Dear Dr. DiTolla,

After watching your clinical veneer videos, I just prepped a 10-unit case and tomorrow I have 6 units. (When it rains, it pours!) In the past I have used 3M™ ESPE™ RelyX™ veneer cement (St. Paul, Minn.). Will you please share your luting material of choice and technique specifics? Your clinical video advocated Parkell Brush&Bond^® (Edgewood, N.Y.) and Nexus™ by Kerr (Orange, Calif.), which is now NX3 with OptiBond™. Do you use another product? Please let me know. I need to get the product ASAP since I will place these cases next week.

– Sylvia Rogers, DMD
New York, N.Y.

Dear Sylvia,

Good for you! Certainly, the more you do something, the more proficient you become.

There is no difference between veneer cements, only personal preference of consistency. I prefer thick veneer cement, which is the main reason I switched to NX3. Every brand of luting cement has a translucent shade, which is the shade I use most often. I now use OptiBond with NX3, as you pointed out, because I have heard from clinicians like Gordon Christensen and Michael Miller that the highest bond strengths are typically achieved using bonding agents and cements from the same family.

After rinsing the water-soluble try-in cement from the veneers etched with hydrofluoric acid in the lab, we place liquid silane in the veneers for 60 seconds and then air-dry. Next, we paint a thin layer of OptiBond inside the veneers and air thin it before placing the veneers under a lid that protects them from the light.

Intraorally, I pumice, rinse and etch with phosphoric acid — for 15 seconds on enamel, 10 seconds on dentin. Next, I paint a thin layer of bonding agent on the tooth surface, then air thin. Finally, I cure the bonding agent on the tooth after air thinning, although many clinicians don’t. I have noticed a decrease in post-op sensitivity when I cure at this point.

My assistant loads the veneer with cement, and I place it on the tooth. Using two orangewood sticks, one pushing incisally and the other facially, I seat the veneer. My assistant cures the gingival margin for approximately two seconds, and I clean off the semi-hard excess with an explorer. She then cures for another one to two seconds at the gingival. I then clean the excess on the lingual and interproximal before final curing.

As you mentioned, we have a couple of different videos showing this. And while the products may change, the technique stays the same.

– Mike

Dear Dr. DiTolla,

How’s everything? I can’t believe it has been a year already since I saw you at the Greater Long Island meeting. I did a nice case with Glidewell recently: IPS e.max^® crowns (Ivoclar Vivadent; Amherst, N.Y.) on #7 & 10 and veneers on #8 & 9. I locked on the temps as you recommend in your videos. My patient kept the gingival area as clean as possible, and when I cut off the temps the tissue was pink and healthy. After tack curing the veneers first and removing the excess cement in the gingival area, the tissue started to bleed. I luckily had tight margins and no bleeding seeped under the veneers, but it still was a headache.

Is there anything you can recommend to prevent this, and should it cure, what steps do you take to continue cementing the case?

– David M. Rahr, DDS
Kings Park, N.Y.

Dear David,

Anytime I have temp veneers on, I now find myself pre-treating the gingiva, if you will, before I even touch it and test it out. At the very least, I hit the tissue with ViscoStat^® Clear (Ultradent Products, Inc.; South Jordan, Utah) and some soft scrubbing action with the Mini Dento-Infusor^® tip (Ultradent Products, Inc.). If that process creates bleeding, I place Expasyl™ (Kerr Corporation) in the sulcus and wait a few minutes before rinsing and proceeding. If Viscostat Clear does not cause bleeding, I rinse it off and continue with the bonding process. In the most extreme cases, I will pack an Ultrapak^® #00 cord (Ultradent Products, Inc.) in the sulcus to prevent bleeding and retract the tissue approximately 0.5 mm as well.

The biggest difference: I used to begin the bonding process with the hope the gingiva wouldn’t bleed and then deal with it if it did. Now I test the gingiva before etching the teeth to control it before committing to the bonding process in earnest.

– Mike

Dear Dr. DiTolla,

Let me start with a huge thank you for the video presentations, articles and many techniques that I have learned from watching you practice dentistry. As a relatively young dentist (graduated in 2003), my day-to-day crown & bridge technique has been shaped and formed by your teaching. It is always exciting to receive the latest issue of Chairside^® or a DVD with innovative things to learn.

I have started selectively using BruxZir^® on some of my posterior cases. Just today I had a male patient come in who had ground through the porcelain and metal on a PFM crown. I re-prepped him for a BruxZir crown. What ADA code are you using for these BruxZir restorations? Are they considered porcelain/ceramic substrate, PFM, all-metal or all-ceramic restorations?

Recently, I purchased the VITA Easyshade^® Compact (Vident; Brea, Calif.) and it has made my life a little easier. However, I noticed from your DVDs that you prefer to choose shades from the Classic shade guide, not the 3D-Master. Is there a reason for this? Is it easier on the lab techs? I tend to write both on my Rx. I thank you once again and look forward to your response.

– Robert M. Lieder, DDS
Baltimore, Md.

Dear Robert,

Thanks for the kind words! For BruxZir Solid Zirconia, dentists are using ADA code D2740 Crown – Porcelain/Ceramic Substrate.

Unfortunately, not every product is made in a 3D-Master shade, so the lab technician converts back to a VITA Classic shade if the product does not come in a 3D-Master shade. I typically show the VITA Classic shade because it is the one used on 92 percent of the lab slips.

In reality, I think your solution is the best: Give the lab tech both shades. If there is a 3D-Master shade available, they can use that. If not, you have provided the correct conversion for them.

– Mike