Prepless Veneers

Part 1 - What are DURAthin Prepless Veneers?

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 describes how DURAthin prepless veneers provide a new technique for minimimally invasive and no preparation dentistry. An overview of the DURAthin prepless veneer technique will be reviewed.

Hi, Marlene Hilton and welcome to this HDiQ Dental presentation. Today we visit with one of the premiere cosmetic dentist in the US, Dr. Dennis Wells. Dr. Wells practices in Nashville, TN and treats some of country and western music’s biggest names. Dr. Wells is also one of only a handful of clinicians to appear on ABC’s hit show “Extreme Makeover”. In 2001 he received the AACD’s presidential award and has been recognized by Woodward/Whites 2004 & 2005 edition as the Best Dentist in America. But that is not what is motivating Dr. Wells. Today he is devoting much of his time and talent to DURAthin prepless veneers. Created by Dr. Wells and lab technician Marc Willis, the DURAthins bond directly to the tooth enamel without reduction of the tooth surface, making it both reversible and virtually pain free for the patient. Today, we will help you decide who is the perfect candidate for DURAthins, we’ll show you the importance of the mock-up and taking the time necessary to show the patient what the end result will be. We’ll visit with lab technician, Marc Willis, to see what he has to do to create a veneer the thickness of a contact lens and finally we will compare and contrast DURAthins with other similar prepless veneers. I’ll be back at the end of the program to show you how to get your CE credit online and how to join the chat room about prepless veneers and have your questions answered directly by Dr. Wells himself.
Hi, I’m Dr. Wells. I am incredibly excited about a new procedure and a new technique that we are here to talk about today, DURAthin Veneers or prepless veneers. This is something that myself and Mark Willis, a ceramist from Utah Valley Dental Lab have been working on for over 3 years now and of course we are standing on the shoulders of many great clinicians for over 2 decades that have pioneered some of these early minimally invasive and no preparation techniques many years prior to our involvement with this. So this is not a new procedure, this is something that we are incredibly excited about, as we have managed to come out with a few new creative ways to make this process very exciting and very, very beautiful. You know someone once said to be creative you have to do one of two things. You either have to completely invent something new or you have to reassemble some old information or old ideas. In this case we have certainly done the latter. We have not created something profoundly new or different. In this tape you will not see something that you have probably never seen before but what we have done is rearranged some ideas and added a few little nuances to make this procedure very unique and yet very durable and very, very beautiful. What we hope to share with you today is some pearls that will help you get excited about this process as much as we are and I hope seeing is believing. I hope when you see the beauty of these margins and the beauty of the contours and the beauty of these cases that you too will want to go out and implement this tool in your practice. This is certainly not for every procedure and case selection will prove to be one of the most important elements as you embark upon doing prepless dentistry but it is a very viable option for many of the patients that come through your door and it’s another weapon you should have in your arsenal.
We’ve been taught that we do have to have a margin, we do have to have a certain amount of room in order to create a nice, translucent restoration with a lot of depth and the dentists have been taught that as well that you need to have a lot of room to be able to create that depth and have a nice natural looking restoration. And what we have found is that that is not necessarily true. We do have to have some depth, we have to have room to create the contours and the translucency that we need but if we can do this without removing the enamel which all ready has depth and translucency we’re just changing some contours and by using the natural beauty of the tooth it allows us to do that with much less room as opposed to removing all the enamel, getting into dentin and then we have to try to recreate what nature has all ready created so we just use the natural tooth to our advantage instead of removing all that enamel and then having to rebuild it.
When you are considering a case for DURAthin Veneers, one of the very first things that should be done is to take good accurate study models of the case and send it to your laboratory. In our instance, it is Utah Valley Dental Lab, who does all of our DURAthin Veneers for us and in fact who has trademarked that product. It is important that they put their eyes on it and look for any red flags or any concerns that they may have prior to you actually engaging and committing to do the case. Once you feel like you have a green light from the lab to begin the case then you really want to set the case up for success. A couple of things that we are looking for are: A. we want to make certain that our occlusal forces are balanced and managed. So just as with traditional dentistry, you want to go through all the steps that you typically would to make sure that your bite is balanced, to make sure that you do not have premature interferences and to make sure that you have interior coupling to protect that system. Another thing that we do on the back side to manage occlusal forces is that we place all of our patients in an E appliance which was developed and patterned by Dr. Jimmy Eubank, which is a wonderful device to wear at night, a dual arch appliance that basically shuts down the grinding and bruxing and protects all of the teeth. So once you have the occlusal forces managed, then you want to look at tissue architecture as with any case, you want to make certain that you have the proper gingival display and that the gingival architecture is aesthetic and how it needs to be. Once these preliminary things are done then you are ready to go to the next step which is a mock up or a wax up or both to determine whether or not the teeth can if fact handle this labial augmentation and have the visual appearance and the functional appearance and the finetics that we are looking for for success.

So we have sent diagnostic model to Utah Valley Dental Lab and asked them to assess this case as a potential for DURAthin treatment and then they have waxed this case for us with the stone models just to get some sense of the feasibility. I like to point out that even though we send the lab photographs and even though they have some visual ideas of the appearance of the patient and the whole visual aspects they have the distinct disadvantage that they are not able to see the patient in 3-D and to see the lip movement and all the various things that go into a smile so they are truly giving their best interpretation based on some still photographs and stone models so it’s very important that we as doctors have the ultimate creative control in a case and that we are not totally relying on the ceramist to design and build these cases and have all of the creative control. But we have asked Utah Valley here in this instance with Sheri, to wax this case and give us their best guess as to where these teeth need to be placed and if you notice here on the articulator that Marc has waxed the case for us and the only concern that he voiced to me is tooth #6 might have enough labial presence all ready that we may struggle to get it into the arch form without doing any preparation so that will be one of the key things that we are looking at today as we mock up this case in the mouth. We will be looking to see can we build more labial presence and incorporate that cuspid and will we in fact be forced to do some minimal amount of reduction on that one tooth to get us into the arch form. Apart from that one concern everything else from Marc Willis’s prospective is a go. So we are very excited to today begin the process of the intraoral mock up and try to determine if in fact we can get this case completely where we want it without any drilling or reduction of the teeth.
As part of the consistent protocol from Utah Valley Dental Lab, once they have done the wax up they are going to provide us with some guides, thickness guides, and in some instances we would call them prep guides but they are simply silicone matrixes that they have developed that we can remove and analyze how much room we actually have in the process so this matrix is developed off of the wax up of what they consider to be an ideal position for the teeth and we can now check that against the unprepped teeth, the unprepared teeth or in this instance the unaugmented teeth and we can place it on here and we can get a real good visual of just how much room we have to work with here, in other words how thick the actual final veneers would be if we followed in fact that wax up. And what I use this for, is when I am doing my intraoral mock ups I can instantly get a visualization on about how much room I have to work with to stay within the confines of the wax up that was done by the lab. In this case as we have all ready talked about, this #6 is out labially a bit further than the wax up that has been done by Marc will allow, so in other words it is not in the arch form unless we prepare on it a bit. So today I am probably going to exceed the confines of the wax up and actually augment the teeth a bit more labially and incorporate #6 into the arch form. This guide helps me do that; it helps me visualize where we’re going. Once I am finished with the introral mock up we will be able to make a similar silicone matrix and compare how much room we have versus how much the wax up gave us and in general just kind of know where we are with the thickness of the veneers.
In creating these silicone matrixes there are actually two pieces, one of which we just showed is a labial version which allows us to see directly the amount of labial thickness that our restorations will have. And then there is a second component, which is the incisal and palatal portion of this, which gives us an idea of exactly how much length we can build onto the teeth. This is showing us where the length would be if we followed the length of the wax up and in this instance you could use this in your intraoral mock ups if you cared to as a guide for how long to lengthen the teeth. For those of us that do direct bonding, this is a technique that we are familiar with, we use it a lot to predetermine where we are going to layer and build the composite. Since I am not so much interested in these prototypes in doing stratifications of color and things like that since they are only temporary then usually I do not worry too much about following this matrix form but rather just freehand in the mouth using my own judgment as to the position of the teeth and where they are going to look best. But if you wanted to use a matrix like this intraorally this makes a nice tool and a nice roadmap for you as you are doing your intraoral mock ups.