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Vertical Shoulder Laminate (VSL) Veneer

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sujatabyahatti's picture
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The Vertical Shoulder Laminate (VSL) Veneer is based upon a unique preparation design that enables accurate reproduction of the facial anatomy of anterior teeth. Traditional veneer preparations focus on conservative tooth reduction, yet little effort is made to ensure that the definitive restoration will have a sufficient structural design to maintain structural integrity under stress. Due to the clinician's desire to perform conservative tooth preparation, anatomic accuracy in the cervical third, incisal third, and interproximal aspects of traditional veneer preparations are neglected. As a result the ceramist is forced to compromise the esthetic and structural quality of the veneer. The VSL veneer preparation design emphasizes tooth morphology rather than conservative reduction. The idea is to provide a stable base on which to build a structurally sound and accurate restoration. Used in conjunction with the VSL veneer preparation the ceramist can recreate tooth contour in the facial, interproximal, cervical, and incisal aspects, which were previously unfeasible with a chamfered margin laminate preparation. If attention is given to to certain anatomic components during the preparation phase, the resultant biomimetic behavior of the porcelain laminate veneer can be optimized.

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Vertical Shoulder Laminate (VSL) Veneer

When it comes to restoring the mouth with porcelain in order to improve the aesthetics, the PLVs are one of the most conservative and aesthetic techniques that we can apply. The longevity of the veneers are quite long and durable especially if the right indications are chosen and the correct techniques are applied.

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drmithila's picture
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Vertical Shoulder Laminate (VSL) Veneer

The terms laminates, veneers, porcelain laminate veneers all refer to the same procedure. What are laminates? Laminates are coverings that are designed to enhance the shape, and color of natural teeth. In most instances, laminates are 1/2 mm in thickness (about as thick as your little fingernail). Laminates can be used to repair broken, chipped or cracked front teeth. Laminates are more widely used to create beautiful new smiles... Whether you want a Hollywood Smile, or a smile that says quietly, “You are a healthy, happy person”. laminates are the way to go.Are all laminates the same? No.
Laminates can be made of different types of material. They can be made of composite bonding, or porcelain. The more poular choice among dentists is to use porcelain. Porcelain is a more durable dental material than composite resin bonding. Porcelain requires less long term maintainance, is more fracture resistant, and is more stain resistant than composite bonding.

Are all porcelains created the equal? No.
Their are different types of porcelain to chose from for laminates. The most poular porcelain used to fabricate laminate veneers is pressed lucite porcelain. IvoclarVivadent (the inventors of this technique), is a company recognized as the world leader in pressed porcelain technology. Their porcelain product line is called Empress. Empress porcelain laminates are recognized as the standard by which all other laminates are judged. They produce the most beautiful results.

Dr. Schwartz is recognized as an expert on Empress Laminates. Dr. Schwartz teaches dentists and ceramists worldwide how to create beautiful natural results with Empress porcelain. It is his restoration of choice. When consulting your dentist make sure you ask for the standard by which porcelain laminate veneers are compared... Empress porcelain.

How Long do Laminates Last?
Dr. Schwartz makes his veneers with the utmost integrity. It is his intention that you will get greater than 10 years service out of them. But as with natural teeth porcelain laminate veneers are subject to the same abuses and habits that can prematurely wear teeth. Protect your investment, and learn good hygiene habits and your laminates will look beautiful for many years to come..

Do I have to take care of my laminates any different than my natural teeth? No.
You care for your laminates just as you do all of your teeth. Good clean hygiene habits are the cornerstone to a beautiful smile.

Will my laminates feel different than my other teeth? No.
Your teeth, whether laminated or not should feel like your teeth. That is.. smooth, polished, and natural feelin

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Drsumitra's picture
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Vertical Shoulder Laminate (VSL) Veneer

 Myths are often attached to new practices (using new techniques and materials) that replace those that have become unfounded when cycles change and new technology and new materials become available that totally, not gradually, alter the landscape and, therefore, the best practice of the day. Often, new practices scare professionals and others who don't want to make changes. So, old ideas are held in place by professional schools, professional practices, laboratory technicians, and journal articles that often continue to discuss "traditional preps" for veneers done by habit, experience, and convention. 

 

Language about the new practice, often captured in slogans or stock phrases, is generated and then repeated. The use and power of such slogans are well-known in the arena of political campaigns: "no prep, no good." (Notice how this idea is "suspended" in language, and is therefore "held" in place.)

Some Background on Replacement Technology
First, let's clear up a misconception: Many articles in journals and speakers on aesthetic dentistry, refer to "traditional veneers" as those that involve preparations; that is, prepping to the degree that tooth structure is removed as "traditionally/conventionally" done today. Historically, one must remember that original porcelain veneers were meant to be "prepless" (without preparation). It is a myth that the original version of the traditional veneer included the amount of preparation as we observe as the norm today, and that no-prep veneers are a "new" trend. 
When "cosmetic bonding" was introduced, the more conservative-minded dentists used the material to aesthetically improve a smile. I remember laboratory-fabricated composite veneers that were en vogue for a very short time, as they were quickly replaced by porcelain veneers. Cerinate porcelain veneers released in the 1980s by Dr. Robert Ibsen, were meant to be done with no preparation, and I did many of these in the 1980s. However, when we wanted to improve the aesthetics on larger or misaligned teeth, we developed "veneer preps" that would enhance the aesthetics of these formerly "prepless" porcelain veneers. 
With time, veneer prep design "matured," and as dentists and dental technicians demanded better aesthetic results, the preps grew more and more aggressive, often removing all the enamel, shortening the teeth, sometimes wrapping over the incisal edges and even opening the interproximal contacts. We can look at many veneer articles in journals and find, in some cases, aggressive veneer preparations are practically impossible to distinguish from nearly full-crown preparations

TO PREP OR NOT TO PREP
My philosophy from day one has been and is: It is always desirable to preserve natural tooth structure for our patients, whenever it is possible.
—Such a benign-sounding word, but its meaning is anything but benign. Prep in this context means drilling or shaving, grinding down to a depth that leaves little behind, making the result irreversible. 
The term "no-prep veneers" generally refers to very thin shells of porcelain that are designed to cover or replace enamel.

Top Reasons We Believe We Still Have to Prep
First, dental schools, in general, and most aesthetic teachers/gurus in particular, teach prepped veneers. They advocate reducing the labial of the tooth, rounding it off, removing the proximal line angles, shortening the incisal edge, and bonding to enamel and/or dentin. This is what many dental students are taught. Fortunately, in the author's opinion and that of others, this trend is gradually changing. At a recent meeting, a speaker recently noted that he no longer "tells [attendees/students] to drill as much as I used to." It's how we were taught, but the cycle of new technology and materials is responsible for a sea of change in our procedures. We now have materials and techniques available to us that eliminate the need to prep.
Second, dental laboratory technicians want more "room" to create their restorations. Instructions from the laboratory may dictate to the professional the amount of room necessary to create aesthetically pleasing porcelain veneers. Again, this is usually determined without the dental technician being able to personally and visually evaluate the patient with the doctor.
Third, habit and experience keep this idea for prepping (more often than not) perpetuated. Many dentists still believe in "remove and replace" dentistry. Some say there are times you have to prep, such as in a case of severe misalignment. This may be the case, but, with the new materials, you no longer have to prepare the tooth to the previous depth, and a shoulder or chamfer is no longer needed at the gumline unless the presence of caries or a previous fracture dictates it. Also, I have found that a supragingival margin with a feather edge (similar to a feather edge design that is used with gold) will not cause a periodontal reaction. Of course, orthodontics as an adjunct to veneers is always a good option for severe misalignment.

 

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Vertical Shoulder Laminate (VSL) Veneer

 Seven Reasons to Not Prep!

  1. The failure rate of dentin-bonded veneers is much greater than those that are bonded to enamel. It is always optimal to bond veneers to enamel for both strength and long-term durability. Bonding porcelain to enamel creates a solid and secure bond, compared with bonding porcelain to dentin. This bond, when the techniques are done right, is even stronger than nature's bond of enamel to dentin.
  2. Prepping is sometimes done to compensate for material deficiencies. Pure and simple: It is the porcelain that makes the difference. For example, in the case of the Lumineers (DenMat) system and philosophy, the objective is to provide a safe and wear-, stress-, and microleakage-resistant, restoration that is highly aesthetic and that has been shown to last more than 20 years...all without preparation!
  3. You may have an aesthetically beautiful result with a subgingival prepped subgingival margin, but patients will have a higher likelihood of gingival recession than with a supragingival margin. Additionally, with subgingival prepped veneers, there is a higher likelihood for other untoward periodontal reactions.
  4. Even in cases of minimal prep, with slight overlaps and spacing for which some contouring should be done, one still rarely has to touch dentin or use anesthesia.
  5. Postoperative sensitivity will never occur when intraoperative procedures have been performed without anesthesia, if the patient feels no sensitivity during the recontouring of one's teeth. (Once a tooth has been anesthetized, it is impossible to distinguish between sensitive and nonsensitive tooth structure.) It follows that the need for endodontic therapy will simply not occur as a result of the no-prep procedure and subsequent restoration. Because no-prep veneer procedures are a noninvasive, pain-free procedure, excitement about the procedure can spread among patients.
  6. In this procedure requiring 2 patient appointments, temporaries are unnecessary in no-prep veneers, so the procedure takes much less chair time than those requiring preparations with the associated fabrication and then removal time needed for provisionals. And by experience, I know how making, maintaining, and removing veneer temporaries can be quite stressful and time-consuming.
  7. Cosmetic contouring that removes only nonsensitive tooth structure without placing any predetermined margins, creating a foundation suitable for placing no-prep veneers and creating optimal aesthetics, is the most conservative basis for beginning to put patients into porcelain veneers. In ideal recontouring cases, patients leave the office looking better than before the appointment began, even when their veneers have not yet been delivered. And they actually could remain without their veneers forever. This is how we used to improve smiles long before the ability of bonding to tooth structure existed.

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Vertical Shoulder Laminate (VSL) Veneer

 

 

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Vertical Shoulder Laminate (VSL) Veneer

The Vertical Shoulder Laminate (VSL) Veneer is based upon a unique preparation design that enables accurate reproduction of the facial anatomy of anterior teeth. Traditional veneer preparations focus on conservative tooth reduction, yet little effort is made to ensure that the definitive restoration will have a sufficient structural design to maintain structural integrity under stress. Due to the clinician's desire to perform conservative tooth preparation, anatomic accuracy in the cervical third, incisal third, and interproximal aspects of traditional veneer preparations are neglected. As a result the ceramist is forced to compromise the esthetic and structural quality of the veneer. The VSL veneer preparation design emphasizes tooth morphology rather than conservative reduction. The idea is to provide a stable base on which to build a structurally sound and accurate restoration. Used in conjunction with the VSL veneer preparation the ceramist can recreate tooth contour in the facial, interproximal, cervical, and incisal aspects, which were previously unfeasible with a chamfered margin laminate preparation. If attention is given to to certain anatomic components during the preparation phase, the resultant biomimetic behavior of the porcelain laminate veneer can be optimized.

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Vertical Shoulder Laminate (VSL) Veneer

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