Achieving Strong and Esthetic Cementation
I treat my fair share of patients in their 40s, 50s, and 60s with worn-down teeth who are looking to enhance their smiles. But I treat just as many younger patients who are looking to take their appearance to an entirely different level. Esthetics are becoming increasingly important to this younger generation that has grown up, for better or worse, in a culture saturated with social media and selfies.
In this case, a 34-year-old woman presented with a desire to close up the interproximal spaces or black triangles on her teeth. You can see from her preoperative photo that her smile was already attractive, but she had an active social media following and essentially viewed her smile as her business. It was decided that the whiter, bigger teeth she was looking for could be achieved through veneers.
Smile Design and Veneer Placement
I created a digital smile design for the veneers and received a wax-up of the proposed treatment from the lab. To ensure minimally invasive preparations, I crafted each tooth by placing a provisional material on an impression of the mockup. By using the smile design as a guide, I was able to move forward with the most conservative preparations possible once the patient approved treatment.
Achieving ideal cementation is essential in any veneer case, but it can present challenges when it comes to color stability, handling and cleanup, and debonding. I do a lot of veneer cases where esthetics are at a premium to both myself and the patient, so I want to use materials that ensure the veneers are completely seated and will not discolor over time.
In this case, the veneers fabricated for this patient were extremely thin. To cement them in place, I used BISCO’s Choice 2 cementation system. I’ve been using BISCO cements and bonding agents for as long as I’ve been practicing cosmetic dentistry. Not only will they do everything I need them to do from a bonding perspective, but I trust that I can consistently achieve a natural looking result for my patients. Choice 2 is specifically formulated for color stability, so I knew it would provide high esthetics for this patient. There is a variety of VITA and chromatic shades from which to choose, but I love using the Milky Bright shade; it’s perfect for my veneer cases.
Choice 2 has a low film thickness to ensure the veneers are completely seated, and also is highly filled to ensure the veneers will stand up to daily stress over time.
Final Outcome
The patient was very pleased with the final result and her new veneers, which gave her the whiter and brighter smile for which she was looking. It’s understandable that in many cases, clinicians may not agree with veneer treatment for such a young, healthy patient—especially considering that healthy enamel needs to be grinded. But there is a cultural difference at play here. Patients with Latin American backgrounds see this as the norm, and many Hispanic and Latin American dentists are showing off their veneer cases in patients of all ages.
In addition, using very thin veneers and a smile design mockup as a guide in this case allowed me to complete minimally invasive preparations on each tooth and preserve as much healthy enamel as possible.
Go To Product Used in this Case
Choice 2 is a light-cured luting cement designed specifically for cementation of porcelain and composite veneers. It is formulated to exhibit color stability, which is a critical factor in esthetic veneer cementation. A range of VITA and chromatic shades are available, and corresponding try-in pastes can be used for shade confirmation prior to final cementation. The highly filled resin cement enhances the strength of the restoration and ensures veneers will stand up to stress over time, while a low film thickness ensures the veneers are completely seated.
Adriana Vasquez, DDS
Dr. Vasquez is a dentist and international speaker from Venezuela who specializes in operative and esthetic dentistry as well as biomaterials. She received her DDS degree at Universidad Gran Mariscal de Ayacucho in Barcelona, Venezuela, and earned a specialty degree focused on esthetics and restorative dentistry from the Universidad El Bosque in Bogotá, Colombia. Her interests include digital photography, digital planning, smile design, allceramic restorations, and restorative dentistry. Dr. Vasquez is the clinical advisor and facilitator of the live patient treatment segment of the worldwide BeBetter Program. Her focus is on treating patients with esthetic concerns and restorative needs.
