Understanding Veneer Misalignment

Veneers are a popular option for improving the esthetic appearance of misaligned, discolored, broken, chipped, and/or misshapen teeth. Veneers are more unique than most other indirect restorations (e.g. crowns, bridges, inlays, onlays, etc.) due to the increased emphasis on esthetic appearance. Therefore, the veneer cementation process may present a unique set of challenges that can be met with a unique set of cements. Challenges such as veneer misalignment can be particularly difficult to overcome, even for the most experienced specialists.

Why Misalignment Matters

Veneer misalignment is an important issue to understand because it not only affects the esthetic results, but also impacts the longevity and functionality of the restoration. From a functional standpoint, veneer misalignment may cause discomfort, interfere with the bite, and potentially increase wear on surrounding teeth. Esthetic concerns arise when the veneer doesn't properly align with neighboring teeth (causing visible gaps) or an unnatural appearance (crooked/slanted appearance).

What is Veneer Misalignment?

Veneer misalignment occurs when a veneer is not properly seated on the tooth preparation and may cause the final results to appear uneven, crooked, or slanted. This can happen for several different reasons, however, even a slight error can cause significant veneer misalignment.

Causes of Veneer Misalignment

There are many potential causes for veneer misalignment, one of which being improper cementation technique. The cement, bonding agent, and primer/silane you select to use will all have an impact (for better or for worse) on the final results. During the cementation process, refer to the manufacturer’s instructions for use to ensure that the indications are being followed properly.

How to Avoid Veneer Misalignment

A crucial factor that helps to avoid veneer misalignment is selecting the right materials. Choice 2 is specifically designed for veneer cementation and exhibits excellent strength and shade stability, ensuring long-term esthetics and functionality. Choice 2’s viscosity and light-curability are great aids when placing veneers as well. Between the unlimited working time of the light-cured cement and the highly filled resin matrix, clinicians may place multiple units of veneers onto preparations without displacement to visualize the complete results, prior to curing the cement. Choice 2’s low film thickness is also ideal for veneers as it helps to ensure the restoration is properly seated. Below is an example of the step-by-step cementation process for porcelain or lithium disilicate veneers, using Choice 2. Following this process can be helpful in avoiding veneer misalignment.

Preparation Steps

A. Tooth Preparation

1. Etch enamel and dentin with phosphoric acid (e.g. Uni-Etch® 32% phosphoric acid) for 15 seconds. Rinse thoroughly and remove excess water but do not desiccate; preparation should appear visibly moist.
2. Apply an adhesive (such as All-Bond Universal) according to manufacturer instructions.

B. Veneer Restoration Preparation  

1. Verify the porcelain veneer has been properly etched or etch veneer with hydrofluoric acid according to manufacturer’s instructions with hydrofluoric acid (such as 9.5% Porcelain Etchant).
2. Apply 1-2 coats of silane to the intaglio of the restoration (when using Bis-Silane 2-Part Porcelain Primer, mix parts A and B in a 1:1 ratio) and allow to dwell for at least 30 seconds. Dry with warm air syringe.
3. Clean the tooth preparation. Rinse and dry.
4. Try-in the silane-coated restoration on the preparation for proper fit. Apply the desired shade of Choice 2 Try-In Paste to the veneers and gently seat prep.
5. When the desired Choice 2 shade is determined, remove the restoration, and rinse both the preparation and the restoration with water. The veneers should be rinsed thoroughly with water spray or use a cleaning agent (e.g. ZirClean®).

C. Cementation Process

1. If desired, for porcelain and lithium disilicate veneers, apply a very thin layer of HEMA-free resin such as Porcelain Bonding Resin* to the internal surface of the veneer.
2. Apply a generous amount of the selected shade of Choice 2 veneer cement to the internal surface of the veneer.
3. Place veneer and gently guide into place.
4. Light cure each for 3-5 seconds to tack the veneers into place.
5. Remove the excess cement.
6. Light cure each veneer for 40 seconds from lingual and 40 seconds from the facial.

Ready to elevate your veneer procedures? Discover the benefits of Choice 2 veneer cement and ensure your patients long-lasting, beautiful smiles. Learn More About Choice 2