In this blog, Dr. Nosti provides insight into his treatment process during a porcelain veneers case.

Porcelain Veneers & Undersized Teeth

A 27-year-old woman presented to the office with the desire for a more feminine, attractive smile. She had orthodontic treatment as a teenager and Invisalign during her 20s. These options failed because of the arch size/tooth width discrepancy.

There were interproximal spaces between many of the patient’s undersized anterior teeth. The canines were rotated facially, showing the mesial interproximal embrasures and giving them a prominent appearance in her smile. Due to the canines position, the premolars were deficient in the buccal corridor.

Porcelain veneers and restoration case.I performed an exam that included radiographs, periodontal charting, occlusal analysis with T-scan III, and Joint Vibration Analysis for TMJ. I discussed esthetic options with the patient post-exam, including mock up assisted minimal preparation veneers and correction of slight gingival level discrepancies.

To show her the ideal length and position of her teeth for the final restorations, I completed a mockup by adding flowable composite to the incisal edges of the anterior six teeth. I added flowable composite to the facial of the premolars and molars to communicate the buccal corridor position.

Impressions were taken of the mockup and of her teeth preoperatively. A facebow transfer was completed using the Kois Dento-Facial Analyzer and a centric relation bite was taken. I also took photos of the patient preoperatively, the mockup, and with shade tabs of her dentition.

I completed a diagnostic waxup to the incisal edge position, width, and facial position of the teeth. I fabricated an enameloplasty model and stent in addition to the diagnostic waxup, siltech and final reduction stents. Once the initial reduction was performed (without anesthesia), the siltech was filled with Luxatemp bisacryl and placed over the anterior 10 teeth.

I’ll finish up discussion of this case in my next blog…