Click here to read Part One of this series. If you haven’t noticed, we are now in an age of dentistry that praises “conservation of tooth structure.” It is often referred to by many names: minimally invasive, minimally destructive, biomimetic, etc. However, we must remember that even an ultra conservative restoration is still a restoration and will have to be maintained and possibly replaced over time. The benefit of being more conservative is that it leaves more tooth structure for the patient when it needs to be retreated.
For example, this patient presented with a failing #9 that required extraction and implant placement. In addition, she wanted to improve the esthetics of her smile by replacing the veneer restorations that were placed five years earlier. (Figures 1 and 2)
Given the shape and thickness of the existing veneers, the treatment plan was to remove the ceramic veneers and bond temporary composite veneers prior to orthodontic treatment. This would allow the orthodontist to more easily align the teeth correctly.
To accomplish this, I used an Er,Cr:YSGG laser (Waterlase MD). When set and used for veneer removal, the laser penetrates the veneer and hydrolyses the water in the resin cement thereby allowing the veneer restoration to be removed with no alteration of the underlying tooth structure. Luckily, whoever placed the existing veneers had done them as no prep veneers on the premolars and canines and only minimal localized preparation of the laterals and central. (Fig 3)
The patient was pleasantly surprised when I informed her that the restorative treatment required after the orthodontics would not only be a single tooth implant in the #9 site, a minimal prep veneer on tooth #8, and some direct composite on the laterals. Note how the laser was able to remove the veneers without damaging the underlying tooth structure at all. The implant was placed and provisionalized post orthodontic treatment. (Fig 4)
The final restorative treatment consisted of some direct resin and a single tooth implant and veneer restoration on the centrals. (Fig 5) Without a laser to help in the removal of the existing restorations, she may have had no choice but to end up with same number of veneers as she started with.
Gregg Kinzer, D.D.S., M.S., Spear Faculty and Contributing Author