For this particular blog post, I would like to share with you a case that I’ve posted onto Facebook and talked about a couple of times. It is a porcelain veneer case and it illustrates a concept that I believe in my practice, and that is I’m dedicated to creating long-term results for my patients. So wherever possible, long-term clinical results, and I will talk about this concept a lot in my dental excellence videos.

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If you look at this particular patient, these are photographs I shot in September 2014 and this patient had four porcelain veneers placed by me and these are the ten-year post-op photographs for this case. So ten years post-op and when I posted these on Facebook, people thought it was amazing to have such wonderful results after ten years and I’ll tell you, again, this is what we can do in everyday practice. This is what can be accomplished with excellent lab support, excellent clinical techniques and really great planning and thought about how you design the occlusion.

Here are a couple of other views of this case. You can see that the tissue looks excellent because we’ve had proper management of the tissue and the porcelain margins. The patient’s done his part by keeping his teeth nice and clean, coming in for really regular maintenance, flossing and, obviously, just having a good overall starting position or condition of his tissue to allow this kind of result to happen.

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If you look at the preparations, this is a primary key that I talk about in all of my training programs when we discuss porcelain veneers, and that is that you want to prepare the case to leave the majority of enamel on the tooth. I don’t want the majority of the enamel disintegrated into vapor– I want the majority of the enamel left on the tooth so that I can bond my restorations to a preparation surface that has a majority of enamel and if you can do this, you’ll have very, very few veneers de-bond, even at the ten-year mark, even, maybe, at the fifteen-year mark. If you can do this, you can get really great, long-term success for your patients.

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So my primary goal, when I’m teaching and talking about porcelain veneers, is to leave as much enamel as possible and if you look through the dental literature, that is echoed through a lot of different research papers, retrospective papers, longevity papers, etc. The main goal is leave as much enamel as possible, that’s something I really like to drive home and wherever possible, when I’m treating a porcelain veneer case that is what I do.

So if you look at this particular case, you can see a starting condition and when we started, his teeth were not in great alignment and the one lateral incisor was really sticking out, labially, and I would have really had to over-prepare that tooth to get it into alignment so my suggestion to the patient was what I have suggested to most of the patients that come through the practice is do orthodontics first and he didn’t want to have braces, per say, traditional orthodontics, but he did agree to Invisalign.

Dental Excellence V2 5So with Invisalign, we were able to bring the lateral incisor in and level the lower incisors much better so that at the veneer insert appointment I could just equilibrate those lower incisors and level them a little bit with Soflex XT discs, some polishing discs, as oppose to a fairly aggressive enamel-plasty that would be needed if they were left as they are in the pretreatment condition. With the Invisalign, I was able to line up the lower incisors quite nicely and then just enamel-plasty them a little bit to have a better contacting surface for the new incisal edge position of the upper porcelain veneers.

Here is the patient finished. These images probably were taken around the five-year mark.

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So another lateral view, you can see the aesthetic integration of the porcelain into the surrounding dentition. We have good surface anatomy, surface luster as well as shade and value.

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And another view. This view illustrates a point that I like to make that the porcelain veneers shouldn’t stick out too far labially.

So I hope you enjoyed this long term porcelain veneer case example and the before and after images of the porcelain veneers for this patient.

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