Conservative Anterior Veneers & Total Etch

For a long time I have felt that both total-etch and self-etch techniques can be used based on the clinical circumstances and the clinician’s preference. This past weekend I added another indication to my list of uses for total-etch. I had the great fortune to attend and lecture at the USC 5th International Restorative Symposium in Los Angeles. Dr. Markus Blatz, Chair of the Department of Preventive & Restorative Sciences at The University of Pennsylvania, presented before me Saturday morning. As happens to me so many times when I attend a dental education program or I talk to a group of dentists I learned something impactful, that at first blush seems obvious, but I hadn’t put the pieces together just that way by myself. Dr. Blatz’s topic was modern all ceramic systems, he discussed both the material science and some aspects of the technique of preparing and seating these restorations.

During the segment on bonding anterior veneers he presented the concept that a total etch technique has distinct advantages when seating conservative anterior porcelain veneers. If you are smacking your own forehead right now think “of course” that is exactly how I felt Saturday morning. One of the advantages of a total-etch approach is improved ability to etch enamel surfaces, and therefore better bond strengths to enamel. Conservative veneers are defined by limited tooth reduction that stays within the confines of the thickness of the enamel for the majority if not the entire prep. The flip side is that total-etch can be challenging due to the risk of over-etching dentin and  collapsing dentinal tubules due to over-drying, both of which reduce the bond strength and increase the risk of post operative sensitivity.

Conservative porcelain veneers are a near perfect clinical situation for utilizing a total etch technique. We want to maximize enamel bonds with a preparation that is mostly in enamel, and with very little dentin the risk of over-etching or over-drying disappears eliminating the reasons to worry about this approach.