Chairside - Glidewell Dental Labs

have really come around to no-prep veneers. As our technicians and the ceramics have improved, I have been
getting much better results on a much wider variety of cases. There are still those cases, however, where some
minimal enamelplasty can make a big difference in final esthetics. I usually have a conversation with the patient
to determine if they are set on no-prep veneers or open to minimal-prep veneers. It’s a little ironic because no-prep
patients don’t want their teeth touched, but it would be impossible to ever remove the veneers without prepping tooth
structure. I am comfortable with both and I welcome patient input when planning these cases.
Figures 1-3: This 32-year-old female patient wanted to
improve her smile but did not have much luck with vital
bleaching. A previous dentist had placed some direct
composite veneers on the upper and lower anterior teeth,
but most had broken off or worn away. These photos are
used to judge macroesthetic issues, such as smile line,
and whether there are gingival issues that need to be addressed.
Figures 4-6: The retracted views of her smile show there
are small islands of composite still attached to the teeth
in random areas. There is some composite on the lower
teeth as well, but the patient can only afford to treat the
upper arch at this time. These photos are used to evaluate
esthetic issues related to the interdigitation of the upper
and lower anterior teeth such as overbite, overjet and
crossbites.
Figures 7-9: The addition of a black background makes it
easier to see specific esthetic issues. Tooth rotations, gingival
embrasures, shade issues and incisal translucency
are much easier to see when the lower teeth are not visible
and the contraster is in place.
Figure 10: It is not until you see this occlusal photo that
you can begin to determine whether this is going to be a
no-prep or minimal-prep veneer case. Since most dentists
Figure 1 Figure 2
do not take photographs, they must wait until the lab
pours the model and views it from this angle. Based on
this view, we decided to do minimal-prep veneers.
Figure 11: Based on Fig. 10, we decided minimal reduction
was needed on teeth 7, 9 & 11. My definition of a
minimal-prep veneer is one that requires enamel removal
for optimum esthetics but exposes no dentin. Part of a
minimal-prep veneer is patient approval for removal of
the tooth structure. I’ve had many minimal-prep patients
who wanted no-prep veneers. While it compromises esthetics
somewhat, I cannot force the patient to value esthetics
over conservation of tooth structure.
Figure 12: Teeth 7 & 9 require facial reduction to improve
the esthetic result of the final restorations, while tooth 11
only needs reduction to the distal third of the tooth. It is
surprising how often the distal third of the canines have
rotated facially, which throws off the overall esthetics of
a smile. Ideally, the distal third of the canines should not
even be visible from a straight on smile view.
Figures 13-14: I had the laboratory make a putty wash reduction
guide for me to ensure I would reduce the teeth
only as much as needed. The lab has taken the study
model and reduced it in the areas we agreed upon, duplicated
the model, and then waxed it up to ensure they
Minimal-Prep Case Photo Essay15