Letter to the Editor

Raymond L. Bertolotti; David S. Alleman

In reference to the paper “Enhance Esthetic Excellence through the Combination of Bleaching and a Pressed Venus Porcelain® Veneer” (January 2008, pp. 94-96), the reader is certain to be impressed with the esthetic results of a master artist. However, one needs to question the technical aspects of such a treatment. It appears that the “veneer” preparation shown is not based on science. We are concerned that the treatment rendered may not be in the patient’s best interest. Such treatment most likely leads to a less-favorable prognosis for the tooth^1,2 than would result from more tooth-conservative treatment. When we consider that the need for subsequent endodontic treatment is directly related to the amount of tooth removed in the preparation, conservative preparation is highly desirable.³ Is this really a “veneer” or a partial crown?

Let’s consider the patient, aged in her 20s with a minimal shade discrepancy of an apparently lingually tipped right central incisor. Was full informed consent given? Were all the treatment options explained with pros and cons given, particularly in regard to heavy tooth reduction? Was minor orthodontics ruled out? Was it discussed that the procedure being done to maximize the cosmetics would likely minimize the long-term service of the tooth? Since the treatment rendered seems unnecessarily aggressive, we raise these questions.

A master artist should be able to produce a comparable esthetic result, especially on a lingually tipped tooth, by making only a facial-incisal preparation in enamel. There is no apparent justification for compromising the strength of the tooth by heavy interproximal and incisal preparation. Taking the preparation to what is shown in Figure 5 and adding about 2 mm of incisal reduction would maximize the strength of the resulting veneer and allow the technician sufficient room to create incisal effects.⁴

This case may be an example of “preparing the tooth to fit the pressed ceramic” rather than selecting a ceramic (perhaps feldspathic or thin pressable) to fit the prepared tooth. One should prevent the tooth/veneer complex from being too compliant, as that, according to Hooke’s law, will stress the bonds unnecessarily.^2,5 Even leaving about half of the facial enamel would reduce the tooth compliance significantly.⁵ Besides which, bonding to enamel rather than dentin is clearly desirable, for obvious reasons.

Sincerely,
Raymond L. Bertolotti, DDS, PhD
San Leadro, California

David S. Alleman, DDS
West Jordan, Utah

References

1. Magne P, Douglas WH. Optimization of resilience and stress distribution in porcelain veneers for the treatment of crown fractured incisors. Int J Periodont Rest Dent. 1999;19(6):543-553.

2. Magne P, Versilius A, Douglas WH. Rationalization of incisor shape: experimental-numerical analysis. J Prosth Dent. 1999;81(3):345-355.

3. Zollner A, Gaengler P. Pulp reactions to different preparation techniques on teeth exhibiting periodontal disease. J Oral Rehabil. 2000;27(2):93-102.

4. Castelnuovo J, Tjan AH, Phillips K, et al. Fracture load and mode of failure of ceramic veneers with different preparations. J Prosth Dent. 2000;83:171-180.

5. Magne P, Douglas WH. Cumulative effects of successive restorative procedures on anterior crown flexure: intact versus veneered incisors. Quintessence Int. 2000;31(1):5-18.

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