Vivaneers™ No-Prep Veneers

My experience with no-prep veneers has been overwhelmingly positive. My initial concern over the potential bulkiness of the restorations and the gingival margins have proven to be non-issues in all the carefully selected cases where the patient requested no-prep veneers. More importantly, the enthusiasm over no-prep veneers from my patients has made this procedure very rewarding for me, as I am able to change a smile painlessly in one appointment.

Also, once all the restorations are in place we will give the patient a hand mirror so that they can take a look at the restorations as well. At this point I have also printed up an 8x11-inch picture of their "before" shot so they can remember what they used to look like. Whether or not they have had temps, this before picture helps give the patient some perspective on where they started and where they are now.

The try-in paste is water-soluble, so it is very easy to rinse out of the internal aspects of the veneers and off the teeth. At this point I like to clean the teeth with some fresh pre-mixed pumice (Preppies, Whip-Mix Corp) and then apply some liquid Consepsis (Ultradent) and air-dry the teeth.

The unprepared teeth are now etched with 37 percent phosphoric acid for 15 seconds and the etch is rinsed off.

The teeth are now dried, and you'll see the frosty appearance associated with etching enamel. A thin layer of Scotchbond adhesive is placed with a microbrush.

The Scotchbond is air-thinned.

The translucent veneer cement is placed in the veneer and the veneer is placed onto the tooth, ensuring that excess cement is visible around all the margins. If, for example, no excess cement comes out of the gingival margin when seating the veneer, I will quickly remove the veneer and add some more cement so that I can see the excess squirt out the margin. Every veneer case is done the same way with the central incisors (#8 and #9) placed simultaneously. I apply pressure at the incisal edge with an orangewood stick to make sure the veneers are seated all the way and I apply some pressure with another orangewood stick at the junction of the gingival and middle thirds of the tooth to make sure the veneer is all the way against the tooth here as well.

Then my dental assistant takes our LEDemetron curing light (Kerr) and holds it about 5-7 mm from the excess cement at the gingival margin and cures it for about five seconds as she waves the light back and forth.

The goal here is simply to get the cement to its gel state without completely curing it, since the more cleanup we do now, the less we will have to clean up with a handpiece later.

Once the gingival margin is cleaned up with an explorer, we place the light half on the gingival margin and half on the gingival tissue in order to complete the cure at the gingival margin and tack the veneer into place.

This allows us to use Glide floss interproximally to clean the excess cement out of the contacts before it cures completely. Once the contacts are cleaned, the light is held 5-7 mm from the lingual surface and is activated for five seconds to bring the lingual excess cement to the gel state and facilitate cleanup). Once the excess is removed, final curing is completed. The centrals are placed first and simultaneously because they are so crucial to the overall success of an esthetic case.

After the centrals are fully cured I will place the rest of the restorations on one of the sides. I then etch the lateral cuspid, 1st bicuspid, and 2nd bicuspid if it was included in the case. The contacts have already been adjusted at the try-in, so at this point all of the veneers should go right into place. For cement that has been smeared across the glazed ceramic surface, such as on the facial, my favorite way is to clean it up with a Brownie cup, from the Brownie/Greenie kits we use to finish and polish cast gold restorations. The neat thing about using a Brownie is that it does a great job of removing cement but won't do a thing to porcelain.

Axis also makes some excellent safe-sided serrated metal strips that do an unbelievable job of cutting through contacts that have been inadvertently bonded closed with resin cement. Because they are safe-sided strips and only cut on the end, they do not create open contacts like a finishing strip can if used too aggressively. Once you have vertically cut through the excess resin cement, Glide floss can often be used to remove the excess.

Other cured cement can be removed with a sharp, disposable scalpel. The more cleaning you do with the Glide floss while the cement is in its gel state, the less cleanup you will have to do when it is rock hard.

Once the veneers are completely cured we can adjust the occlusion where necessary. As with any all-ceramic restoration, it is best not to put it under a lot of stress until it has bonded into place and gains strength from the underlying tooth structure that it is bonded to, and can withstand full occlusal forces.

So when we try in the veneers we have the patient bite down gently to verify that the occlusion is right on, or very close. If it is, we can then bond the veneers into place and adjust the occlusion after the cement is fully cured. If the occlusion is way off, we gently address those issues before the veneers are seated, just in case they cannot be corrected.

Final polishing of all adjusted surfaces is done with Axis Dental CeraGlaze porcelain polishing kit. These points and cups work extremely well for me intraorally because I use Kavo electric handpieces. Electric handpieces have so much torque that they can polish porcelain intraorally as well as a lab handpiece can extra-orally, which is very important for PFMs and all-ceramic restorations.

The final 3 pictures of the patient show that no-prep veneers can be an excellent way to conservatively restore esthetic challenges while meeting the patient's treatment expectations.

The final 3 pictures of the patient show that no-prep veneers can be an excellent way to conservatively restore esthetic challenges while meeting the patient's treatment expectations.

The final 3 pictures of the patient show that no-prep veneers can be an excellent way to conservatively restore esthetic challenges while meeting the patient's treatment expectations.