What goes around comes around

Nov. 1, 2009
From time to time we all need to revisit our dental practices regarding the services we offer, and think about changes and improvements in those services.

For more on this topic, go to www.dentaleconomics.com and search using the following key words: Dr. Louis Malcmacher, Common Sense Dentistry, no/minimal prep veneers, Lumineers, esthetic porcelains, minimally invasive, armamentarium.

From time to time we all need to revisit our dental practices regarding the services we offer, and think about changes and improvements in those services. Times change and certainly dental technology and materials have changed over the past 30 years, and they continue to change. What was true a few years ago can now be completely different with the advent of new materials. This is certainly true in the arena of no/minimal preparation veneers, where there have been some recent major advancements that are very exciting.

A few short years ago, Lumineers by Den–Mat Holdings LLC exploded into the marketplace with direct consumer advertising about a product that had been around for 25 years. This once again popularized no preparation veneers, with consumers knocking on dentists' doors for the concept.

As a result, there was a backlash in the dental community, with many dental laboratories claiming no preparation wasn't good and didn't work. It certainly seems that the truth has changed because it's now hard to find a dental lab that does not offer some kind of no/minimal preparation veneer. There is now a whole myriad of no preparation veneer options, including Glidewell's Vivaneers, Arrowhead's Razor Thin Veneers, and many others.

The biggest complaints about no preparation veneers were that they were too bulky and too opaque. Patients may have been satisfied with the esthetics, but dentists weren't thrilled with the opacity or bulkiness of the veneers. While it is true that when the patient is satisfied the case can be considered successful, we also need to feel good about what we are providing the patient. Sometimes these problems are related to the dentist's improper case selection, and other times it is the laboratory's use of the wrong kind of porcelain for the technique.

A no/minimal preparation veneer is a specialized veneer technique, which requires specialized porcelain. To be successful, you need a porcelain that can be fabricated very thin yet still be strong enough to withstand the pressures of being seated on the tooth.

A veneer can be made 0.3 mm thin with many porcelains, but as many dentists have experienced, when the laboratory uses the same porcelain they use for crown and bridge, there is an annoying breaking sound as they seat the veneer. Indeed, I have had some laboratories use the wrong porcelain, and the thin veneers have broken in the shipping box!

Some dental laboratories have now developed more specialized porcelains that are thinner and stronger than ever, specifically for this technique. Aurum Ceramic Laboratories, a preferred laboratory at LVI, is known for their high esthetic quality.

They now use one of the most beautiful porcelains ever developed specifically for the no/minimal preparation technique. Aurum's Cristal Veneers have been a wonderful addition to dentists' armamentarium in the no/minimal preparation veneer category. These veneers can now be made with high–level esthetics never seen before in this category. This has been a major advancement in no preparation veneers that will highly satisfy the esthetic demands of the patient as well as the dentist.

From the practice management side of no/minimal preparation veneers, the economy has certainly made us all take a step back in some of these esthetic services. The big advantage with no/minimal preparation veneers is that there is much less time involved, they can be more reasonably priced than other veneers, and it is minimally invasive.

In addition, it is wise to package other esthetic services with a veneer case. We routinely include bleaching and some Botox and dermal filler therapy in the total case price to achieve maximum facial esthetics surrounding our veneers.

With the advancements of new materials and techniques, patients more easily accept these veneers because of their conservative nature. With the advent of esthetic porcelains designed just for this technique, now 30 years later, no/minimal preparation veneers are here to stay. They should be a part of every dentist's armamentarium.

Dr. Louis Malcmacher is a practicing general dentist and international lecturer, author, and dental consultant known for his comprehensive and entertaining style. Contact him at (440) 892–1810 or send an e–mail to [email protected]. Go to www.commonsensedentistry.com for more information on his lecture schedule, audio CDs, to download his resource list, and to sign up for a free monthly e–newsletter.

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