Rapid - Fire Temporary Veneers

by Martin B. Goldstein
Wolcott, CT

The technique described in this article demonstrates that occasionally, dental procedures can be simpler than they might appear. In this new world of mock ups, templates, matrices and silicone indices, the would-be cosmetic dentist may well live in fear of under-engineering a cosmetic provisional, thus failing to live up to current standards.

As we all know, the porcelain veneer has changed dramatically since the early days of scratch-the-surface preparations. In many instances, what we call veneers today are actually metal-free, three-quarter crowns. In fact, it might be better to simply rename today’s veneers “porcelain restorations.” The advent of pressed ceramics, along with improvements in fabrication of stacked porcelain products and techniques, has encouraged the profession to tackle “instant orthodontic” projects. Procedures such as moving midlines, eliminating diastema, and closing open bites—without so much as a bracket lifted—have become commonplace.

We must not forget that effective dentin bonding had not yet arrived on the scene when dental cosmetics was in its infancy, thus dictating that our preparations remain in enamel. This largely eliminated the need to temporize our early cosmetic efforts. Our patients lived with scratchy enamel for a week or so while waiting for their new veneers. It was that simple. Today, veneer preparations are more likely to involve dentin. However, this poses little problem since our profession is blessed with highly effective dentin bonding chemistry from a host of manufacturers.

Case

The following case, though simple, demonstrates a technique for rapidly provisionalizing a pair of modern-day veneer preparations. An earlier effort to close the diastema of an otherwise pretty smile had reached the end of its cycle, exhibiting excessive wear and discoloration (Figures 1 and 2). As a result, the patient’s diastema had reappeared. After discussing various options, the patient selected porcelain veneers to provide a longer-lasting solution. She also decided to avoid involving any adjacent teeth and to leave existing tissue contours as they were. A close-up digital image of tooth No. 7 was taken to provide the ceramist with more information regarding coloration and surface texture (Figure 3). As a matter of course, we informed the patient that this indirect approach necessitated provisional veneers to protect the teeth and maintain appearance while waiting for the porcelain restorations to be fabricated.

Preparation Day

After local infiltration with Septocaine™,¹ 4%, teeth Nos. 8 and 9 were prepared (Figure 4). Supragingival wrap-around preparations were created, featuring an incisal bevel against which the lingual aspect of the veneers would abut. Supragingival margins work well when the underlying tooth structure is the same shade as the planned restoration, as was the case here. The veneer/tooth interface becomes very difficult to spot.

After obtaining a satisfactory Impregum™ polyether double-arch impression, the case was ready to be temporized. Because only two teeth were involved, my usual method of mock-up and template fabrication, followed by a provisional, was omitted in favor of a direct technique using a favorite composite of mine, Epic^®-TMPT ². For those unfamiliar with Epic-TMPT, it may be classified as a microfill, but it is distinguished by an organic filler that chemically bonds to its matrix as it cures. According to the manufacturer, this imparts unusual wear resistance to the material. Most typically, I employ Epic-TMPT for direct composite veneers and have found that it holds up marvelously between recall visits. The handling characteristics that make Epic-TMPT a fine direct veneering material also qualify it for fabricating provisional veneers. The material is very nonsticky and flows well but still maintains its shape long enough to coax it with a plastic instrument. It cuts and polishes with ease, and because of its relatively high translucency, it possesses chameleonlike shade characteristics. I used Epic-TMPT shade A2 to fabricate the provisional described here.

Glop It On

In preparation for the provisional, teeth Nos. 8 and 9 were spot-etched for 20 seconds with 33% phosphoric acid (Figure 5). The size of the “spot” depends on how retentive you would like the temporization to be. In this case, since I planned on leaving the temporizations connected (and thus multiplying the retentive factor), I felt safe keeping the etch spots small. Bear in mind, the larger the spot, the longer it will take to remove the temporizations later. However, I normally favor larger etch spots for better retention. It is easier to shave off the residual composite before definitive cementation than it is to replace a dislodged temporary. Consider this a word to the wise. Additional retention is provided mechanically as the Epic-TMPT engages the long parallel walls created by prepping the mesial surfaces of Nos. 8 and 9.

After etching, the veneer preparations are painted with an unfilled resin, blown very thin, and then light cured (Figure 6). One other word to the wise: Use a dentin primer only if you wish to have a supreme struggle when attempting to remove your provisional.

Though Epic-TMPT is not excessively runny, it does flow. The size of the diastema necessitated use of the semi-adjustable digital matrix to contain the mesial surfaces of the provisional (Figure 7). After the first application of composite, and before curing, a midline was imprinted with the blade of a plastic instrument (Figure 8). A second application created a block suitable for rapid sculpting with a #9 ET finishing bur (Figure 9). In about 15 minutes, a serviceable provisional restoration was generated. Final polishing was performed with Enhance^® cups and points and enamel gloss polishing pastes (medium and fine grit). The luster seen is Epic-TMPT polished. A coat of finishing resin is unnecessary (Figure 10).

Such temporization can also serve as a 3D model of the desired contour. An alginate impression and/or photograph of the bonded provisionals can be sent along with the working impression to improve communication with the laboratory. Similarly, the provisional veneers may also allow the patient to comment on the shape and feel of the new temporaries, providing additional insight into the finished product.

I have found such provisional veneers to be very serviceable, so long as care is taken to avoid interference in lateral excursions. Failing to do so may result in a fractured incisal comer. While these fractures are quickly and easily repaired, everyone is happier if these inconveniences are avoided completely. These mishaps are most likely to occur with nighttime bruxers (Figure 11).

At cementation, the provisional is removed via judicious sectioning with a fine diamond, first severing the wide interproximal contact, and then following with shallow, coronal midline cuts that allow a steel plastic instrument to pry the halved veneer apart. A back-action crown and bridge remover fitted with the end normally used to engage crown margins can provide gentle assistance. As alluded to previously, any remaining resin clinging to the etched spot can be shaved off with a fine diamond. In fact, before cementation I make it a habit to either microetch or use a fine diamond to rid the bonding surface of any residual resin that might resist etching or influence fit of the porcelain veneer. This practice will not alter the fit of the patient’s veneers, but will serve to enhance the tooth-to-porcelain bond. The finished veneers, provided by Americus Labs of New York, were luted in place with the Insure^® system and PowerBond from Cosmedent (Figure 12).

Conclusion

This article described a quick and easy technique for provisionalizing limited veneer cases using Epic-TMPT and the semiadjustable digital matrix (your finger). Certainly, other resin microfills lend them- selves to this technique as well. Keep in mind that in this age of over-engineering and detailed treatment planning, there will be occasions when serviceable provisionals can be accomplished with little preparation in rapid-fire style!

1Septodont, Inc, New Castle, DE
2Parkell, Inc, Farmingdale, NY

This article was first published in The Compendium of Continuing Education in Dentistry (Sept, 2002). It is with the kind permission of Dental Learning Systems, which holds the copyright, that Dr. Goldstein’s article appears in Parkell Today.

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©2002 Parkell, Inc. Notice