Veneer Cementation: Step By Step

Proper veneer cementation is an essential factor in clinical success. In this guide, adapted from Dr. Ruiz’s book, Supra-Gingival Minimally Invasive Dentistry: A Healthier Approach to Esthetic Restorations, we go through the process, step by step.

Step by step veneer bonded cementation

The Tooth

1. After dental anesthesia, and the removal of the provisional, isolate using OptraGate (Ivoclar) refractors, cotton rolls and good suction, or your isolation method of choice, including a rubber dam (Figure 1a).
2. The tooth needs to be completely cleaned of remnant cement by using a microetcher. This is especially important if composite build ups have been done. Consepsis scrub or pumice is a second option (Figure 1b).
3. Try-in all veneers with water. With teeth very wet, dip the veneer with water and set on the tooth. Repeat with the rest of the veneers. Alternatively, use the Accolade PV try-in system described above. Avoid desiccating adjacent teeth, which will then appear lighter.
4. When the water or try-in paste has created a visual connection with the tooth, check that the veneer has the look and color that the patient wishes (Figure 1c).
5. Choose an appropriate cement by try-in, as previously described.
6. Dr. Ruiz prefers to cement only two veneers at a time, to avoid the possibility of any restoration not seating fully, or moving during cementation. However, Dr R Bertolotti prefers to seat all six anterior veneers at once, and has many years of successful results. Readers should make the final decision based on their own skill and experience. 
7. Carefully place triple-0 cord dipped in water to clearly uncover the margins for cementation. Should hemostasis be required, over the counter Visine works well to soak the cord (Figure 1d).
8. Adjust the constant and fit if necessary (Figure 1e).
9. It is common for some slight openings to be present on the margin with porcelain veneers. A resin cement should be used to permanently seal these slight openings.
10. See Intaglio Veneer preparation below.
11. Selectively etch the enamel for 10 seconds, being careful to avoid touching the dentin. It is important to use a clear matrix, such as Blue View (Garrison) or plumber’s tape to separate and isolate the adjacent prepared teeth from being etch or bonded (Figure 1f).
12. Wash thoroughly with water and dry. The tooth is dry when it is not shiny; desiccating the tooth is never desirable.
13. Apply your bonding system of choice (such as Clearfill SE Protect) for 20-25 seconds over the dentin and the enamel, agitating it on the dentin (Figure 1g).
14. Remove the solvent with air until the liquid stops moving.
15. Apply the second component of Clearfil SE Protect, the bond, thinly over the enamel and dentin, but do not cure.
16. Apply veneer cement to both veneer and seat.
17. Clean the gross excess cement with a plastic tipped massage gum (manufactured by GUM) (Figure 1h).
18. Light cure each veneer for once cycle, leaving a comment that is hard, but not super hard. Alternatively, Dr. R Bertolotti prefers to spot cure in the center, then gel the margins for easy removal of any excess (Figure 1i).
19. Cleanup can be done now, using a no. 12 blade (Figure 1j).
20. Try to pass floss through, but if unsuccessful, use a Cerisaw (DenMat; Figure 1k).
21. Repeat steps 7-20 for all the subsequent veneers, two at a time.
22. After all veneers are cemented, remove the cord and flood the tooth with an oxygen inhibitor liquid. Do the final cure, one cycle lingual, once cycle facial, on all restorations. 
23. Use a gingival retractor to do a final check for margin quality. If necessary, use a flame diamond to smooth the margins (Figure 1l).
24. Polish with the Sof-Lex (3M) or Dialite (Brasseler) system.
25. Do a final bite adjustment.

Figure 1: (a) Isolation veneers. (b) Cleaning teeth with Consepsis. (c) Try-in with water or try-in paste. (d) Placing triple-0 cord. (e) Adjusting contacts. (f) Etching teeth, placing a matrix to isolate adjacent teeth from etch. (g) Apply primer. (h) Removing cement with a gum stimulator (Buttler). (i) One cycle of curing. (j) Removing cement with no. 12 blade. (k) Using a Cerisaw (DenMat). (l) Using a Kincheloe (Hu-Friedy) gingival retractor to check margin integrity.

Intaglio Veneer preparation 

1. Prepare the porcelain for adhesion with a hydrochloric acid, Ultradent Porcelain Etch. Pressed feldspathic is etched for 1 minute, and lithium disilicate for 20 seconds. Over-etching weekends the ceramic surface, so it is undesirable.

Note: Veneers may come pre-etched from the laboratory. If so, after making your adjustments, only re-etch for 10 seconds or less, to remove contaminants, or clean with phosphoric acid.

1. Wash and dry porcelain thoroughly. Porcelain needs to be bone-dry before applying the silane.
2. Apply ceramic primer and leave for 1 minute, then air dry.
   1. If using Kuraray ceramic primer, no additional step of applying resin is needed, since the silane itself contains resin.
   2. If using a silane without resin, wait 1 minute, dry, then apply the bond. 
   3. The restoration is ready. When using Kuraray ceramic primer, there is no need to protect the onlay from ambient light.
3. Go back to step 11 in Step By Step Veneer Bonded Cementation above.

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Los Angeles Institute of Clinical Dentistry & Ruiz Dental Seminars Inc. uses reasonable care in selecting and providing content that is both useful and accurate. Ruiz Dental Seminars is not responsible for any damages or other liabilities (including attorney’s fees) resulting or claimed to result in whole or in part, from actual or alleged problems arising out of the use of this presentation. The techniques, procedures and theories on this presentation are intended to be suggestions only. Any dental professional viewing this presentation must make his or her own decisions about specific treatment for patients.