The Importance of Evaluating Temporary Veneers

In recent articles, I went over the steps I use when bonding porcelain veneers. In this article, I'd like to reintroduce Julie as my example patient to go over the evaluation process of the temporaries.

If you watched the video on her tooth preparations, you know that they were very conservatively done, since I am adding length and prominence to her existing tooth form. Following the preparations, temporaries were made using a matrix from a diagnostic wax-up that had increased the tooth length. The temporaries were then spot bonded. Since I was lengthening the anterior teeth 1.5mm, which also increased her overbite 1.5mm, I decided on a trial period of four weeks to see how she responded functionally and esthetically before committing to the final tooth size in ceramic. It is important to bring up that she had a slight lisp before treatment, and I was also waiting to see if the increased length would exacerbate the lisp.

At this point in the procedure, the temporaries have been made and bonded to place for about four weeks. Since I haven't seen her during that time period, there were certain things that I needed to evaluate to assess how she was responding to the temporaries.

Any loosening or fractures? In Julie's case, two left posteriors had broken off from eating bread about three days before she came in for her evaluation. She also informed me that that her right posteriors were very loose, but had not fractured yet. As we all know, since veneer temporaries have no mechanical retention, and we only spot bond them, loosening is not uncommon, so these issues were a minor concern for me. The anterior veneer temporaries with the increased overbite were doing fine.

How is her speech? Julie said she noticed her lisp increase for two weeks after the temporaries were placed, but it had then reduced. However, a friend of hers had mentioned that he noticed a greater lisp when she spoke. I evaluate any speech problems by instructing the patient to say words, such as, "55," "66,"and "Mississippi," and ask if they feel their upper anteriors hitting the lower anteriors, or if their upper anteriors dig into the lower lip. With Julie, I held thin articulating ribbon against the upper anteriors while she said "66" to see if there was any contact. Sure enough there was contact between the lower incisors and the lingual of the upper temporary incisal edge, adjusting the lingual of the upper temporary until no contact occurred eliminated the lisp.

Do they like the appearance? The most important goals for Julie were to close the diastema between her centrals, increase tooth size for a fuller smile, and whiten up her teeth. She was extremely happy with how her teeth looked and the fact that her smile was more esthetic. This means we can send a model of the temporaries to the lab as a guide for fabricating the final ceramic veneers.

When we are making minimal changes in tooth position or occlusion a trial period is usually not necessary for veneers. However, when you desire significant changes in tooth size and overbite, as I did in Julie, having a trial period before having the lab fabricate the final restorations allows you to feel very confidant about the acceptability and longevity of the final restorations. This can also minimize significant grief of having to alter the ceramic restorations or have them fracture.