Anterior Ceramic Veneers, Part 3: Incisal Butt Veneer

[@2kidsnosleep]

28 yrs and still learning. Very nice prep design, will incorporate much of this video technique👍🏻😎

[@StevensonDentalSolutions]

Awesome! Me too!

[@shahinershad3924]

Thank u dr....u r a gem....u r a great mentor...coz u r very kind to reply for ur comments....i am learning veneer for the first time....n i am happy i am getting to know the topic very well zhrough ur videoa sir....thank u so much....god bless u sir.. With lots of love from kerala ,india....

[@samiasalama100]

I love they way you teach us with ,very informative lectures ,god save you ..greetings from egypt

[@StevensonDentalSolutions]

Thank you! Love my Egyptian friends. All he best to you. Dr. S

[@hadeeraliraqi8071]

I cannot thank you enough for your valuable videos for first time someone talking not only about preparation but also stones, size and shape that can be very important to use.. thank you so much 🌷🌷🌷

[@StevensonDentalSolutions]

So glad to be of use! Thank you.

[@dentalmitra7864]

That was a great video doc , helping those of us at the learning end to grasp the nuances in the making of a good veneer. Thanks for your earnest efforts in educating .

[@StevensonDentalSolutions]

Thank you Rupa - I appreciate your comments and support.

[@stevenlopez1717]

As always, great work. I'd love to see you do a video on placing a direct composite restoration on one of these veneer preps, ideally the butt-joint veneer prep.

[@cuddlethepug9962]

Loved ur video. Learnt more then all the lectures I have been to. Thank u .

[@StevensonDentalSolutions]

Awesome - thank you!

[@veroxism1791]

I realy have to Thank you alot for these rich contetns doctor if you can go ahead with implants and endo courses, regards ♥️

[@StevensonDentalSolutions]

Yes, will be coming in our Clinical Series, soon to launch on this channel!

[@hagaressammahmoud2636]

thank you dozens ..you 've helped me much with those demonastration.greetings from egypt

[@StevensonDentalSolutions]

Great!

[@dipalipatil7366]

Thanks a lot dr.stevenson,your videos are very helpful for veneer preparation,detailed description of the techniques & materials as well.it helped me in my practice.All my best wishes to you doc !

[@StevensonDentalSolutions]

Thank you, Doc!

[@haoyang9719]

Amazing work and very thorough explanation!

[@StevensonDentalSolutions]

Thank you Doctor. Appreciate you watching and your nice comment.

[@Pistoldiego]

Thank you so much for this amazing lectures Dr. Stevenson @Stevenson Dental Solutions, I wanted to ask, how do you keep proximal contact point tight if you are eliminating it with the diamond strip and the restoration doesn't seem to contact in the part that was reduced? Thank you so much again!

[@StevensonDentalSolutions]

The amount of opening is less than 100 microns - just enough for the technician to separate the dies without marginal damage. Since you are extending the interproximal finish line slightly into the contact area, the final veneers will make good contact. It's an amazingly predictable technique, taught to me by the world class Prosthodontist and Technician, Ed McLaren about 20 years ago...

[@Pistoldiego]

@@StevensonDentalSolutions Thank you so much Dr. pretty clear explanation!!

[@StevensonDentalSolutions]

@@Pistoldiego Great

[@radicevicdent1354]

amaizing!!!!!

[@johnny9516284]

Thank you very much for your gorgeous lecture and all the details

[@abodghafir3582]

Amazing prep as always!

[@nainachopra1983]

Thank you Dr.Stevenson for this amazing video. If we have a shallow overbite and after reducing incisal edge 2 mm our centric contact is falling at the butt joint junction( where ceramic would meet tooth,) what do it do....do a lingual wrap and take my lingual margin a mm away from that contact?

[@StevensonDentalSolutions]

Not usually. The interface of the ceramics and tooth with a bonded veneer is not designed with MIP (not "centric", which is an outdated term) as a factor. The margin will be smooth and the ceramic strong under compressive load. I like to think of bonded veneers behaving like enamel.

[@nainachopra1983]

@@StevensonDentalSolutions thank you so much for the reply. So you mean it's absolutely safe to keep the mip contact at the tooth ceramic interface The texts recommend to keep the interface half a mm to a mm away from mip contact so i believed that it's the weakest link. Thank you Regards

[@Vishalonpodcast]

Amazing work Shukriya for wonderful content 🇮🇳

[@StevensonDentalSolutions]

Thank you Doc! Best, Richard Stevenson

[@JoonKimDMD]

If the teeth had nice contact, would you still run the diamond strip between the teeth to remove both the contact and the enamel rods?

[@StevensonDentalSolutions]

Always - this allows the technician access to trim the dies.

[@rehamfaisal7761]

very informative Dr, i would like to ask about the failed case with papilla . u mentioned in the video that u would overcome that mistaje if u lowered the contact 4 mm from bone and modify proximal wall. can u clear that point i tried many times to get it but i couldnot ,,,,,,,,,,thanks in advance

[@StevensonDentalSolutions]

If the most gingival aspect of the contact is 4 mm above the bone research shows us that the papilla will be able to fill the gingival embrasure 100% of the time...Paper by D. Tarnow about 20 + years ago.

[@rehamfaisal7761]

@@StevensonDentalSolutions Thanks alot dr

[@StevensonDentalSolutions]

@@rehamfaisal7761 My pleasure

[@dingdental4310]

thankyou doc, waiting for the final part

[@drshadykhalifa4839]

Thank you very much doctor for your effort .. if you dont mind sir in this .. the incisal reduction should be straight or inclined lingually … thank you sir

[@StevensonDentalSolutions]

It may be perpendicular, sloped facially or sloped lingually, depending on the case. I usually try not to incline lingually because it will place a slight limitation on the line of draw which may lead to more tooth reduction. However, if lingual wear requires removal, then I'll incline lingually, instead of wrapping. My typical prep is parallel to the long access of the crown.

[@takreemalfahd5490]

Thank you for your valuable videos. Please if we have a barrel shape 4 up incisors what type of veneer prep is needed?specially the patient wanted a change of color from A3 to B1?thank you

[@StevensonDentalSolutions]

This will usually require a deeper prep on the facial, which allows for color change. The depth would be 0.8 or so and this will necessitate a super veneer wrap veneer design to overcome the loss of retention form the enamel insufficiency.

[@euricequeen842]

The donut bur is always magic!

[@StevensonDentalSolutions]

True!

[@simple2471]

Thankyou Doc for the amazing course. What type of veneer prep you recommend for peg shape lateral?

[@StevensonDentalSolutions]

Create a finish line on the gingival and the proximolingual (butt joint. That's usually it.

[@simple2471]

Thanks a lot.

[@darakshanvakil8235]

Its really informative and a great contribution .Thanks a lot doctor.

[@StevensonDentalSolutions]

Thank you, Doctor!

[@Feeleydental]

Hi, thank you so much for these videos. My question is with the prep guide. As you continue to prepare the teeth do you lose a stable stop when using the guide to assess your reduction?

[@StevensonDentalSolutions]

You may prevent losing prep guide stability by extending the guide over more surface area, particularly areas which will not be prepared. But it does become less stable after more preps are completed, so your clinical judgement will come to the rescue.

[@mahalak4383]

I have a query. When we are cutting through a diagnostic mock up for veneer preparation, all the composite resin left behind s remove n then an impression is made or before that.

[@StevensonDentalSolutions]

Remove all of it, roughen any un touched enamel, and create a finish line, then take the impression. It is key to try to make a prototype mock up and not strictly an additive mock up. Instruct your lab to prepare the teeth prior to the wax up to place the proposed contours in the precise location desired. Often the putty made from this will not fit onto unprepared teeth, hence the need to prep them first.

[@mahalak4383]

@@StevensonDentalSolutions I didn't expect a reply back so thank you. Cleared one doubt which was nagging me☺️

[@wrtswrts]

Thank you for the amazing video doc. Would the last step, stripping the interproximal to open contact points a little bit, also be necessary in a digital workflow (scanning + CAD CAM)?

[@StevensonDentalSolutions]

Yes, as it will help obtain a clean finish line during scanning.

[@dorinamenkulasi8846]

Thank you doctor for the great video and accurate explanation.Why do you prepare the incisal butt and shorten the teeth if we want to lengthen it.How much longer can we make a tooth with a veneer without interfering in the occlusion?Thank you!

[@StevensonDentalSolutions]

Just to give the tech more control of the incisal translucency. If we are happy with the existing shade and only want yo lengthen, it is indeed possible to avoid prepping the incisal, but it is tricky - the edge must be a butt joint at the g to avoid ceramic thinning. For the functional, we set our length based on esthetic norms or slightly younger than the patient, then test this with a bonded mock-up for phonetics and pathways (excursive movements and border movements).

[@scottsdaledentistprincessc4744]

Thanks for sharing doctor. So much great informative in your videos

[@StevensonDentalSolutions]

Thank you Doctor!

[@zahraamohammad4545]

Fantastic video 👍👍

[@ekucukkeles]

Thank you for the videos, but why not place some videos on cementation as well for the different types of veneers you explain ?

[@StevensonDentalSolutions]

Yes! Working on it.

[@josephryanmabaquiao4825]

dr hope you can make a discussion about cementation and managment of discolored tooth during cementation.

[@StevensonDentalSolutions]

I will - this is a great topic! Thank you.

[@aamin6933]

Great work doc. How would you tell if patient is bruxing during night or day? During night can provide splint but what can you do for daytime bruxism ?

[@StevensonDentalSolutions]

Diurnal Bruxism will require asking the patient questions about their habits and suggesting a lower occlusal guard (usually tolerated better for diurnal bruxers). You also want to make sure that the issue is not related to a chewing pathway - use the chew test to help diagnose this - I'll provide a video on this later I hope!

[@aamin6933]

@@StevensonDentalSolutions Fantastic advice doc. Really looking forward to the chew test video as I feel it is so important to increase the longevity of beautiful restorations we have managed to learn from you.

[@drsubikashgorai5970]

With due respect it is very much helpful

[@StevensonDentalSolutions]

Awesome!

[@josephryanmabaquiao4825]

hi dr i hope you can do e demo on splice techniques in veneer prep. or what they call proximal overlap thanks

[@StevensonDentalSolutions]

Send me a reference on this prep design - I'll look into it!

[@josephryanmabaquiao4825]

Stevenson Dental Solutions the prep usually used for diastema and not aligned teeth cutting the proximal areas parallel to the long axis.

[@josephryanmabaquiao4825]

Stevenson Dental Solutions kzbin.info/www/bejne/bajbcpuPjKeCqbs doc i want your thoughts about the prep technique kay e you can make a close up prep and how we can do it properly. some dentist they dont have finish lines in the proximal doing this prep

[@josephryanmabaquiao4825]

doc can you make a video with prep on veneer with proximal cutting or extension?

[@StevensonDentalSolutions]

I will!

[@aamin6933]

Thank you Dr Stevenson for putting in so much effort so we can all learn benefit from the videos. Are there any situations where anterior slide of the lower incisors can fracture off the incisal edge of these veneer designs? What should I look out for in anterior guidance when I want an incisal butt finish?

[@StevensonDentalSolutions]

Good question - the key is bilateral even protrusive contacts, and canine guidance through lateral movements AND no pathway interferences while the patient is chewing (perform the chew test with the patient chewing on wax or gum and use 200 micron paper between the anterior teeth while they are chewing and make sure that no marks touch the veneers). Also, the last thing is a crossover check, where the teeth should have broad contacts with the lower teeth and no bumps or "catches" from large lower embrasures during border movements and while edge to edge. Before starting treatment, the lower teeth are leveled out and polished to facilitate the above requirements.

[@aamin6933]

Fantastic explanation Dr Stevenson. Thank you

[@StevensonDentalSolutions]

@@aamin6933 My pleasure Doc!

[@jigarpatel98980]

If there is fractured anterior teeth in the middle 3rd with pulp open, we proceed with RCT followed by composite build up in middle and incisal area. If we want to give veneers than can we give margin on composite on lingual aspect of the teeth or normal butt joint is sufficient??

[@StevensonDentalSolutions]

Great question. In this situation, you will be best off extending the finish-line all the way to the gingival and the facial AND lingual - like a veneer crown. It's usually not a good predictor of longevity to leave veneer margins on composite, as this does not encase the clinical crown - It's wise to take advantage of both micro- and macro-mechanical retention and resistance forms. Best wishes, Dr., Stevenson

[@aamin6933]

Thank you for this great video.Is buccal seating of the veneer difficult when we aim for slight inclination towards the lingual during incisal reduction ? I feel this may introduce an undercut unless the veneer is placed incisal reduction.

[@StevensonDentalSolutions]

Yes - the line of draw is not buccal and not incisal but a combination of the two. Preparing the incisal and then further extending by wrapping always limits the paths of insertion and this will usually lead to preparation modifications to allow for no undercuts.

[@josephryanmabaquiao4825]

dear doc how is it the same with canine and pre molars?

[@내귀에습진]

Did you mean to say a slight inclination towards the facial instead of the lingual? as in it's almost a straight reduction but with the ligual is supposed to be slightly lower as opposed to higher than the facial aspect of the incisal prep.

[@StevensonDentalSolutions]

Slightly more reduction on the facial incisal angle compared to the lingual. The resulting incisal will angle facially - in other words will be visible when looking straight at the facial. Thank you!

[@내귀에습진]

@@StevensonDentalSolutions Thank you for your reply. And is the lingual just kept as virtually a 90 degree butt margin angle with no beveling?

[@StevensonDentalSolutions]

@@내귀에습진 Slightly beveled gingivally - just a few degrees to make sue the enamel is not left rough/undermined.

[@내귀에습진]

@@StevensonDentalSolutions I appreciate it!!

[@StevensonDentalSolutions]

@@내귀에습진 Thank you for your insightful question and observation.

[@nicksaveka5078]

why dont you bring the interproximal margins all the way through the contact points- wont this run more risk for staining or caries or even heavily discoloured teeth to show through

[@StevensonDentalSolutions]

Great question! We teach a stain prevention technique using bullnose etching and a clean and cure vs a tack cure technique. Rather than hiding our ineffectiveness, let's address it appropriately...However, heavy smokers will stain everything, even the stain-free approach we use, so for these patients, we will extend interproximal. Esthetics will guide our margin locations with dark teeth, and the preps will often require more extensive margins. Our veneer course is three days in duration and covers these topics and many more in detail. Perhaps you could join us! All the best, Dr. S.

[@Bordondental]

great thanks. - one question - how much reduction is caused by your finishing ? and semi polishing

[@StevensonDentalSolutions]

Very little about 0.1-0.2 mm at most

[@georgieboy0511]

I’m a dentist in the UK, is there a way of obtaining your burs and other equipment in the UK 🙏🏼 amazing videos I have watched most of them thank you so much.

[@StevensonDentalSolutions]

This is often difficult, I don't have a resource yet... we do ship to the UK and this works well. Thank you.

[@DragoDent]

and can u tell me please if there any different in the measurment of preparation in this vedio(incisal buut) and the vedio part 2 I mean same measurment?? In the facial and gingival third and middle third and incisal third??

[@StevensonDentalSolutions]

The same

[@gojnebbich7474]

Thank you for sharing your experiences! I might be a little late with my question. You were so kind as to share a failure, too. Under that perspective in this special case wouldn't you rather extend your preperation on the plastic model further interproximal closer to the gum. Wouldn't this have created a black triangle between 11 and 12 as well? Greetings from Germany!

[@StevensonDentalSolutions]

Yes you are correct! Good eye Doc!

[@عبدوحبيب-ك8س]

Great explanation,,, thanxxx Dr,,,

[@StevensonDentalSolutions]

Thank you Doctor

[@vmathvmath]

Thanks doc for showing your mistakes, when you are a solo practitioner you sometimes think your the only one that makes errors

[@StevensonDentalSolutions]

Thank you Doc. Dentistry is incredible and yet so humbling at the same time - I think that excellence means that you never stop learning and always try your best...

[@grishater-antonyan2206]

Thank you 🔥

[@DragoDent]

Doc. can u please tell me why u used Lvs1 instead of Lvs2 and please tell me the incisal reduction is 1.5 From the facial is 0.7? and from the middle is what?? and from the gingival margin is 0.4??? Doc I mean the measurment of prepararion

[@StevensonDentalSolutions]

The LVS1 gives you 0.5 mm of reduction and the LVS2 gives you 0.3 mm of reduction. In general, the gingival 1/3 is 0.3, the middle 1/3 is 0.5 and the incised 1/3 is 0.7 mm. The incised reduction ranges from as little as 1.0 mm for cases not requiring much incised translucency characterization to as much as 2.0 mm in cases where a lot of characterization is required. I will show different burs to show how they work and what they may produce. To keep it simple, use the LVS2 for the gingival 1/3, then us the LVS1 with the tip in the middle 1/3 and estimate 0.7 mm in the incised 1/3. I hope this helps.

[@DragoDent]

@@StevensonDentalSolutions I don't know how to thank you doctor, you are a great person

[@StevensonDentalSolutions]

@@DragoDent My pleasure doc!

[@eugeneee7328]

Hi Dr. Stevenson thank you for the video. What is the maximum incisal reduction to give better porcelain support? Is it 2mm porcelain ?

[@StevensonDentalSolutions]

Correct, 2 mm. Any more than that you are best to use lithium dislocate as a foundation, layered with feldspathic. Thank you!

[@megacicilia8978]

please make a video bout preparation on mock up..coz i got confused with the concept 🙏

[@StevensonDentalSolutions]

I will, thank you

[@megacicilia8978]

@@StevensonDentalSolutions thankyou so much..i'll be waiting for it and all your valuable contents 🙏

[@StevensonDentalSolutions]

@@megacicilia8978 My pleasure!

[@avo9741]

beautiful!

[@StevensonDentalSolutions]

Glad this was helpful!

[@olaahmed821]

thank you

[@StevensonDentalSolutions]

My pleasure.

[@rushinkadeeja457]

What kinda veneer prep is apt for flurosis case

[@StevensonDentalSolutions]

If the fluorosis is deeply stained, grade 3, the veneer preps will require a deeper axial reduction and likely will need wrapping and e.max veneers. However, if the staining is Grade 1 or 2, normal veneers may work. After preparation, assess the color and reduce more if the area is deeply opaque or brown. Another consideration is enamel quality - frequently, fluorosis patients have enamel that will not provide the long term adhesive predictability we expect, hence, a lingual wrap may again be indicated. These are some of the most challenging cases and must be approached with caution and full disclosure to the patient. In other words, the patient must be advised that the final preparations may need to be much closer to full coverage and that opaque layers usually require greater layering and therefore more reduction.

[@rushinkadeeja457]

@@StevensonDentalSolutions thank you for the prompt and accurate reply dr

[@rushinkadeeja457]

Is there any way I can send u the pic of the patien?

[@alirezamotazarre5512]

the best

[@StevensonDentalSolutions]

Thank you!

[@nasseragize8019]

Thanks alot doctor ❤️

[@1smail.khaled]

If we make the incisal straight lingually without bevel , what about the anterior guidance ? I think this will lead to stress concentration that can fracture the veneer ..

[@StevensonDentalSolutions]

Thank you for your comment. I like your thinking.

[@1smail.khaled]

@@StevensonDentalSolutions I don't know if i make incisal bevel lingually , can i have the 2 possible path of insertion ( from incisal and from buccal ) or we will have only incisal path of insertion like lingual overlap prep ?

[@StevensonDentalSolutions]

@@1smail.khaled If beveled the path of insertion will tighten, much like a wrap. Thank you for your thoughtful insights.

[@harhoor2006]

nice

[@devangkankane]

👍🏻👍🏻👍🏻

[@StevensonDentalSolutions]

Thank you!

[@nooraldeenadeeb2524]

👍

[@StevensonDentalSolutions]

Thank you Doc!

[@alishahab3018]

Wao

[@DragoDent]

❤🧡🧡🧡🧡🧡

[@StevensonDentalSolutions]

THANK YOU!!

[@dsndds]

please reduce the volume of your intro it blows my eardrums then you talk at 50% volume lol. But thanks and great job!

[@StevensonDentalSolutions]

Yes, sorry!