Page 62 - SURE DENTAL CATALOGUE 2023

Porcelain Veneer Case Dr. Ray Bertolotti

by Raymond L. Bertolotti, DDS, PhD

This is a specific procedure which utilizes Accolade PV's unique Try-in composite
(patent pending). To obtain the absolute maximum try-in time, use the directions
that are in the Accolade PV kit. In those directions, no light curable bond is placed
on the silane. Instead only Accolade PV Try-in is used and then later mostly
removed by mixing with Prelude #2. That procedure is excellent but I choose to
use my Clearfil Photo Bond routine here, due to its long track record and dual-cure, but I do sacrifice some
try-in time.
1.Before trying in the veneer, apply a silane [Rely X (3M), S-Bond (Danville)] to the uncontaminated, fluoride
etched veneer. Follow the silane manufacturer's instructions (sometimes an acid wash is necessary with the
particular silane but not with 3M or Danville, a great convenience).

Next, coat the silaned veneer with an unfilled, light curing, “enamel- bonding" resin [Enamel Bond (3M), Visar
Seal (DenMat), or E-Bond (Danville)]. Don't cure. Avoid dual cured resins, especially Photo Bond, for this
step in substitution for the light cured one since they may cause premature composite setting problems. The
silane is now "locked in" by the unfilled resin and is permanently attached, unless dissolved in solvents such
as alcohol.

2.Try the resin coated porcelain veneers for fit both individually and in adjacent groups on the unetched teeth.
The unfilled resin protects the silane from contamination. After try-in, just brush off the resin with a dry brush,
if contaminated, and brush on fresh resin. (In extreme cases, ultrasonically clean the veneer in ethyl alcohol
and begin again with the silane step.)

3.Choose the desired shade of Accolade PV Try-in composite and place on inside of veneer to check shade
on unetched tooth. [If you are not using Accolade PV, you will need to follow the manufacturers directions for
try-in paste, especially noting how it is removed after try-in.]

I usually try-in Accolade PV Try-in "Translucent" shade first; it is acceptable about 90% of the time. If the
color needs to be modified, remove the veneer. Just wipe off the first try-in composite with a clean brush and
change to the new shade. Try-in again. I find that when the first try-in does not produce an acceptable shade,
slight white opaquing is usually needed (the tooth shows too much). Accolade PV has two excellent pre-
opaqued whitish "veneer shades", Light and Extra Light, which greatly simplify this procedure. They usually
eliminate the need for a custom mix. One of these two shades nearly always produces an acceptable try-in
when the Translucent does not. In the rare event that the veneer needs darkening, just use a dark shade of
flowable composite or the Accolade Brown or Yellow shades, or perhaps a blend of these. In addition to the 5
PV shades, Accolade PV has a White Opaquer shade that is intended for custom blending. It is the "super
white and opaque" blending shade used at Danville to produce Light and Extra Light PV shades. Especially
to be avoided for veneers are relatively high viscosity composite resins. They require excessive pressure to
seat the veneers (veneer cracking problems), easily tear and form bubbles (black staining problems later).

4.Isolate, when necessary, with retraction cord [Ultradent #0 cord preferred], immersed in Visine if necessary
for hemostasis. (Visine will not form a black sulfide stain at the margin like Astringident and other ferrous
sulfates do.)

5.Clean try-in resin off the enamel surfaces, using pumice in a rubber cup. Avoid gingival contact to prevent
bleeding. A Kincheloe "Retract" instrument (Danville or Tin Man) is a handy way to protect and retract the
gingival tissue. Rinse with water and dry with oil-free air.

6.Brush at least 50% or Accolade PV Try-in composite off veneers and replace with the fully catalyzed
Accolade PV.

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