough clean up and notice how there is nice marginal detail here and fairly nice emergence profile before we even touch the porcelain or the teeth with a bur. That is so exciting, that gives us a very nice place to start and then with a little bit of finishing with rotary instruments we’re going to be able to make that emergence profile just as nice and in some cases a little nicer than conventional veneers that have had marginal placement done on the teeth.
So once we have done all the gross debridement there and removed a majority of the cement we are going to come back with our 12 fluted carbide bur that are flamed shaped and we are going to go in and very carefully with three power magnification, we bumped our magnification up a little bit, carefully go around the margins and remove the cement and even slightly smooth the porcelain. Basically try to blend the cement, enamel interface to where you can’t feel that anymore with an explorer. Once we have done some initial clean up with the rotary instruments we are going to come back with our cerasaw by Denmat and just open up the contacts here. Again, we are doing this without any anesthetic so we want to be real careful. If we have done our clean up really nicely then this shouldn’t be too difficult. Once we have completed the cleaning and marginal smoothing with the carbide burs then we are going to go to a football diamond and finish the underneath interface between the porcelain and the tooth being careful not to be too aggressive here but we really want a great smooth margin here lingually. Once we have completed the lingual smoothing then we want to come back and do our marginal finessing as we would call it and we will start with a very thin, pointed finishing diamond and we are going to take our margins to the next level and emerge this profile by very carefully smoothing and blending that so that there is no detection at this point with the explorer as we go from the porcelain to the tooth. Explorer, please. And we’ll be very careful and check this tooth by tooth and be certain that we cannot feel any interruption between the porcelain veneer and the enamel. So now that we have broken between all the contacts, we’ve successful cleaned the margins and smoothed and blended them we’re finally ready to remove the rubber dam and go into the occlusal adjustment, if necessary, and then of course the fine polishing and getting all the composite residue off of there. So we are now going to slide the rubber dam off, these plastic clamps are flexible enough you can just pop them off just like that, get that out of the way.