Dr.

Nesrine Elsahn 4/21/2018

• Do use heavily filled composites in stress-bearing areas (eg, incisal

edges).

• Do use a composite with very fine particle size on the surface

(preferably a microfill).

• Do make the final outer layer continuous whenever possible to

avoid irregularities or voids in the surface.
Dr. Nesrine Elsahn,
BDS, MS, PhD
Assistant Professor of Operative Dentistry • Do look for adverse tissue responses at recall. Dr. Nesrine Elsahn

 A rubber dam is placed and stabilized with a # 212 clamp  A mylar matrix band is positioned in the interdental spaces of
the teeth

Phosphoric acid is applied for 30 seconds After rinsing with air/water spray & air drying
Dr. Nesrine Elsahn Dr. Nesrine Elsahn
Dr. Nesrine Elsahn 4/21/2018

 Adhesive is applied over etched enamel then polymerized for  Remember to leave a space for the
20 seconds ( primer is not needed in preparations limited to surface layer of microfilled resin
enamel). insertion.

 If template is not used, composite

is placed and spread with the
plastic instrument and polymerized
for 40-60 seconds

Dr. Nesrine Elsahn Dr. Nesrine Elsahn

In the event the teeth exhibit different hues

in the cervical, middle and incisal regions,
the hybrid resin produce theses hues with
gradation between various shadings,

the cervical increment is extended 30%

of the area targeted for the middle increment
next the incisal increment is positioned to
extend over 30% of middle increment, the
Liquid Vaseline is applied on plastic instrument and brush The matrix is positioned until
middle increment is positioned last. correctly seated and pressed to
the inner surface of the matrix without incorporation of air
and excess is removed by a bubbles in the resin. allow for the excess displacement
Dr. Nesrine Elsahn mild air jet. Dr. Nesrine Elsahn
then removed with an-explorer.
Dr. Nesrine Elsahn 4/21/2018

• Discs are preferred lateral to the marked lines

(Transition line angle)

• Burs and stones are preferred medial to the

marked lines
Dr. Nesrine Elsahn Dr. Nesrine Elsahn

Dr. Nesrine Elsahn Dr. Nesrine Elsahn

Dr. Nesrine Elsahn 4/21/2018

Schematic map of color modifier usage under

a full facial composite veneer

Dr. Nesrine Elsahn Dr. Nesrine Elsahn

 Color modifiers can be used between layers of

composite.

 This is particularly convenient between

the supportive and surface layers of larger composite
restorations.

 It is also advantageous, because the use of a color modifier allows

space for a continuous outer layer of resin. This reduces the
possibility of facial voids.

Dr. Nesrine Elsahn Dr. Nesrine Elsahn

Dr. Nesrine Elsahn
 Color modifiers are best placed over a cured
bonding agent and then covered with composite.
 Color modifiers should always be cured prior to covering with
composite.
 Regardless which combination of materials is used, the
shades and their locations should be recorded in the patient’s
dental record to aid in making future repairs and adjacent
restorations.
Dr. Nesrine Elsahn
 If temporaries are necessary or desired, they are fabricated by
2 methods;
1- Direct.
 Composite, kept supragingival, out of heavy occlusion, and
attached by spot etching the enamel in the center of the tooth
away from any margins.
2- Indirect.
Dr. Nesrine Elsahn
4/21/2018
 A great majority of patients do not require temporaries
because the preparations are shallow and involve only
enamel, for these cases, the patient instructed to:
1. Avoid biting hard foods, objects.
2. Keep the areas clean with a soft bristled brush.
3. Expect the possibility of some mild sensitivity to hot and
cold.
Dr. Nesrine Elsahn
 A clear polyvinyl siloxane material is used.
• If the existing contours of teeth are to be
replicated, the impression is made directly in the
mouth.
•If a diagnostic wax-up was made on the study
model, the impression is made on the study
model.
Dr. Nesrine Elsahn
Dr. Nesrine Elsahn
The teeth to be temporized are "spot etched"
with 35-37% acid for 30 seconds.
only 2mm circle of facial enamel should be
etched so that temporary veneers will bond
to this area only.
Then teeth washed with air/water spray for
10-20 seconds then dried with air jets.
Dr. Nesrine Elsahn
The clear impression is loaded with flowable
composite or bis-acryl material and immediately
positioned in the mouth and pressed then allowed to
be cured chemically or light cured.
Once the resin material set, the impression is
removed.
Dr. Nesrine Elsahn
4/21/2018
The etched preparations are treated with an
bonding resin at the spot etched position and
around the margins ( to reduce sensitivity)
, then cured for 30 seconds.
Dr. Nesrine Elsahn
 The excess material facially and ligually
is removed carefully with;
The tip of needle shape diamond finishing bur following the
scalloped outline of the gingiva to separate flash from the
veneer margins.
Alternatively, no. 12 blade is used carefully to trim the excess
temporary material around the margin and in gingival embrasure of
each tooth(to open the gingival embrasures so that they do not
impinge the papilla and be easily cleansed).
Dr. Nesrine Elsahn
Dr. Nesrine Elsahn 4/21/2018

Then the occlusion has to be checked and veneers

 The patient is advised to:
are polished with polishing paste to add
A. Do warm salt water rinses twice daily until the cementation
smoothness and luster . appointment, to aid in gingival repair.

B. Take soft diet, though the restorations are placed with

enough bond to hold them in place.
A light-cured resin agent is applied and cured to
generate a glazed surface texture. C. Take anti-inflammatory/analgesics whenever there is pain or
sensitivity.
Dr. Nesrine Elsahn Dr. Nesrine Elsahn

 Veneers are somewhat fragile, and should be

handled carefully.
1. Check marginal fit.
2. Check inside of veneer for uniformity and The temporaries can carefully
contaminants. remove with plastic instrument
3. Check proximal contacts with veneers in place on or spoon excavator.
cast to make sure that complete seating occurs.
4. Check marginal contours particularly at the
gingival area to assure they are not over
contoured.
Dr. Nesrine Elsahn Dr. Nesrine Elsahn
Dr. Nesrine Elsahn 4/21/2018

Temporaries sometimes need to be cut off and care must be taken not to damage margin
areas of preparations. Dry teeth and inspect for resin tags over spot
etch areas that need to be lightly resurfaced
The patient can be anaesthetized
with a flame-shaped diamond to ensure no
residual resin present that could preclude
proper seating of the final veneers.

Use pumice to clean all prepared tooth

surfaces and wash thoroughly.
Use fine tapered diamond bur to make cuts Then use hand instrument
through temporary veneers without damaging to torque off the veneers.
the underlying teeth Dr. Nesrine Elsahn Dr. Nesrine Elsahn

Place the retraction cord to isolate the gingival

tissue. If color adjustment is needed, select
appropriate shade of non-setting water
Moisten the veneers with water and place them soluble try-in paste, apply to veneer, seat, and
carefully on the prepared teeth. examine for color.

All veneers should be placed without bonding

medium on teeth to assess the fit, shade, also contacts
need to be carefully assessed to make sure one
veneer does not prevent the seating of another.

Occlusal adjustments are best done after bonding Dr. Nesrine Elsahn
Dr. Nesrine Elsahn
Dr. Nesrine Elsahn 4/21/2018

1. Preparing the restoration 1. Preparing the restoration

A. Clean: with enamel etchant (35% phosphoric acid) to

help clean any salivary contaminants that may have come in
contact with the bonding surface.

B. Etch: Most of the time the laboratory has etched

• Hydrofluoric etching generates a significant amount of crystalline debris that contaminates the porcelain
the restoration. surface and may reduce bond strength by 50%.
 Visually reevaluate the quality of the etched surface • To remove this debris, the veneers were rinsed with water for 20 seconds, then cleaned with 37% Phosphoric
(frosted look). acid.
 If the restoration has not been etched, etch with • Re-rinsed with water for 20 seconds and air dried.
hydrofluoric acid. • Following this protocol the veneer surface should appear clean and have a similar appearance to etched
enamel
Dr. Nesrine Elsahn Dr. Nesrine Elsahn

1. Preparing the restoration

C. Apply Porcelain Primer (Silane Coupling Agent):

Applied with a brush and allowed to set on the surface
for 60 seconds.
Then dried with a gentle stream of air (do not rinse).

Dr. Nesrine Elsahn Dr. Nesrine Elsahn

Dr. Nesrine Elsahn
Dr. Nesrine Elsahn
2. Preparing the tooth
A. Isolation: Rubber damn isolation is usually not
practical for multiple anterior cementation
techniques.
Retraction cord and cotton roll isolation and an
assistant are usually sufficient for cementation.
B. Clean: all tooth surfaces with rubber prophy cup
and pumice/water mixture and rinse thoroughly.
Dr. Nesrine Elsahn
4/21/2018
Dr. Nesrine Elsahn
2. Preparing the tooth
C. Place clear Mylar strip between involved
adjacent teeth to minimize etching and
placement of adhesive and cement on the
adjacent teeth .
This will also facilitate removal of excess
composite in the embrasures and leave a
smooth finish in the interproximal area.
Dr. Nesrine Elsahn
Dr. Nesrine Elsahn
2. Preparing the tooth
D. Etch: The enamel is etched for 30 seconds
with 35% phosphoric acid then rinse the tooth
thoroughly to make sure no etchant remains
and air dried .
E. Adhesive is applied to the surfaces of the
Preparation, air thinned and light cured for
20 seconds.
Dr. Nesrine Elsahn
3. Final resin cementation.
C. Excess cement removal: with a
micro- brush.
D. Light cure: veneer from the facial
surface for at least 60 seconds, then cure
from lingual surface if the incisal edge is
included in the restoration.
Dr. Nesrine Elsahn
4/21/2018
3. Final resin cementation.
A. Apply the cement: the selected shade of
light-cured or dual-cured resin cement is
applied to the inner surface of the veneer
with a brush or plastic Instrument.
B. Seat the veneer: with firm finger pressure
and vibrated into position with a blunt
instrument,then excess cement is removed with
a micro- brush.
Dr. Nesrine Elsahn
 Remove excess set bonding material with
a #12 blade and/or sharp carvers,
keep instruments stable against restoration
and tooth surface to prevent tissue damage.
 Recontouring and occlusal adjustments of
the porcelain are done with a fine and extra fine
diamond and high speed using water coolant.
Dr. Nesrine Elsahn
Dr. Nesrine Elsahn 4/21/2018

 Any surface which has been modified with

a finishing diamond needs to be polished with
rubber discs, cups and points.

 Floss and finish the proximals using fine strips.

 Use porcelain polishing paste and prophy cup to

achieve final surface luster.
Dr. Nesrine Elsahn