She wanted to change the appearance of her teeth, but did not want to undergo another long preparation process or more anesthetic injections. The clinician, patient, and technician discussed the case together and decided veneers could be fabricated to fit over the existing crowns with minimum facial reduction required. A small amount of preparation interproximally was required to create embrasure form. The technician prepped the patient’s study model, giving the dentist a guideline to follow when prepping the patient’s crowns. With goals set and communication established, the case could proceed.

Color, shape, and occlusion needed to be re-evaluated to achieve a perfect form over what had already been cemented. For instance, special care had to be taken to mask the C3 shade of the crowns through the custom shading process. The veneers needed to be slightly lighter in color than the patient’s adjacent teeth to create a match that was not too dark, because one of her primary complaints was the color of the crowns.

Following is the illustrated and annotated case as it was handled in the laboratory.

Fig. A This pre-op view of the patient’s PFM crowns on teeth Nos. 6, 7, 8, 9, 10, and 11 shows the square shape of the restorations and their monochromatic and metallic appearance.

Fig. B  A side view of the PFM restorations pre-op.

Fig. C  I created detailed computer images to help achieve the final patient goals. The brown lines equal the three-dimensional lobe; the blue lines, the increase of the incisal edge; and the black lines indicate that the area is too bulky and needs to be brought in. (The same applies to both sides of the mouth.)

Fig. D  Next, I created a lab test to achieve the correct color match using two porcelain veneers, a GC IQ™ press veneer, a B1 ingot, a natural tooth, and a laboratory-fabricated tooth.

Fig. E  A backlit view shows the porcelain veneer, the GC IQ™ veneer, and the B1 ingot with natural translucency. Also, on the left is a natural tooth and on the right is a technician-fabricated tooth.

Fig. F  The lab processed a full-contour waxup of the case, using Renfert GEO Natural™ wax.

Fig. G  The veneers were sprued and readied for investing.

Fig. H  The case was invested using the GC IQ™ system.

Fig. I  After divesting, GC IQ™ Lustre Paste was applied to the veneers.

Fig. J  Surface texture was crafted onto the veneers to achieve a three-dimensional appearance.

Fig. K  Next GC IQ Lustre Paste was applied for the dentin shade.

Fig. L  Lustre Basic Shade A was applied for the lateral.

Fig. M  Lustre B was applied to the veneers for the canine.

Fig. N  The veneers after the first bake.

Fig. O  A Neutral Lustre Paste was applied. The veneers were visibly thicker than we are used to from a normal glaze bake.

Fig. P  The GC IQ™ pressed material after final glazing.

Fig. Q  The final restorations were fitted on the solid cast.

Fig. R  Try-in for tooth No. 7.

Fig. S  Try-in for tooth No. 9.

Fig. T  Immediate view after all veneers were placed at try-in.

Fig. U  Pre-operative appearance.

Fig. V  Post-operative appearance.

Placing veneers over existing crowns is not something we do everyday. Usually, it’s recommended that the old crowns be removed and the case redone. However, for this patient, it was a way to resolve the unhappiness she felt about her smile without undergoing the discomfort and pain she experienced with the original crown preparation. It was a win/win situation for everybody! 

Fig. C Detailed computer images helped illustrate the patient’s desired results.	Fig. D A lab test achieved the correct color match.	Fig. E A backlit view shows the porcelain veneer and GC IQ™ veneer and B1 ingot with natural translucency.
Fig. F The lab processed a full-contour waxup of the case, using Renfert GEO Natural™ wax.	Fig. G The veneers were sprued and readied for investing.	Fig. H The case was invested using the GC IQ™ system.
Fig. I After divesting, GC IQ™ Lustre Paste was applied to the veneers.	Fig. J Surface texture was crafted onto the veneers to achieve a three-dimensional appearance.	Fig. K Next, GC IQ Lustre Paste was applied for the dentin shade.
Fig. L Lustre Basic Shade A was applied for the lateral.	Fig. M Lustre B was applied for the canine.	Fig. N The veneers after the first bake.
Fig. O A Neutral Lustre Paste was applied. The veneers were visibly thicker than we are used to from a normal glaze bake.	Fig. P The GC IQ™ pressed material after final glazing.	Fig. Q The final restorations were fitted on the solid cast.
Fig. R Try-in for tooth No. 7 in the mouth.	Fig. S Try-in for tooth No. 9.	Fig. T Immediate view after all veneers were placed at try-in.
Fig. U Pre-operative appearance.	Fig. V Post-operative appearance.