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I’ve polished up a presentation tonight that I will be giving tomorrow in Bellevue Washington on Anterior Esthetic Techniques & Materials. One of the concepts we will be looking at is incisal reduction as part of a veneer prep, when do we do it and why? Another way to look at this is when would we not need to create incisal reduction. If we are placing a veneer simply to correct damaged labial enamel on a tooth that has the correct length, incisal edge position, contour and we have underlying dentin that will create exquisite esthetics the tooth can be prepared without incisal reduction.
If we are increasing tooth length to correct display at rest and tooth proportion we want to create adequate incisal reduction. When we wrap porcelain over the incisal edge, we want a minimum of 2mm from the incisal edge of the prep to the incisal edge of the restoration. This dimension of porcelain creates material properties to minimize the risk of fracture. The amount of incisal reduction we need is only to create the 2mm dimension, so when teeth are shorter than the proposal we can be conservative in our tooth preparation. I accomplish this by mocking up the final result with bisacryl from a wax-up, which gives me a reference to the final incisal edge position. I then place my depth cuts into the bisacryl to ensure adequate reduction for the final restoration. Another change in incisal edge position that necessitates incisal reduction is when we want to procline or retrocline an anterior tooth. In the case where want to move the incisal edge anterior, we reduce the incisal edge to give the technician running room for the restoration and avoid an overly thick incisal dimension. The converse would be when we want to move the incisal edge to the lingual, and would have to make the tooth far to thin if we did not prepare the incisal edge.
Another reason that I commonly create incisal reduction is to optimize the esthetics of the final restoration. When the technician has a 2mm wide band of porcelain at the incisal they have the optimal ability to create incisal effects. This preparation design allows the restoration to be cut back, and layers of porcelain added in the incisal edge to create lobes of dentin and incisal translucency. Some of this can be accomplished without a cutback and using stains, but my experience is it limits the technician in what they can accomplish. Very often when I am restoring anterior teeth the existing esthetics is not ideal, the patient has lost incisal translucency, or wants the final result to have characteristics that their natural teeth do not. If you are wondering about this feature, send your technician pre-operative photos, along with a description of what you see as the final esthetic result. Once they have all of this information they can let you know what the need to make create what you are asking. I have even had my technician prepare a model of the teeth to show me the minimal prep parameters they need.
As a relatively recent dental grad I wanted to let you know how much I appreciate your blog and value the posts such as this. It is harder than it should be to find experts willing to share dental pearls like these without having blatant product pushing. Though sometimes your snippets get me wanting to know more of its subject just as I finish the post. This one was one of your best since I’ve begun following.
May I ask what other sources you would recommend for someone who would like to get a better handle on occlusion (complex treatment planning-/messing with vertical/restorative considerations etc)?
I’m glad you are getting value from the site, and please let me know if you have suggestions for topics. As for occlusion it is an ever moving target, so I am always learning. I am a member of the American Equilibration Society and go to their meeting every year for an “update”. As to courses I have done Pankey, Spear, and Dawson. I hear good things about Kois. Where do you live that may be relevant east or west coast?
Would use ce credits wisely. Find stuff u like. Say pharmacology. Vicodine was named VI codeine so 6 times stronger than codeine. U remove tough molar and any codeine makes them sick. Give them a few Xanax to sleep and let them take Tylenol. They will love u. Percocet has caffeine and makes me ill and dizzy.not gonna make me happy after a tough extraction. Sleeping will. Had some great pharma courses. Hope helps. Dental school gives u a start. Then do things that work for u.
In preparing veneers I lika a very positive seat on lingual which gives u a positive seat and veneers will last 15 years plus. I live in a middle class area so charge about a third of prostodontist,but I have done roughly 10.000 of them over last 30 years. They are great restorations. The problem is expensive labs will charge 450 vs a nice quality one for 150 from nice lab.
Great practice!
On ur last picture I like ur preparation as looks go but suggest u can do without the cervical shoulder and bury cervicle with wiping away shoulder. I do like idea of prepping veneer teeth fairly aggressively as u can do wonders. Just let patient know the more crooked the teeth greater chance a tooth may need an RCT in future. These are patients who refuse ortho. U can be surprisingly aggressive. Another note is misnomer not to break contact. With 35% of cases fixing spaces I don’t get. I also find spacing cases people get ortho and puch small teeth together. Not an ortho case a veneer case. Good luck and have fun with them.
Very practical and realistic practice style, Kobe,thanks.
U can save ur self a lot of time by looking at and devising how it would look great without wax ups and depth cuts. If u do a lot wax ups are cute but only make labs rich and patient confused. Just prep teeth and take incisal so u have nice lingual seat. I remember cutting a tooth and went 1.5 mm and pulp. Was in shock as was my assistant. Looked at X-ray and tooth had interal resorption. It needed rct anyway but felt dumb I missed. It came out beautiful in end. Another tip I find is leave upper molars to endodontists. Would say 80% MB root has area.. So tooth post crown endo and area. Total waste. Hope this helps all.
To one of above posters think east coast more practical unless u going to park avenue practices. Changing ovd unless with dentures very tricky. To do right u looking at 60 to 100.000 cases and can cause more trouble. Work on drs and lawyers and they don’t wanna part with that kind of money. Don’t agree but in my area a single implant hard to sell. Stick to basics. Nice lab in Philly that makes day/ night guards. Be careful with courses. In theory things work til patient runs out of money half way thru. Now patient will be worse off than started. Probably biggest pet leave I have is composite posterior restorations on 20 year olds. Lifespan 10 years vs amalgam 30 years. U can’t predict patients ability to redo at 30 and if u aren’t using a rubber damn then posterior composites unless very shallow should not be done and all posterior kits throw in garbage.u aren’t helping ur patient. An analogy would be a small pacemaker with slightly smaller scar that lasts 10 years vs one with slightly larger scar that lasts forever. Dentistry is medicine so believe posterior composites poor medicine until can last as long as amalgam.