No Prep Veneers Part II

Part 2 - Veneer preparation and veneer placement

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.

Dr. Wells assistant will prepare the veneers and then he will demonstrate the procedure for veneer placement.

So to this point we have not anesthetized the patient and with few exceptions we normally will go ahead and use about half a carpule infiltrating around the root of each tooth before we bond it on. We found through the years that this just keeps the patient a lot more comfortable and there are some level of discomfort as we put the chemistry around the gum tissue and just the trimming and smoothing of the margins, some of these things can be pretty irritating to most patients so we would prefer not to create a lot of drama right in the middle of seating and so thus we generally will do a little bit of numbing before we get started. While I'm doing that, Michelle and our team members are over here preparing the veneers one by one. We like to use a little suction grip to hold on to the veneer so that we don't touch the margins. Once we rinse them off with the try-in gel and start the preparation and cleaning, from that point on we do not touch the margins. We feel real strongly that that's an area that we do not want to contaminate. We want to keep that real pure during the whole bonding process. All right we are about to prepare our veneers so what we're going to do is I have already rinsed out all the try-in gel so now we're going to use our little lumigrip veneer suction. And what we're going to do is we're going to place some Ivaclor ivoclean on the veneers to get all of the glycerine try-in paste off. We'll get them nice and clean before we put the bonding agent on. If you can see we just kind of have our little paper towel number here. We have a little bucket that we're going to be rinsing in. You want to be just real careful when you're preparing these veneers that you don't [0:15:20] [Indiscernible] of them.
We're just going to take this little suction. We're just going to pick up each veneer one by one. I'll just use my little microbrush to brush that on the inside. Once I have that all inside I'm going to let the suction go and then pick up the next one. So we'll just continue doing that on each one of these. Finished loading all of these veneers with the ivoclean and we're ready to rinse them off now. So I'm going to go ahead and pick one. We're going to rinse it over the bucket and make sure you're over a bucket. We're going to rinse that really well make sure we have all the ivoclean off. We want to air dry it with your syringe but then you also want to take your little air dryer and make sure that's dried really well and then now we're going to go ahead and place our saline primer. So I'm going to a little microbrush again and just paint that on the inside and always try to make sure I stay over my paper towel. That way for some reason if it were to fall off, it would fall right here on the paper towel and not anywhere else. And then we're going to lay that down and then we'll just go to the next one and go all around until we've done all of them. As we said we're going to give just a half a carpule or so around each tooth, infiltrate that. Next, Dr. Wells will place a rubber dam and use vanilla moose. There's lots of ways to isolate and execute the bonding process but in our opinion, the rubber dam is the most predictable way to do this. We have actually flossed the dam in between her molars back there without using clamps so we don't have to do [0:18:03] [Indiscernible] injections or have the patient tolerate some discomfort there and then we've used some vanilla moose by Philips. It used to be discus dental and that vanilla moose very nicely sews up our palate area there and keeps everything completely isolated. So this is the way we routinely do rubber dams. Occasionally we will have to go on and put a clamp back there. Hopefully in this case, we're going to be successful without using the clamps and the discomfort that brings. So now we are ready to start the meticulous bonding process. We've got it very well isolated. We're going to start with the super oxyl which we apply around the tissue and this does two things. If there's any hemorrhaging it does that out real quick and then it also dries out temporarily the sulcular fluids so that we get no proteins there or anything that's going to compromise our bond right at this cervical area. Somebody has been practicing 30 years when I see veneers failing, most of the time it's either from the marginal breakdown right in this very zone here or it's from chipping and breaking. So if we can master our adhesive techniques, really maximize our bond strings around the cervical area, that should help with our longevity along with understanding bite forces and be certain that we have real favorable occlusal forces on our final work. Those two things I believe will enhance our longevity more than anything else with our restoration. So as you can see when we rinse that super oxyl off, it tends to just cauterize around that area somewhat and dry it out for us which is exactly what we need for some interval of time. now we're using chlorhexedine cleaning in between this area real well, cleaning the whole surface of each tooth. We've already gone over the teeth with cups, cleaners and things to make certain that we have no debris on the enamel but here we are just in our final sterilization before we bond. Okay. So we put a little barrier there between molars that we do not want to etch. Next Dr. Wells place the etchant. Okay. So we're going to rinse the etchant off and we didn't have to be super meticulous on the timing of it because there's no dentin here, significant dentin that's exposed so we can etch at that for at least 30 to45 seconds without concern. If there was any significant exposed dentin or cementum, we would be using something like gluma as a desensitizer and wetting agent but in this instance I feel confident that we're fine to omit that so we're going to go straight to our unfilled resin. We're using an Adeck, warm air dryer right now to really be certain that we have no more extra left here. In this case we're using optibond by Kerr as our primer and resin, and we're going to choose to not polymerize this prior to placing our veneers. So we'll just dry it real well and the and go straight to placing the veneers. Now we're going to dry the primer real well and we'll remove our matrix man barrier now. Hemostats. And we will start with placement of number 8. So we air dried our unfilled resin and we are now ready to place our veneers using the Lumigrip here to help us handle those real nice, Ivaclor instrument. This is a nice little cotton and that's really great for placing the veneer. Get that. Let's the gross excess away. Great. Ten. One thing about using this light, this crusty, somewhat runny cement is that we have to work hard to clean it all up. Let's another cotton roll. So we're just using a cotton roll to get some of that excess off of our teeth so we don't have to do that after we polymerize it. So we're continuing to just remove as much of the excess cement as we can prior to polymerizing. The thing is coming along very nicely here. It's about time now to go ahead and tack these into place. This is an area where we want to be very careful and not put too much pressure with this tip. Okay, go. Stop. Okay, go. Stop. Go. Stop. Go. Stop. Go. Stop. So if you notice I'm trying to protect the adjacent teeth and hold them into place, protect them from the light of the curing light and then when I get it just where I want it, we'll say go. Good. Stop. So a little bit of technique here to making certain we've got it tacked in the right place. Okay god. Okay. Now we're going to floss through the teeth very carefully. Obviously we got to be very careful not to punch through there and create any hemorrhaging. So now we're just taking our sharp explorer and basically just eating of all of the marginal areas. Doing our last little bit of cleanup here. So we're almost finished here with our initial cleanup ready go polymerize. So now we're going to ahead and cure out everything. We'll do one cure over just to get it initially polymerized, kind of lock it down if you will and then we'll use our osteo-inhibited layer of glycerin over to really cure it more profoundly. Before we put the glycerin on I want to double check and be certain that all of the margins are sealed especially on the lingual. We'll double check to be sure we have no gaps or areas where the cement was pulled away. I do see one little spot here. Michelle if we add just a little bit more resin cement. Okay. Cure that. Okay. Let's have the glycerin now. We'll use two different lights to cure at the same time just to speed up the process and to also get a double check there in the event that one light output maybe is not as strong as it should be even though we do check these weekly our output meter. I just like the idea of having two different light sources.