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The Principles of Advanced Minimally-Invasive Dentistry.

Part 3 - Moshe Mozrachi, CDT continues the builds up the Pearlfect veneer

Instructors:
Dr. Michael Miyasaki, DDS
The last layer of the Pearlfect veneer is added in this sequence and Moshe discusses where the finish line should be placed.

So that is basically the final layer before we’re going to put the translucent material all over this veneer. The translucent material as I said before will be, just the final layer to give another dimension to this whole color combination. The biggest question would be where is that finish line located. And you will probably have different answer from different experts but I can tell you from down in the 20s when this is made the CEJ is the junction where you want to get the veneer to. There is a nice little bump in there and if you can take the veneer down in there and flatten it down to nothing, you will be a 100% bonded that margin on enamel. If you choose to get that below that junction, you’re losing the strength you’re now bonding it to dentin. So if it’s all possible you always want to require or instruct the technician to put their finish line right on the enamel junction. That will give you the best bonding and the best looking. Now how you get to that junction obviously as Dr. Miyasaki mentioned not by placing a cord, retract the tissue, and going to all this invasive procedures. You simply use the double method with a hard body and a light body and you will achieve that retraction. Okay for our final layer, I’m using this light translucent material. It is a very nice clear translucent material and it glaze and polish very very nice. It also gives this opalescence effect of optics to the veneer itself. This is what I like to put all over the surface to create this effect. Now before I put it or while I’m putting I like to bring out some important point. You notice that this is my fourth layer and this veneer hasn’t bee cured yet. So we have two schools of thought. One should we cure every year and then add the new one or two should we do what I’ve just done, get all the layers together and the cure. If you ask me, I would say do all the layers all together and cure them at the end. And my point for that is that way you can control the thickness better. And if you scoot up the first layer and it’s too thick and you harden that, now you actually cannot flatten it out anymore so you over contour it. Saying that of course it’s a little more demanding to do it the way I do it but is very well worth it the effort to ensure that it’s going to be thin. So here’s our final and last layer. This is the mother of all effect. This is the opalescent layer that will enhance our surface tremendously. Here it is ladies and gentlemen we got four layers in. You can see that on the cross-section here it’s no more than 0.3 mm. And I’m even flattened that more. I got the translucent spread all the way down to the margins and it’s through the side and now the trick is to make sure you don’t have any overextension. The point is when you a Pearlfect veneer you have such an accuracy of placing the coloring, shaping, control thickness and create a finish line that is perfectly aligned with where it needs to be. So this is a very precise, very predictable lab veneer which my 35 years of experience in this business I do not able and I am not able to create that kind of final result with anything else other than what you see right here in front of you. This is ladies and gentlemen, this is the final layer. I’m just putting some texture. I like to do some vertical and some horizontical layer just to create this light dispersion. As soon as you get light dispersion, you can see how the tooth sparkles. You don’t want the tooth to be flat and without texture. You would not see the dispersion of light as you see here on the screen. This is the veneer completed. The next step will be to light cure it. One of the nice things about this is again with the porcelain restoration if you had any fracture that would occur in the end, you know, I always tell my patients when they ask well what’s a veneer going to be like as far as durability. And I always tell the patients that a veneer basically has the same inherent strength as the natural tooth structure. And in saying that we see people have worn their natural tooth structure down or has chipped or broken their natural tooth so that could happen to a veneer. So in the past the challenge that we have as clinician is the patients will come in with a great porcelain veneer and part of it would be chipped. So I as a clinician was forced to make the decision do I replace that one veneer and if I did that could I match the color that one veneer to the other veneers in a typically multiple units. Or would I just try to repair that fractured veneer as I would a natural tooth. Well then if I was choosing to repair that restoration often times we’d used composite try to bond that porcelain which is always a difficult task. You know bond strength aren’t optimize in that scenario. Whereas today with the Pearlfect system where actually if we were to see a fracture, we would then be bonding resin composite direct resin to the indirect resin of the Pearlfect and we should get a nice strong durable bond that way. We just completed layering the four different shades that compose of this color. We are now at the stage of turn it into a hard material utilizing initially the light. I have here the FlashLite Magna which is a Discus light cure handheld. I’m going to use that to just tack this material off before it will actually go into the process, into the baking. And then we’re moving on to the special baking oven which it’s going to be bake under high pressure in nitrogen atmosphere with high temperature. So it will turn it into inorganic material. It will be hard and it will indistinguishable between the hardness of this material or any other materials that you’re accustomed. It will resemble natural enamel to the point where if you close your eye and grin on it, you’ll think you’re grinding natural enamel. So that is final process here and from here we are going to take it to the baking. So we have the restorations back. We have 10 second by resin veneer all set and ready to go. We have photos for you to look at to see the fit and pick and be able to see some of the colors that the material they will pick up. What we’re going to do is we’re going to take the restoration and we’re going silonate the restorations. Again the silane is just a coupling agent to help our restoration adhere to the composite resin cement and then we will be using a [0:40:14][inaudible] technique to bond to the enamel in this case. So we’re just going to take a little silane. Take the internal surface of the restoration. Put a drop silane in each restoration. Let it sit there 30 to 60 seconds. Gently dry that so we’ve got that fresh coupler on the internal surface and then we’ll go ahead and we’ll do our try in and make sure that the fit and the color and everything is exactly what we want to be. Then we’ll rinse out the restorations and be set and ready to go. Our patient in this case is ideal. You know young gentleman who likes the way his smile is right now. Isn’t looking for any profound changes in length or shape and he wants to kind of keep his teeth the way that they are. His biggest want is just to have whiter teeth, you know, permanently white teeth. So he doesn’t have to worry about continuing whitening his teeth or doing anything like that. So he just wants his teeth to look like they looked now but just whiter. And again that lend itself very well to the Pearlfect system.