Prepless Veneers

A lot of people ask me, well what’s the difference between Durathin technology and Lumineers and though it takes a while to answer that entirely a few things that I like to mention right up front is that A. we are really pleased that Denmat has spent so much money advertising Lumineers and have made the public basically aware that there are some conservative alternatives to traditional dentistry and for that I think we all owe them some gratitude. We’ve simply tried to take the prepless process and perhaps refine it a bit and perhaps take it a bit more to our personal liking when it comes to the overall effect visually and maybe even a little bit more attention to detail in some of the areas such as layering the ceramic, the contours and line angles that are formed and the marginal integrity, things that are really going to make that restoration look great and basically adhere to AACD accreditation standards. That is our stated goal as we do each one of these cases is that we want to hit that AACD standard. Whether we are doing traditional dentistry or whether we are doing prepless Durathins, we have the same grading system that we are looking for in all of our results. We really want this work to be undetectable and to have the same functional and aesthetic parameters as our conventional dentistry.
So again, I’m a big fan of using hand sculpted composite and intraorally designing the smile as opposed to doing it with wax. But that is the technique that many people find to be the best in their hands.

Doctor Wells will continue to form the prototypes until he is satisfied that they will give an accurate reflection of the final work to the patient. Again, keep in mind that as this may seem to take up too much time you don’t have to anesthetize the patient or remove any tooth structure. And that says nothing of the patient’s comfort.
As you are developing these new prototypes, it is so important to stand in front of the patient as well as look across their normal view to make certain that we are getting proper symmetry and contouring, I find that it is very essential that I move around and check that different prospective from time to time.

So here we are, we have completed all 10 of our prototypes, we have taken the time to individually build these teeth with composite one by one and we have separated them with a cerasaw where the patient can floss between the teeth without any hindrances there. We want to make sure that the tissue is very, very healthy for us when she returns to us to bond in the permanent veneers. Some people would argue that maybe this is too lengthy of a process to build prototypes and that this would take too long but in our practice we have got this down to about an hour and again since we are not using a lot of time to prepare on the teeth and anesthetize we kind of swap that time for building individual, accurate prototypes that help me and the patient visualize where we are going in the permanent work and their also going to be very cosmetic and attractive for the patient to test drive as we are having the permanent work completed.
Durathins or prepless veneers are not for everyone. Case selection is so critical in the final success of these cases. Things that I look for as ideal Durathin candidates are A. people who have had bicuspid extraction orthodontics. Many, many times these people have had there teeth lingualized to the point that hey truly need some labial presence with the teeth. Another situation that I look for are short or worn teeth. As we know so many of our patients have what we call occlusal disease, they simply have worn their teeth down or abraded their teeth down and these types of patients many times by just augmenting the labial surfaces can have beautiful radiant smiles without ever having to drill down any further to their all ready short and worn teeth. Another situation that we look for is just an imbalance between the lips and the teeth. Many times people will have very nice large lips and rather small teeth that just simply do not harmonize and do not balance. These many times can be great cases for Durathin or prepless veneers.

Just as there are some people who are awesome candidates for Durathin veneers there are some who obviously are not good candidates. One thing that we always look for is good color of the teeth. Since we are using relatively thin porcelain laminates, we are not going to be able to block out and do some of the more exotic color shifts that are required to dark teeth, especially tetracycline or gray teeth. Those are not good candidates. And of course people who all ready have very full smiles and the teeth are all ready, if anything too far labial. Those are not good candidates to try to augment and further increase that labial prominence. So there are case selection principles here that you must adhere to. You cannot use this as a technique to use on every case. And unfortunately I think some of our competitors out there have fell into this trap of trying to over use this process. I want to warn you that that is not a good idea. You want to be selective in the cases that you are doing but just know that when you find the right case the end result can be absolutely stunning.

Durathin veneers are made from Feldspathic Porcelain. We feel real strongly and have a definite bias that we can create the best, most natural look by using feldspathic ceramics and using powder liquid build up where we were able to create multiple layers of color. It is now becoming increasingly popular to use pressed ceramic with a prepless approach as well where the pressed ceramics are pressed down to their smallest thickness and then actually ground down to even thinner thicknesses beyond that. You know whatever approach one is comfortable with the end result can definitely be beautiful and wonderful and we feel that the whole idea of conservative dentistry has just become a hot topic today, that we are going to see more and more innovations and more and more ways that we can create beautiful dentistry with minimal invasiveness.
A lot of it is going to be developing the eye to see what can and cannot be done. Because in the beginning, especially for me, I was getting cases that I would never have thought would have been good candidates for this. And the more that I have done, the more success that I have seen with it, the more I learn what can and cannot be done with this restoration and so developing the eye is a huge part of it because that is not traditionally what we have been looking for in our patients. We have not been looking for, necessarily, ways to do conservative dentistry. So it may take a little bit of a shift from the prospective, so continuing education is really a huge part of that. But just once you have the knowledge, taking that back to your practice and looking for these patients and trying to find applications of where this will work. And there is going to be some trial and error but the more you do, the more you will see and you’ll see the benefits and your patients will appreciate it.
Well we are back here today to do the very exciting part of cosmetic dentistry and that is seat the porcelain veneers that we have worked so hard to prepare. Sheri has been in our prototypes now for about 3-4 weeks and I know she is excited to remove those and put on the permanent work. We are going to hope to prove today that even though we have not prepared on these teeth, not even as much as a small marginal line, that we are going to be able to create, right from the beginning, very beautiful margins that are undetectable both with an explorer and also visibly there undetectable as well. We are going to be able to create real nice contours that despite the fact that we have not drilled on the teeth or prepared on them in any way, that the contours are going to look natural and believable and very, very beautiful and appropriate for this person and her mouth. So this is a very exciting day. We hope that this production is going to help you see the real beauty and value of Durathin veneers.