Porcelain laminate veneers

Porcelain laminate veneers (PLVs) are the most accurate and reliable treatment in field of cosmetic dentistry. PLVs are very thin ceramic layers which will be placed on the outer surface of the teeth to modify color, form and size of the teeth. Due to patient need, this thickness could be variable between 0.2 – 1 mm. This thickness could be checked in mock up procedure before starting the final treatment and depends on the difference between the initial and final position of the teeth. The important point is that PLVs are placed in labial or outer surface of the teeth and the palatal or inner side of the teeth remain intact.

Similarity to tooth enamel and life time of PLVs

Since our goal is reaching to ultimate beauty without sacrificing the teeth structure, PLVs will be placed over the teeth enamels, leaving the most enamel volume and dentin intact. Looking to enamel structure shows us this tissue contains up to 96% minerals and the microscopic structure of it is based on enamel crystals. On the other hand new dental ceramics are basically crystal materials, so the similarity of ceramic structure and enamel structure will bring a trustful result; mechanical and optical properties of natural teeth will remain the same after cosmetic treatment with PLVs. These similar characters brings similar reaction with chewing forces, thermal shocks, and also light transmitting for both natural teeth and PLVs. It is now clear why PLVs remain too long in patient mouth. The average life time of PLVs is 15-20 years.

Light and color characteristics of PLVs

As discussed, the behavior of modern ceramics in front of light is very similar to natural tooth tissue. So it is obvious why PLVs look so natural. Light refraction index and also physical phenomena like reflection in PLVs are so close to natural teeth. The external surface of PLVs will be glazed in the final process of fabricating them. The glazed surface of PLVs do not absorb any moisture and stains. So now we understand why PLVs color are so stable among the colorful foods and drinks in long term. Color of PLVs never change. On the other hand you have to pay attention about the thickness of PLVs. These restorations are very thin and they do not cover the inner surface of teeth. So, if the oral hygiene would not be proper enough or the patient has colorful habits such as smoking or severe coffee drinking, it is obvious that these uncovered areas can get stains and through the thin PLVs this discoloration can be seen. In these cases, patient may have a misunderstanding that the PLVs color themselves has been changed. Therefore in these kind of patients we seriously recommend they have to clean their teeth once or twice a year to prevent teeth color changing.

PLVs color

PLVs have various different colors. Since modern ceramics cover all natural teeth colors, so it is very simple to fabricate PLVs with natural colors. In addition, new ceramics are produced in several bleach colors. These types of color are mainly referred to those color which are lighter and brighter than natural colors. Speaking the truth, these bleach color are now very acceptable by many patients. 

Bleach colors have a wide spectrum of light colors, which starts from gentle natural bleach color and ends to super bleach color. PLVs have the capability to seems very natural even in super bleach color mode. For choosing the right color for your PLVs Dr. Navab recommend you to upgrade your perception of light and color. Please follow the subject to get more information about color.

Color perception in modern esthetic dentistry

In spite of importance of color in today esthetic dentistry, it is still one of the most complex subjects in these treatments. To avoid these kind of problems, both cosmetic dentist and patient should deeply understand the concept of color in esthetic dentistry. The other factors such as form, anatomy and also surface texture beside surface brightness of the laminates in addition of translucency of the ceramic, often are more important than color itself. By using different and various layers in construction of porcelain laminate veneers, beside the natural texture on the outer surface of them, the light reflection seriously affected and it causes we see very bright and light colors as natural as possible. Paying attention to these elements could lead dentist and patient to successful results. So, natural or fashion design of the final restorations depends on many factors not just color code of ceramic. The process of color selecting in these kinds of treatments needs patience and enough time spending by dentist and patient.

Tooth preparation / reduction for PLVs

It is obvious that preserving the teeth structure and preventing of irreversible damage to them, is the first and most important term in esthetic dentistry. Any esthetic treatment with uncompensated harmful touch of the teeth is not acceptable at all. To get beautiful results, there is no need to sacrifice the teeth structures. All ceramic crowns or classic porcelain laminate veneers; as traditional aggressive methods, are replaced by modern ultra conservative treatments. So, today we have to pay more and more attention to preserving gum and tooth tissues.

The dentist cannot decide to reduce the teeth volume by himself alone. In fact, this is the patient who observes and evaluates the final position of the teeth, can decide about this matter. In other words, dentist in mock up procedure tries to add on the teeth surfaces and shows the patient the new position of the teeth without any teeth structures reduction. This add on procedure is mimic to final PLVs thickness in the first step of smile design. If the patient accepts the new position of the teeth, so both patient and dentist understand there is no need to teeth reduction. But, if the patient complain the new position of the teeth, it will be obvious for both of them there is a necessity of teeth reduction. The important key point is all these procedures and decision making happens before the main treatment starts.

Today we have better treatment outcomes with less sacrificed tooth structure and this comes through better understanding of tooth structure, improvement of dental materials; specially modern ceramics and bonding resins from one side and on the other hand using more precise equipment and technology such as oral scanners and dental microscopes.

PLVs fabrication

PLVs are thin layer of porcelain which made in specialized dental ceramic laboratory. When teeth prepared for these treatments, the dentist make an impression or preferably scans them. After model fabrication in dental lab, the ceramist digitally designs the final PLVs. Since during Dr. Navab protocol all items already have been checked in mock up procedure, now the initial design of mock up has been pasted over the prepared teeth and adapts over them. Finally the main model of future PLVs constructs over the teeth. After that, these models converts to final PLVs by means of precise equipments such as CAD/CAM and press system. At the final stage, the dental ceramist apply the essential layers and color effects on the PLVs and glaze them. Now the final PLVs are ready to deliver to patient.

Bonding PLVs to teeth

PLVs have been bonded to teeth by special bonding resins. In contrary with dental crowns which cemented with conventional dental luting cements to teeth – and for this reason they need a retentive preparation of the teeth – PLVs do not need teeth preparation for this purpose. The bond strength is more than enough, so there is rare situation in which PLVs detach from the teeth. Thanks to such a reliable bond strength, in situation with massive force, PLVs break not debond. This is one of the most important factors which guarantee the long life time of PLVs in function.

Achieving this powerful bond needs special preparation of the teeth. This procedure is very critical and must be very precise.

Due to bond strength, if anytime we need to remove PLVs from the teeth, we need special hard tissue laser equipment to burn out the bond layer or reducting the whole PLVs structure from the teeth surface by means of special dental burs. Unfortunately, PLVs could not be removed by crown remover through knocking them, in contrary with dental crowns.

Clinical procedure for smile design with PLVs

Several years experience in smile design and cosmetic treatments with PLVs and also updating in esthetic dentistry science, leads Dr. Navab to design and run a unique protocol for such treatments. Through this exceptional protocol, patient finally enjoy from having customized and unique smile which designed and fabricated specially for him/her through an step by step controlled procedure which the patient himself/herself has a great role to finalized the treatment. This scientific procedure contains all possible modalities which patient concerns and also based on functional and biological preservation of oral tissues. The ideal results never come true by chance.

To understand the whole procedure by means of
Dr. Navab protocol,
we review the treatment sessions step by step for you.

First appointment

Cosmetic consultation

In this appointment at first Dr. Navab consult with patient about his/her cosmetic problems. He helps patient to review his/her main chief complaints about his/her smile and teeth. Then a complete intra and extra oral examination has be done by Dr. Navab. The important elements of teeth, gums, teeth and jaw relationships and also lips and face which are in related with patient smile have been evaluated carefully. After that Dr. Navab explains the whole procedure and describes his protocol for the patient. During this phase of this appointment, he explains for the patient how the treatment goes on and mention some basic principle of esthetic dentistry beside the structure of PLVs and the nature of smile design procedure. Also he notes how much the preservation of sound tissues of the teeth is important and furthermore how ultra conservative methods goes on to obtain these aims. Dr. Navab always insist on patient fully education about the future treatment. He believes that only through giving complete information to patient, he/she can have the idea of perfect treatment. At the end of this appointment, he gives the patient enough time to make a decision. If all items go well the actual treatment procedure starts from the next session.

In this session the treatment starts. First the essential information has been taken. For Dr. Navab both dental and psyco-social information are very important. For dental part, He examine intra and extra oral tissues comprehensively. Teeth color and sizes have been recorded as well as teeth and jaw relationships. Patient specific demands carefully has been watched. Dr. Navab help patient to realize what he/she truly needs.

In social part, all aspects of patient’s social life from the esthetic point of view, has been assessed. For example the type of patient’s job has a great influence on smile design. The people who patient communicate with them also is very important. Even the make up, hair and dress style of patient is important. Beside these information, a brief evaluation on patient personality and characters should be done.
After collecting the essential information, specific photos and movies have been taken from the patient. Through these photos and movies, patient’s smile could be analyzed from different angles.

And at the end of this appointment, all teeth should be scanned by intra oral scanner. Also the jaw relationship should be digitally recorded.

The complete data will be analyzed by special smile design software and after distinguishing the major and minor problems, a new smile design for each patient will be configured. The final out put of this session is the 3D printed dental model which in the next appointment will lead us to mock up procedure.

Second appointment

Pre op photography and scan

Third appointment

Mock up

In this appointment, Dr. Navab shows the real new design of the teeth to patient through mock up procedure. For this, first teeth should be cleaned and polished. In this process there is no touch to the patient’s teeth. Since the final design has not been approved yet, the patient has a chance to reject the treatment in this session without having any damage to the teeth. So without any preparation or reduction of the teeth the provisional model of the final teeth will be made in patient’s mouth. This procedure takes about 1 hour and after that, patient has enough time to evaluate the model. Patient will have up to 24 hours to check the new teeth. These new teeth should be checked from different points of views and angles. Dr. Navab trains the patient to how capture good and useful photos and videos to evaluate completely the new design. Mirrors due to light refraction and distortion of the image, are not ideal device to evaluate the patient’s new look. Also patient has a chance to check the new look with anybody whose opinion is important for him/her.

If patient distinguish an error or complain from anything about the new design, it can be simply modified over mock up. For example if the patient complains about new teeth length, they can be shortened very fast and easy to satisfy the patient.

 

When patient satisfies from his/her new smile design, now it is time to choose the final laminates characteristics. From several different types of laminates which Dr. Navab can do for patient only few of them can be made upon the specific design for each patient. Dr. Navab take enough time to consult with patient about laminates characters and help him/her to decide which one is the best choice for him/her. Also at this moment patient realizes how many teeth need PLVs, or furthermore if lower teeth also will be candidate for this treatment or not. Only now the final cost of treatment can be clear.

It is so important to notify again, if for any reason patient does not like the design and wants to reject the whole treatment, he/she can remove mock up easily without any damage to the teeth. Before the main treatment starts, if any teeth need complementary treatment such as filling, cleaning, root canal therapy or surgical gum lifting now is the time. Dr. Navab and his team will do anything is necessary before the laminate procedure begins.

In this appointment teeth have been prepared for final PLVs. Through mock up session, patient understand if the teeth need any reduction or not. So if there is a necessity for any teeth to be reduced now it should be done. In most of the cases, the final position of the teeth are acceptable so there is no need for teeth reduction. But since the intact surface of the teeth do not permit any bonding procedure, even there is no need to tooth reduction, it is a necessity to prepare the teeth surfaces for bonding procedure. This operation involves only 50 micro meter of the teeth surfaces. The amount is so tiny which could not be done by dentist eye (because the human eye can not see such a this little volume). So, Dr. Navab do this procedure by 3D microscope to enhance the preciseness. This amount of tooth preparation is so small that patient hardly can differentiates the changes in teeth surfaces. The procedure often has no pain. So, there is no need to injection and anastasia. But if patient demands for it, it is possible to do that.

After the preparation, all of the teeth will be scanned for final PLVs. Using oral scanners not only improves the preciseness of the treatment, but also make the procedure in the lab faster and easier. At the end of this session, provisional laminates will be bonded to teeth. This provisional are the same as mock up. The patient can modify the shape and color even in this part of treatment. So, before final PLVs will be made patient can check the design for two times.

The provisional has to be maintained in patient’s mouth for about two weeks. Dr. Navab and his team train the patient to how take care of it.

4th appointment

Teeth preparation and final scan for PLVs

5th appointment

PLVs delivery and bonding

In this appointment, first the provisional removes and teeth should be cleaned. The final laminates will be put on the teeth with a try in paste. This material help Dr. Navab and patient to evaluate the final result before bonding. This procedure is very difficult because there is no bond and PLVs could be easily fallen. After patient and doctor satisfaction the bonding process begins. If there is any problem in PLVs they should send back to lab to correct them.

PLVs will be adhesively bonded to teeth. This procedure is very critical and should be very precise. After finishing the bonding process all contacts will be checked and if there is any roughness on the inner surface of the teeth, it should be polished.

Final control and photography
6th appointment

Final control and photography

This appointment will be held after 2-3 weeks. Dr. Navab will check every laminates, teeth and gums. If any modification is needed it will be done. Finally photography should be done.