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Letters to the Editor
“Dear Dr. DiTolla,
After watching your clinical veneer videos,
I just prepped a 10-unit case and tomorrow
I have 6 units. (When it rains, it pours!)
In the past I have used 3M ESPE RelyX
veneer cement. Will you please share your
luting material of choice and technique
specifics? Your clinical video advocated
Parkell Brush&Bond and Nexus ® by Kerr,
which is now NX3 with Optibond. Do you
use another product? Please let me know.
I need to get the product ASAP since I will
place these cases next week.”
- Sylvia Rogers, DMD, New York, N.Y.
Dear Sylvia,
Good for you! Certainly, the more
you do something, the more proficient
you become.
There is no difference between veneer
cements, only personal preference
of consistency. I prefer thick
veneer cement, which is the main
reason I switched to NX3. Every
brand of luting cement has a translucent
shade, which is the shade I use
most often. I now use Optibond with
NX3, as you pointed out, because I
have heard from clinicians like Gordon
Christensen and Michael Miller
that the highest bond strengths are
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chairsidemagazine.com
typically achieved using bonding
agents and cements from the same
family.
After rinsing the water-soluble tryin
cement from the veneers etched
with hydrofluoric acid in the lab, we
place liquid silane in the veneers for
60 seconds and then air-dry. Next,
we paint a thin layer of Optibond inside
the veneers and air thin it before
placing the veneers under a lid that
protects them from the light.
Intraorally, I pumice, rinse and etch
with phosphoric acid — for 15 seconds
on enamel, 10 seconds on dentin.
Next, I paint a thin layer of bonding
agent on the tooth surface, then
air thin. Finally, I cure the bonding
agent on the tooth after air thinning,
although many clinicians don’t. I
have noticed a decrease in post-op
sensitivity when I cure at this point.
My assistant loads the veneer with
cement, and I place it on the tooth.
Using two orangewood sticks, one
pushing incisally and the other facially,
I seat the veneer. My assistant
cures the gingival margin for approximately
two seconds, and I clean off
the semi-hard excess with an explorer.
She then cures for another one to
two seconds at the gingival. I then
clean the excess on the lingual and
interproximal before final curing.
As you mentioned, we have a couple
of different videos showing this. And
while the products may change, the
technique stays the same.
- Mike
“Dear Dr. DiTolla,
How’s everything? I can’t believe it has
been a year already since I saw you at the
Greater Long Island meeting. I did a nice
case with Glidewell recently: IPS e.max ®
crowns on #7 & 10 and veneers on #8 & 9.
I locked on the temps as you recommend
in your videos. My patient kept the gingival
area as clean as possible, and when I cut
off the temps the tissue was pink and
healthy. After tack curing the veneers first
and removing the excess cement in the
gingival area, the tissue started to bleed. I
luckily had tight margins and no bleeding
seeped under the veneers, but it still was a
headache.
Is there anything you can recommend to
prevent this, and should it cure, what steps
do you take to continue cementing the
case?”
- David M. Rahr, DDS, Kings Park, N.Y.
Dear David,
Anytime I have temp veneers on, I
now find myself pre-treating the gingiva,
if you will, before I even touch
it and test it out. At the very least,
I hit the tissue with ViscoStat ® Clear
and some soft scrubbing action with
the Mini Dento-Infusor tip. If that
process creates bleeding, I place
Expasyl in the sulcus and wait a few
minutes before rinsing and proceeding.
If Viscostat Clear does not cause
bleeding, I rinse it off and continue
with the bonding process. In the
most extreme cases, I will pack an
Ultrapak ® 00 cord in the sulcus to
prevent bleeding and retract the tissue
approximately 0.5 mm as well.
The biggest difference: I used to begin
the bonding process with the
hope the gingiva wouldn’t bleed and
then deal with it if it did. Now I test
the gingiva before etching the teeth
to control it before committing to the
bonding process in earnest.
- Mike
“Dear Dr. DiTolla,
Let me start with a huge thank you for
the video presentations, articles and
many techniques that I have learned from
watching you practice dentistry. As a