Porcelain Veneers, Tooth Remineralization, and Biocompatibility

Porcelain Laminate Veneers: Indications and Contraindications

Indications:

1. Used on slightly/mildly enlarged teeth
2. Traditionally indicated in aesthetic areas where a single crown composite resin veneer would be used
3. To correct diastemas
4. Masking of discolored/stained teeth
5. Repairing enamel defects

Contraindications:

1. Cannot be waxed on short clinical crowns
2. Not suitable for patients with parafunctional habits (e.g., bruxism)
3. Teeth with insufficient enamel for adequate retention
4. Teeth with large restorations or endodontically treated teeth with little remaining structure
5. Patients with tooth wear due to bruxism

Tooth Remineralization: Techniques, Materials, and Concepts

Techniques:

Hand excavation is preferred to preserve as much tissue as possible for remineralization. However, in extensive cases, small round carbide burs may be required to remove soft caries. If the caries extends towards the pulp, hand excavation is recommended.

Materials:

• Novamin (inorganic calcium sodium phosphosilicate)
• Giomers
• BioDentine
• Recaldent (casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), a milk-derived product)
• Glass ionomer cements reinforced with calcium and phosphate

Concepts:

ART (Atraumatic Restorative Treatment) protocol

Use of Recaldent (CPP-ACP), Novamin, tri-calcium phosphate, and xylitol

Biocompatibility of Dental Materials

Definition:

Biocompatibility is the ability of a material to elicit an appropriate biological response in a given application within the body.

Other Biological Effects of Resins:

The primary risk associated with using resin materials appears to be allergy due to frequent exposure to unpolymerized materials. Allergic reactions can manifest as contact dermatitis and, in severe cases, anaphylactic shock.

Resin components have been shown to traverse dentin and may be used for direct pulp capping.

Material Selection: Who Decides?

In the final analysis, who makes the choice about which materials are biologically safe for use in dentistry: the patient, the dentist, or the manufacturer?

• Since no material can be guaranteed to be 100% safe or risk-free, the clinician must rely on clinical judgment, common sense, and available data.
• The clinician must always recognize that the use of materials in the body requires a risk-benefit analysis. Risks must be weighed against possible benefits and should be communicated thoroughly and clearly to the patient so that the patient can make an informed decision.