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March 2010 | Dental Products Report
Clinical 360°: Cosmetic/Restorative

The choice is yours

Choosing the right veneers for your patients and your practice can be challenging. Here’s a breakdown of today’s esthetic veneer options to help make that choice a little easier.

by Dr. Lisa Kalfas

The set-up

At a glance

FIGS. 1-5 Side view of a leucite-reinforced IPS Empress (Ivoclar Vivadent) veneer case. Dentistry by Dr. Kalfas and lab work by Quint Whipple of Phoenician Dental Studios (Fig. 1). A close-up view of a leucite-reinforced Empress veneer case. Dentistry by Dr. Kalfas and lab work by Quint Whipple of Phoenician Dental Studios (Fig. 2). A front view of a leucite-reinforced Empress veneer case. Dentistry by Dr. Kalfas and lab work by Micro Dental Lab (Fig. 3). A lithium disilicate veneer (IPS e.max) from Ivoclar Vivadent (Fig. 4). A full smile view of an IPS e.max veneer case. Dentistry by Dr. Frankie Shull and lab work by Matt Roberts (Fig. 5).

Click here for a slideshow with larger images of Figs. 1-5.

“When considering material selection for porcelain veneer restorations, it is often a compromise between the strength of the material and the esthetic quality of the ceramics. This month, Dr. Lisa Kalfas discusses some of the options and indications for various ceramic materials currently used to create porcelain veneer restorations. New materials, such as lithium disilicate (IPS e.max, Ivoclar Vivadent), may offer the best of both worlds for these thin, esthetic indirect ‘enamel replacements."
—Dr. Robert Lowe, team lead

There are many options in the realm of “all porcelain” restorative materials available to today’s cosmetic dentist. But when it comes to veneers, where esthetics are paramount, some of these materials are best left to posterior applications.

In your veneer cases, strength is important, yet esthetic outcomes are the highest priority. Your goal is to achieve both. But with all the available options, it can be difficult to determine which veneer material will best meet this goal. This article will give you an overview of what’s available, making it easier for you to determine what works best for your patients and your practice.

It should look natural
When discussing esthetic properties, our goal with veneers is to mimic, as closely as possible, the properties found in natural enamel. Translucency tops the list of the most important esthetic properties. This quality separates the life-like veneer from the life-less PFM. The flow of light through the enamel layer and into the dentin truly defines vitality in the restoration. Blocking the light, even when a restoration is beautifully finished, is almost always apparent at the margin. The subsequent “dark root,” even though it may be subgingival, can be evident.

For that reason, I will eliminate opaque “all porcelain” cores, such as zirconia and alumina, from this discussion. And because I want to discuss veneers crafted by skilled technicians, I also will not include “no-prep” Cerinate veneers, whose chemistry is guarded and the work outsourced. This brings us to three choices worthy of examination: feldspathic (stacked) porcelain, leucite-reinforced porcelain and lithium disilicate.

What to consider first
Before discussing material options, we are pressed to identify the qualities important to our veneer goals. In veneering a tooth, we are replacing enamel, that layer of hard, translucent, shaded hydroxyapatite covering the dentin. We therefore need to consider strength, translucency and color management. Proper adhesive bonding of porcelain to dentin dramatically increases the restoration’s strength. However, while we have achieved fabulous esthetic results for years at the hands of highly skilled technicians, advances in technology are occurring mainly in the area of flexural strength.

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