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Continuing Education

Do’s and Don’ts of Porcelain

Laminate Veneers

Course Author(s): Chad J. Anderson, MS, DMD; Gerard Kugel,

DMD, MS, PhD; Shradha Sharma, BDS, DMD
CE Credits: 2 hours
Intended Audience: Dentists, Dental Hygienists, Dental
Assistants, Dental Students, Dental Hygiene Students, Dental
Assistant Students
• Date Course Online: 12/05/2008
Last Revision Date: 03/31/2020
Course Expiration Date: 03/30/2023
Cost: Free
Method: Self-instructional
AGD Subject Code(s): 780

Online Course: www.dentalcare.com/en-us/professional-education/ce-courses/ce333

Disclaimer: Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their
practice. Only sound evidence-based dentistry should be used in patient therapy.

Conflict of Interest Disclosure Statement

• Dr. Anderson has done consulting work for P&G.
• Dr. Kugel reports no conflicts of interest associated with this course.
• Dr. Sharma reports no conflicts of interest associated with this course.

Introduction
This course will give guidelines on how to make esthetic changes for teeth that are discolored, worn,
chipped, malformed or misaligned. Porcelain veneers are considered to be strong and to have great
esthetics and a long-term prognosis.

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Course Contents wear the veneers while eating since the veneers
• Overview were not bonded. Nine years later, in 1937,
• Learning Objectives Pincus also fabricated acrylic veneers. These
• Introduction veneers were retained by denture adhesive, but
• Types of Veneers failed because there was no adhesion to the
• Indications for Veneer Placement teeth.1 In 1955, Michael Buonocore introduced
• Philosophy of Esthetic Dentistry enamel etching and in 1962, Ray Bowen
• Treatment Plan Phase developed composite materials. Dr. F.R. Faunce
• Clinical Procedure - Visit 1 and Dr. D.R. Myers in 1976 tried acrylic veneers
• Clinical Procedure - Visit 2 luted on etched enamel surfaces. In 1983, Dr.
• Clinical Procedure - Visit 3 Harold Horn etched custom porcelain veneers
• Conclusion luted to etched enamel surfaces.2
• Course Test
• References With the introduction of composite resin,
• About the Authors etching, and bonding techniques, minor defects
can be treated conservatively. While composite
Overview veneers have improved since their introduction,
Porcelain veneers are routinely used to make they still have a few drawbacks, such as wear,
esthetic changes for teeth that are discolored, marginal and incisal edge fractures, and
worn, chipped, malformed or misaligned. discoloration. As a result, composites may
Porcelain veneers are considered to be strong require more frequent replacement than is
and to have great esthetics and a long-term necessary with porcelain veneers.
prognosis. This course will give guidelines
to achieve these results by explaining case Porcelain veneers are more stable and have
selection, treatment plan and procedures step- better esthetics. If a porcelain veneer is bonded
by-step. with a correct adhesive technique and optimal
oral hygiene care is maintained, studies have
Learning Objectives shown that the long-term survival rate of
Upon completion of this course, the dental veneers is very high.3
professional should be able to:
• Understand the philosophy of esthetic Types of Veneers
dentistry. Veneers can be placed directly or indirectly.
• Understand the indications and Composites are used for directly placed
contraindications of veneers. veneers, and a variety of materials can be used
• Learn teeth preparation for veneers, for indirectly placed veneers. These include:
temporization and cementation to achieve 1. Conventional powder-slurry ceramic
predictable results. (feldspathic porcelain). This type of porcelain
is layered on the refractory die by the lab
Introduction technician.
Recent public exposure via the media to 2. Heat-pressed ceramic. These products are
various kinds of esthetic dentistry procedures melted at high temperatures and pressed
has increased demand for veneers. In past into a mold created using the lost-wax
years, full coverage restorations were often technique (e.g., IPS Empress 1 and 2, OPC).
used to correct minor defects or to mask 3. Machineable (CAD/CAM) ceramics (e.g.,
discoloration. However, the more conservative CEREC, E4D).
concept of veneering teeth has been around
for some time. Indications for Veneer Placement
Veneers can be used for functional and
In 1928, Charles Pincus introduced the porcelain cosmetic correction of the following conditions:
“Hollywood Bridge.” These veneers were 1. Stained or darkened teeth
fabricated for actors and used only in front of 2. Hypocalcification
the camera. The actors were instructed not to 3. Multiple diastemas

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4. Peg laterals
5. Chipped teeth
6. Lingual positioned teeth
7. Malposed teeth not requiring orthodontics

Contraindications for veneer placement

include:
1. Insufficient tooth substrate (enamel for
bonding)
2. Labial version
Figure 1.
3. Excessive interdental spacing
4. Poor oral hygiene or caries
5. Parafunctional habits (clenching, bruxism)
6. Moderate to severe malposition or crowding

Philosophy of Esthetic Dentistry

Recolor: The first option is tooth whitening.
Reposition: The second option is orthodontic
repositioning.
Recontour: The third option is to recontour
teeth and equilibrate.
Figure 2. Tooth #7 (top) and tooth #10
Restore: Once the above options have been
(bottom) were treatment planned for
explored, the last option is to restore the teeth Empress Veneers.
with veneers or crowns. The teeth were whitened before veneer
preparation.
Advantages of veneers include:
• Minimal tooth preparation required 4. Confirm that there is no protrusive or lateral
• Porcelain veneers are stronger and more interference
durable than composite veneers 5. Check centric anterior lingual contacts
• Alternative to full coverage restoration in 6. Consider three key elements of esthetics:
case of incisal fractures or tooth discoloration contour, position and color
• Color stability
When restoring anterior teeth with porcelain
Disadvantages of veneers include: veneers, you must be aware of incisal edge
• Potential for over-contouring position, lingual contour, labial contour and
• Requires laboratory procedures inclination.
• Porcelain enamel margins may be thin and
difficult to finish Clinical Procedure - Visit 1
• Brittle margins 1. Impression for study models/bite
• Pitting by acidulated fluoride treatment registration record
• Cannot be repaired easily 2. Radiographs/photographs
• Can sometimes be difficult to temporize 3. Check contraindications
• Color cannot be altered substantially after 4. Shade selection
placement
• Placement is difficult and time-consuming Clinical Procedure - Visit 2
1. Confirm Shade Selection
Treatment Plan Phase 2. Preparation
It is important to confirm the following before In the early days of veneers, either
starting the preparation: a no-preparation or minimal tooth
1. Check for contraindications preparation, not extending into the dentin,
2. Mount study casts was suggested.2,4,5 This is once again gaining
3. Check posterior occlusion (anterior teeth do popularity with certain companies. Dentists
not function alone) routinely remove at least 0.5 mm-0.8 mm

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 of enamel. Removal of some enamel aids in
achieving better bond strength,6,7 but care
must be taken not to remove more than 0.5
mm-0.8 mm, especially in the proximal and
cervical areas. Even though dentin adhesives
have improved dramatically, porcelain
bonding to enamel is better than porcelain Figure 3. Tooth #6 – Incisal Chamfer
bonding to dentin.8 Preparation (Interlock Prep)
Tooth #7 – Incisal Butt-joint Preparation
Depth Guide Cuts – Prior to preparation Tooth #8 – Incisal Lingual Wrap
Preparation
always examine study models in order Tooth #9 – Depth Cut
to avoid over-reducing areas of the tooth
that may be rotated or lingually inclined.
Hence, the use of a reduction guide is porcelain by creating a chamfer along
recommended. A diamond depth cut bur the facial incisal margin using the tip of a
can be used to scribe horizontal depth cut tapered diamond (Figure 3).
grooves on the labial surface of any anterior B. Incisal Butt-Joint Preparation Prepare 0.5
tooth. Extend these grooves from mesial to mm depth cut grooves in the incisal edge.
distal, taking care not to damage the adjacent Using the tapered diamond removes the
teeth that are not being prepared. It may remaining incisal tooth structure. Then
be necessary to angle the bur in relation to round the facial incisal line angle leaving a
the contour of the labial surface to achieve butt-joint margin along the lingual incisal
the appropriate depth for these guide cuts. edge. The incisal reduction should be 0.5
The finish line of the preparation could end mm-1.0 mm. This type of preparation is
gingivally or supragingivally, approximately done in order to increase the length of the
0.5 mm incisal to cemento-enamel junction tooth. The length can be increased from
(CEJ). Do not place your gingival depth cut so 0.5 to 2 mm only.
as to cut into the CEJ area. C. Incisal Lingual Wrap Preparation Prepare
0.5 mm depth cuts in the incisal surface of
Labial Reduction – Using a tapered diamond, tooth. Reduce the incisal surface in a manner
reduce the remaining labial tooth structure similar to incisal butt-joint preparation.
between the depth cuts. Simultaneously Reduce the mesial incisal and the distal
create a chamfer ending 0.5 mm incisal to incisal corners an additional 0.5 mm. Then
the CEJ. This reduction should also extend using a diamond bur, extend the incisal
interproximally. Opening the interproximal chamfer to the palatal surface. This palatal
contact with the adjacent tooth is often chamfer should be a straight line mesial to
preferable to better approximate the veneer distal. All incisal edges should be rounded.
and have a clear finish line in the master The lingual chamfer line on the wraparound
impression. In cases with mobile teeth and preparation should be above or under the
those having recently having completed centric lingual contacts to avoid occlusal
orthodontics it may be advisable to not pass contact on the interface between porcelain
through the contact areas to prevent tooth and tooth structure. Contact should be
movement during temporization. either all on porcelain or on tooth structure.
The incisal wrap prep is a popular option
Types of Veneer Preparation for several reasons. It can be used in most
A. Incisal Chamfer Preparation (Interlock prep) patients, easily fabricated by the technician
The incisal edge is not reduced in length. and easily handled by the dentist due to
This type of preparation is often used on positive seating on delivery (Figure 4).
cuspids and is done in order to preserve
the natural guiding palatal surface of the D. The path of insertion for veneers is in the
tooth, which is important functionally. labial or incisal-labial direction. All undercuts
Add an additional space for the incisal and unsupported enamel in relation to this

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 Figure 4. Tooth #7 Incisal Lingual Wrap Figure 5.
Preparation

path must be removed. A silicone reduction

guide is used in order to check the amount
of reduction required. The reduction guide
is designed to evaluate the amount of
reduction at the incisal, middle third and
cervical third of the tooth. Use of a reduction
guide is particularly important when teeth
are misaligned (Figures 5 & 6).
Figure 6.
3. Check Contraindications
Final Impression
• Strip contact area using a finishing strip is recommended before the fabrication
prior to impression to improve visualization of the provisionals in order to reduce the
for lab technician. sensitivity.
• Place a # 0 cord to reveal the margin, which • Different techniques are used to fabricate
is left in place while taking the impression. provisional veneers. We recommend
• Either polyether or polyvinyl siloxane using a silicone putty impression material
impression materials can be used shell in order to fabricate temps, since it
according to manufacturer’s instruction. reproduces the wax up or study models
very accurately.
Laboratory Instructions • A bis-acrylic temporary material with the
• A detailed prescription is written to the required shade is used. The provisional
laboratory technicians. The prescription is not removed but is rather “locked in”
should include: as a result of shrinkage. The provisionals
• Teeth number, required shade, stump shade. are then finished and polished in place.
• The type of ceramic required to make the Evaluation of tooth reduction is confirmed
veneers. by examining the provisionals for thin
• If any changes in anatomy are required for areas. Although it is unlikely to occur while
the final result, e.g., increasing length. using the reduction guide, it is sometimes
• Make a note of any requests made by the necessary to re-prep under-reduced
patient. areas. If this does occur, then you must
reimpression and retemporize the prepared
Temporization teeth.
• A pre-impression is usually taken prior to • When fabricating a provisional for a peg
temporization and is used as a template for lateral or any single tooth veneer, a free-
the provisional restorations. hand composite veneer can also be used.
• During the period a patient is in • To maintain good periodontal health, the
provisional veneers there is a likelihood patient is told to irrigate the marginal
of postoperative sensitivity. Therefore area with a chlorhexidine rinse using an
application of a desensitizer, such as GLUMA, endodontic irrigating syringe.

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Clinical Procedure - Visit 3 • Apply composite-resin luting cement to the
Veneer Cementation veneer and gently place the veneer onto
1. Try-In/Shade Selection the tooth in an inciso-gingival direction.
• Remove provisionals Remove excess material gently with a resin-
• Use flour of pumice to clean all prepared coated brush. Make sure that cement is
tooth surfaces and wash thoroughly being visible at all the margins to avoid any voids.
careful to not induce gingival bleeding. • Hold the veneer and check the gingival
• Isolate and dry the teeth. margin for proper seating. Then, for each
• Moisten the veneers with water and place of the four regions (gingival, mesial, lingual-
them carefully on the prepared teeth to incisal and distal) remove any additional
check fit and shade. excess. Light-cure the gingival margins first
• Try-in paste can be used behind facings to for 10 seconds, mesial, incisal and distal.
check shades. After curing these four areas, cure for 60
• If color adjustment is needed, select seconds through the facial surface. Light-
appropriate shade of try-in paste, apply to cure each area and margin of the veneer
veneer, seat, and examine for color and fit. for 30 seconds (longer for thicker, more
• Clean the veneers by rinsing with water. opaque veneers or darker shades). (Check
• You should verify with your laboratory manufacturers’ recommendations for
technician but the veneers generally come curing time.) (Figures 7, 8 and 9)
already etched with hydrofluoric acid.
Therefore a 30-second application of 37%
phosphoric acid is used only for cleaning,
not for etching.
• Rinse with water and dry.
2. Cementation
• Apply silane to the etched porcelain surface
for 60 seconds and air-dry. This step should
be repeated twice to optimize bonding.
• Pumice and wash the tooth preparation
dry and isolate the teeth. Figure 7. Post-veneer
• When cementing multiple veneers, you cementation
must always start closest to the midline
and work distally.
• Veneers are luted two at a time starting with
the central incisors and continuing distally.
• Isolate the preparation interproximally
with thin Mylar strips or Tefalon tape.
• Etch the preparation in the usual manner
indicated by the manufacturer of the
bonding agent being used and dry the area. Figure 8. Tooth #7 Post-
• Apply enamel/dentin-bonding system veneer cementation
according to the manufacturer’s
instructions. Sixth or 7th generations
(self etching) bonding agents are not
recommended for veneers only prepared
into enamel. Light cure the tooth
(adhesive) prior to seating the veneer.
• Apply unfilled resin, after primer if
indicated, to the tooth surface and inside
of the laminate veneer. Do not cure this Figure 9. Tooth #10 Post-
layer at this time. veneer cementation

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3. Finishing hard (dual) night guard. This is done to
• Remove gross excess using sharp hand protect the veneers.
instruments — CL carver or perio scaler.
(# 12 scalpel blade) Conclusion
• Using fine and extra fine diamond finishing With the advent of newer conservative
burs, remove excess resin gingivally and treatments such as vital tooth bleaching and
inciso-lingually. retainer system orthodontics, the indication
• Finish the proximals using fine strips. for veneers maybe reduced. Porcelain veneers
• Proceed to the next placement. are still being routinely used as a way to make
• Use porcelain polishing paste to regain a esthetic changes for teeth that are discolored,
smooth porcelain surface whenever necessary. worn, chipped, malformed or misaligned.
• Check occlusion in all excursions and adjust With the advent of newer porcelains and
as needed. better bonding agents, porcelain veneers
4. Night Guard are considered to be strong and have great
• It is recommended post cementation to esthetics as well as a good long-term prognosis.
provide the patient with a soft or a soft and

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Course Test Preview
To receive Continuing Education credit for this course, you must complete the online test. Please
go to: www.dentalcare.com/en-us/professional-education/ce-courses/ce333/test

1. Which of the following is not an indication?

a. Multiple diastemas
b. Insufficient tooth substructure
c. Malposed teeth not requiring orthodontic treatment
d. Peg lateral

2. Porcelain veneers may require more frequent replacement than is necessary with
composites.
a. True
b. False

3. Which of the following is not an advantage of veneers?

a. Minimal tooth preparation
b. More durable than composites
c. Easily repaired
d. Improved esthetics

4. A patient with Bruxism is good indication for veneers?

a. True
b. False

5. Veneers are used for functional and cosmetic correction of which of the following
conditions?
a. Hypocalcification
b. Multiple diastemas
c. Both of the above.
d. Neither of the above.

6. Color of veneers can be altered substantially after placement.

a. True
b. False

7. Do not place gingival cuts so as to cut into cemento enamel junction area.
a. True
b. False

8. To achieve interproximal reduction, contacts should be broken in order to prevent

teeth movement during temporization.
a. True
b. False

9. Which of the following is not one of the recommended of veneer preparation design?
a. Incisal Chamfer Preparation (Interlock)
b. Incisal Butt-Joint Preparation
c. Window Preparation
d. Incisal Lingual Wrap Preparation

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10. When cementing multiple veneers, you must always start closest to the midline and
work distally.
a. True
b. False

11. Use of reduction guide is not critical to the success of a veneer.

a. True
b. False

12. Which of the following is critical when using silane in practice?

a. Must be in a brown bottle.
b. Should be light activated.
c. Must have an expiration date.
d. None of the above.

13. It is recommended to light cure the bonding agent on the tooth before cementing the
veneer.
a. True
b. False

14. While doing an incisal lingual wrap, preparation lingual contact should not be on
________________.
a. porcelain
b. interface between porcelain and tooth structure
c. tooth structure
d. None of the above.

15. Night guards are always recommended after cementation veneers.

a. True
b. False

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References
1. Pincus CL. Building mouth personality. J Calif S. Dent Assoc. 1938; 14:125-129
2. Fradeani M, Redemagni M, Corrado M. Porcelain laminate veneers: 6- to 12-year clinical
evaluation—a retrospective study. Int J Periodontics Restorative Dent. 2005 Feb;25(1):9-17.
3. Calamia JR. Etched porcelain veneers: the current state of the art. Quintessence Int. 1985 Jan;
16(1):5-12.
4. Friedman MJ. Current state-of-the-art porcelain veneers. Curr Opin Cosmet Dent. 1993:28-33.
5. Stacey GD. A shear stress analysis of the bonding of porcelain veneers to enamel. J Prosthet Dent.
1993 Nov;70(5):395-402.
6. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G. Porcelain veneers: a review of the
literature. J Dent. 2000 Mar;28(3):163-77.
7. Van Meerbeek B, Perdigão J, Lambrechts P, Vanherle G. The clinical performance of adhesives.
J Dent. 1998 Jan;26(1):1-20.
8. Van Meerbeek B, Perdigão J, Lambrechts P, Vanherle G. The clinical performance of adhesives.
J Dent. 1998 Jan;26(1):1-20.

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About the Authors

Chad J. Anderson, MS, DMD

Dr. Anderson is a Research Instructor in the Department of Prosthodontics and
Operative Dentistry at Tufts University School of Dental Medicine with a focus on
clinical materials research. During his graduate work he developed a digital system
that quantitatively analyzes small increments of color change. This process in the past
ten years has been used in clinical research around the world. He has presented and
authored abstracts and articles in the area of color science and materials in dentistry.
Dr. Anderson has also worked with companies such as Procter & Gamble, Philips
Electronics, Ultradent, Kerr, Parkell, and Dentsply Caulk in developing and testing new products that
are currently available for professionals and for over-the-counter consumer use.

Email: [email protected]

Gerard Kugel, DMD, MS, PhD

Dr. Kugel is a Professor and Associate Dean for Research with an expertise in
Clinical Research and Esthetic Dentistry. He is a reviewer for The New England
Journal of Medicine, JADA, Journal of Esthetic Dentistry, Esthetic Technique and The
Dental Advisor. He is on the Editorial Board of Practical Periodontics and Aesthetic
Dentistry, Contemporary Esthetics, Compendium, The Journal of Cosmetic Dentistry, and
The Journal of Adhesive Dentistry. He is a Fellow in the American and International
Colleges of Dentistry as well as the Academy of General Dentistry and the Academy
of Dental Materials.

Dr. Kugel received his BS in Biology and Psychology from Rutgers University. He received his
doctorate in dentistry from Tufts University School of Dental Medicine. Dr. Kugel also received his
MS from Tufts Medical School in the Department of Anatomy and Cellular Biology. Dr. Kugel has his
PhD in Dental Materials from the University of Siena, Italy.

Dr. Kugel has published over 100 articles and 150 abstracts in the field of restorative materials and
techniques. He has given over 200 lectures both nationally and internationally. Dr. Kugel is part of a
group practice, the Boston Center for Oral Health, located in Back Bay, Boston.

Email: [email protected]

Shradha Sharma, BDS, DMD

Dr. Sharma is an Assistant Professor in the Scientific and Clinical Research Center,
Department of Research Administration.She received her BDS degree from D.Y. Patil
Dental College and Hospital, Mumbai University, India in 1998. She did a residency
in Esthetic Dentistry Fellowship at Tufts University School of Dental Medicine in
2001.She received her DMD degree from Tufts University School of Dental Medicine,
Boston, USA in 2007. Dr.Sharma has been a clinical instructor at the Undergraduate
Clinic at Tufts. Dr.Sharma has been a Principal and Co-investigator in several studies
at Tufts University. She has published and given lectures on Restorative Dentistry.

Email: [email protected]

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