Marius (Mo) McGovern, from the Liverpool Implant & Aesthetic Dental Spa, attended one of the seminars on veneer luting
AFTER a couple of “lull” years following graduation I became very interested in aesthetic dentistry and wanted to develop my skills. Over the years I’ve attended many courses and had the opportunity to learn from many world-renowned aesthetic dentists including Lorenzo Vannini, Galip Gurel Didier Dietschi, Larry Rosenthal, Ross Nash and David Hornbrook and within the UK Mike Wise, Paul Tipton and Chris Orr.
Observing aesthetic postgraduate education elsewhere resulted in a desire to provide seminars and hands-on training courses in Liverpool, which culminated in the setting up of the Aesthetic Knowledge Training Company.
This company, although in its infancy, will attempt to provide the dentists of the north with more opportunity to enhance their aesthetic and restorative skills by attracting established speakers to deliver lectures and hands-on teaching at a local venue.
Smile Design seminars
The first programme of events was designed to introduce our course members to some exciting practice building opportunities, including Smile Design. Smile Design seminars were led by Rahul Doshi, from the Perfect Smile Academy, who began their presentation by describing their backgrounds and pedigree.
They have made several visits to the USA to learn from “the master” Larry Rosenthal and others and believe in a “philosophy of excellence” involving using the best materials, techniques and all your skill to provide patients with “beautiful smiles” that will change their lives.
The art of successful veneer luting
The first step is to start working with a quality ceramist who understands Smile Design and provides you with exactly what you want. The second step is to work with the same nurse all the time, one who has been trained to follow the same procedure and work to your own particular routine.
This training, which should be carried out before the treatment of every patient, must include regularly rehearsing each individual’s role so that everyone is familiar with the routine and feels relaxed.
You also need to be organised, with a logical layout every time so you will know where to find everything without a search. It is also important to use the highest quality materials and to work in a regular routine.
For example, Rahul only uses LuxaTemp Fluorescence temporary crown and bridge material to fabricate their provisional crowns and veneers. These can then be characterised and adjusted to create an accurate template for the final restorations using LuxaFlow Fluorescence.
Both materials have an inherent fluorescence that mimics natural teeth, enabling them to provide their patients with temporaries that look natural in all lighting conditions. Also, they always spot etch their temporaries in the same areas so that they know where to expect to find the temporary luting cement.
This makes it easier to remove them when fitting the final restorations.
Before cementing the final restorations it is obviously essential to try them in for fit and aesthetics and Rahul suggests that you don’t show them to the patient until you are 100 percent certain they are correct. If in any doubt, do all the adjustments, re-contouring, etc, before you let the patient see them. If they are perfect, go straight to cementation.
Vitique – their luting cement of choice
Both use Vitique as their composite luting cement of choice. It can be used for luting veneers, crowns, bridges, inlays and onlays using either a light cure or dual curing technique. It can be directly applied using an innovative application system that combines the base and catalyst syringes so both pastes are automatically dosed and mixed in the optimised proportions.
Rahul prefers to use a dual cure technique because it guarantees 100 percent success. Consistent shade matching is ensured because only a small amount of catalyst is used and minimal shadechange occurs. The availability of corresponding try-in pastes, including one in the catalyst shade, means you can simulate exactly the shade change caused by mixing the base and catalyst together.
The try-in pastes are water-soluble so no alcohol is needed to remove them afterwards. Another advantage of Vitique is that it is only mixed when you need it, eliminating the risk of premature polymerisation when seating the later veneers in multiple veneering techniques.
Organisation is essential
When cementing veneers, it is essential to follow an organised procedure, training the nurse to replace them on the model between steps; otherwise they can be easily mixed up, leading to terrible problems.
They suggest you establish a routine so that you always work from one direction to the other, allowing for any additional factors like path of insertion, etc. If you have a random approach, you are much more likely to have errors.
We were given a step-by-step guide to the successful luting of veneers, and among the helpful tips was use hydrogen peroxide to achieve complete haemostasis if you get bleeding at the time of placing the veneers, to provide a seal and prevent problems of recurrent caries afterwards.
When polishing veneers, Rahul stressed the importance of using a fast turbine handpiece (not an airotor) with a gentle caressing motion to avoid applying too much pressure and causing the porcelain to crack.
They said re-contouring can save a case if you use the correct materials and have the confidence. This is nothing that laboratories do not routinely do after firing veneers themselves, using the same materials and techniques.
Re-contouring can either be performed at the initial fit or at the seven-day review depending upon the initial appearance and time available.
Sometimes you need to add subtle imperfections to make “perfect” restorations look “natural” because ceramists tend to supply “perfect” restorations to keep dentists happy. Their advice is to delay re-contouring until the patient has become used to the new shade, shape and feel, etc.
This is because, when anaesthetised, it is difficult to judge the natural smile line and adjust the length of the veneer. Once final adjustment has been completed, use Luminescence on a felt wheel to obtain the final lustre.
Building for success
Finally, they suggest advising female patients to bring some lipstick to the review appointment when the final photographs are taken. This is a very powerful tool for patient satisfaction. It also enables you to build up a portfolio of before and after pictures for new patients to see. Rahul has built up a symbiotic relationship with a professional photographer who offers a free makeover photograph to all their patients.
With an easy going but informative style Rahul is easy to listen to and disseminate their “wisdom” in a pleasant manner that captures your imagination and really encourages you to enhance your skills. I think it gave everyone present many valuable ideas on how to perfect their veneer cementation technique and improve their overall patient and professional satisfaction.