COLOR CORNER

Clinical, Laboratory, and Research Solutions for Color Dilemmas in Esthetic Dentistry

Variations in Ceramic Thickness:

Controlling Shade from Uniform
to Non-uniform Reduction
Part 1. Uniform Tooth Reduction
Stephen J. Chu, DMD, MSD, CDT
Clinical Associate Professor and Co-Director of Esthetic Education,
Columbia University College of Dental Medicine, New York, New York.

Adam J. Mieleszko, CDT

New York, New York.

Because of their conservative nature and longevity, ceramic laminate

veneer restorations have seen an expansion in clinical applications
since their introduction in the early 1980s.14 Initially intended for
conservative tooth preparation, their applications have expanded
and consequently tooth reduction has become more extensive and
non-uniform in design, with proximal and lingual extension attributed
to existing and/or defective restorations with recurrent decay.
Midterm survival studies have shown positive results with extend-
ed ceramic veneer restorations.5,6 However, the non-uniform removal
of tooth structure can ultimately influence the final shade of the res-
toration, because varying thicknesses of porcelain change not only
in color but also translucency. For instance, the same color of ce-
ramic powder fired in increasing thicknesses will appear different in
shade.7 This phenomenon is illustrated clearly in Fig 1, where a Vita
Classic A1-shaded porcelain powder fired in 1.0-, 2.0-, and 3.0-mm
thicknesses, respectively, has a final shade of A2 or A3, not A1. This
is applicable for a tooth with a discolored stump shade; increased
tooth reduction allows a greater thickness of ceramic to mask the
underlying tooth color.8 Conversely, a thinner amount of ceramic has

1 2 3

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 COLOR CORNER
Stephen J. Chu, Section Editor
sjc2168@columbia.edu

a more translucent effect (Fig 2), and this strategy can be used when the stump
shade is not discolored. Therefore, the non-discolored tooth stump can act as a
canvas to aid in the favorable blending of the ceramic veneer color (Fig 3).
Uniform versus non-uniform tooth preparation and reduction has a significant
impact on the dental ceramists ability to manage the final color and translucency
of the definitive ceramic laminate veneer restoration. When the existing stump
shade of the tooth is not compromised, uniform tooth reduction can and should
be performed, so the stump shade can act as the appropriate color canvas for
predictable shade matching.9 The following case report addresses color match-
ing with uniform tooth reduction, and part 2, in the next issue, will address non-
uniform tooth reduction.

4 5

A 31-year-old Caucasian man with a high smile line presented with multiple
diastemata involving the four anterior maxillary incisors (Figs 4 and 5). The
goals of treatment were (1) to restore the proper individual tooth size and propor-
tion to the maxillary incisors10 (75% to 80%) conforming to the Bolton analysis11
and (2) to match the color of the patients adjacent natural dentition. It was deter-
mined that the length of the maxillary central incisors (12 mm) was correct based
upon the width of the mandibular anterior teeth, which were larger than average
size and intra-arch width12 (6.5 mm mandibular central incisor width). However, a
maxillary toothwidth discrepancy was present, since the width of these teeth was
8.5 mm versus 9.5 mm (Fig 6).13 The final individual tooth sizes, both width and
length (9.5 mm 12 mm), and individual tooth proportion (~80%) for the central
incisors were transferred indirectly to the working cast using a diagnostic wax-up
(Fig 7). This was verified intraorally with the direct mock-up technique.

doi: 10.11607/ajed.cc0213
2013 by Quintessence Publishing Co Inc.

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 COLOR CORNER

6 7

8 9

The definitive treatment plan em-
ployed contact lens ceramic veneers
and no-prep veneers on the mesial
contact areas of the canines to restore
function and esthetics (Figs 8 and 9).
Double zero cord was placed intra-
sulcularly, and 0.5-mm depth cuts were
made within the enamel layer (Fig 10).
A laboratory-fabricated silicone ma-
trix was used as a preparation guide
to minimize and create uniform tooth
reduction (Fig 11). The final shade was
determined prior to tooth preparation
(Fig 12) and stump shade at the time
of preparation (Fig 13).
A definitive impression was made of
the tooth preparations and a gypsum
cast poured. The uniform reduction
was clearly visible on the casts using
the silicone matrix preparation guide
(Fig 14) and duplicated in refractory
die material (G-Ceravest, GC America).
Since there was minimum and uni-
form tooth reduction, the shade of the
stump preparation was used as a color
canvas for predictable shade match-
ing. An even thickness of ceramic
was achieved in the final restorations
including the no-prep canine veneers
(Figs 15 to 17).
The tooth preparations were cleaned
(Fig 18) and conditioned accordingly to
receive the etched feldspathic veneers
(HeraCeram, Heraeus). Transparent
light-cured resin cement (Variolink,
Ivoclar-Vivadent) was used to lute the
veneer restorations, with cementation of
the no-prep canine veneers sequenced
first, the central incisors second, and
the lateral incisors last (Fig 19).

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 COLOR CORNER

10 11

12 13

14 15

16 17

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 COLOR CORNER

18 19

20

21

The integration of color and harmony the color of the existing noncompro-
within the smile was achieved through mised stump shade to act as a color
uniform tooth preparation and the use canvas for predictable shade matching
of clear resin cement, thereby allowing (Figs 20 and 21).

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COLOR CORNER
10. Sterrett, JD, Oliver T, Robinson
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