Additive contour of porcelain veneers: a key element in enamel preservation, adhesion, and esthetics for aging dentition

Abstract

Esthetics and function are equal concerns when restoring the anterior dentition. Modern concepts in restorative dentistry have brought new solutions through bonded porcelain veneers that are stress distributors and involve the crown of the tooth as a whole in supporting occlusal force and masticatory function. This recovery of the original biomechanics of the intact tooth, the biomimetic principle, is particularly valuable when considering the restoration of an aging dentition. Both function and appearance are affected by the senescent changes of the aging teeth. Erosion and surface wear lead to a progressive thinning of enamel, ultimately leading to increased crown flexibility and higher surface strains. It appears therefore that the restoration of tooth volume will not only re-establish the original and youthful appearance of the smile but will also allow the biomimetic recovery of the crown. The final treatment outcome strongly depends on the therapeutic approach chosen, the driving force of which should be the preservation of the thin remaining enamel. While a number of preparation techniques will expose dentin to a great extent, the principle of enamel preservation can still be fulfilled by the use of a specific approach. This article describes a treatment method which includes the use of a diagnostic template. This type of work strategy, documented with clinical cases, integrates additive wax-ups and acrylic mock-ups. The latter will provide a significant amount of diagnostic information and economy of tooth substrate, the importance of which cannot be overestimated in the completion, functionality, and longevity of the final restoration.