Dr. Jacquemyns takes us step-by-step through a GlamSmile case.

1. At the first visit, case selection is covered and GlamSmile addresses a myriad of patient’s cosmetic concerns including but not limited to: tetracycline stains, fluorosis, mild orthodontic corrections, alignment, microdont teeth, and permanent whitening. There are only three qualifying conditions for patients to be considered candidates for GlamSmile veneers. The patient’s teeth must be healthy, their gums must be healthy and there can be no missing teeth in the treatment/esthetic area. The existences of bruxism or occlusal contacts are not disqualifying characteristics.

Photographic images play an important role in the GlamSmile design process. “Before” images provide a wealth of information to the GlamSmile laboratory artisans regarding the esthetic characteristics of the patient’s face and existing smile. Six photographs are taken at various angles, with and without retractors, including one holding a shade guide between the upper and lower arches. Similar photographs will be taken again after the procedure is complete as a comparison to the “before” photograph.

2. Impressions are always taken of both the upper and lower arches, even if only one arch of GlamSmile veneers is being designed for the patient. A bite registration is mandatory. Accurate impressions are created utilizing proven GlamSmile techniques critical to the proper fabrication of the precision tray delivery system. 

3. At the placement visit, begin by cleaning the teeth with pumice and a prophy brush (Fig. 1), and follow with light enamelplasty (Fig. 2). The teeth surfaces are minimally altered with a long Komet bur (black ring). It is imperative that this is done systematically using light pressure. Upon completion, the appearance of the surface of the teeth should be like that of an ice skating rink.

4. Interdental strips are placed to separate the teeth that are not involved with the treatment (Fig. 3). Next you etch the teeth systematically with 37% phosphoric acid starting at the posterior right and ending at posterior left. In a likewise direction, thoroughly rinse the teeth.

5. Leaving the teeth surfaces wet, use a wet bonding technique and apply a layer of bonding agent (One-Step Plus by Bisco) on each tooth (Fig. 4). Each tooth is then light cured with a high-powered plasma light (Remecure from Remedent) for 3 seconds. After curing the surface has a shiny look.

6. The interdental strips are then removed and the interdental connections opened using dental floss. This step is followed by the application of a layer of bonding agent (Fig. 5) on the inside of the veneers (One-Step Plus by Bisco again). Light cure each veneer for 3 seconds using the high-powered Remecure plasma light from Remedent.

7. Add a thick layer of light-curing luting cement (Variolink II by Ivoclar Vivadent) on the inside of the veneers (Fig. 6). Be careful to do this away from bright ambient light. Now the delivery tray of 10 veneers is carefully positioned exactly in front of each tooth (Fig. 7) and inserted with a smooth movement onto the teeth using continuous, even pressure (light pressure is all it needs). Verify the flow of the luting cement (Fig. 8).

8. Clean up the excess luting cement on the gingival with a brush and then give light pressure with an instrument on the gingival part of each veneer securing the gingival adaptation (Fig. 9). If no more luting cement is coming out after pressure, the veneer is perfectly seated. Proceed with a swift sweep of the curing light—creating a jelly state of the luting cement that makes it easier to remove. Remove the excess cement with an explorer. Then cure through the tray for 3 seconds per tooth (the tray has been created to allow maximum penetration of the light). Only cure the buccal and facial sides.

9. Remove the tray by evenly and bilaterally pulling downward (Fig. 10). Do not twist the tray. The resistance is similar to the removal of an Impregum impression.

10. At this stage, clean up as much as possible, removing excess cement from the palatal side. Easily open up the interproximal spaces with an interproximal saw (Fig. 11) while protecting the gingiva of the patient.

11. Remove the retention tabs with a diamond bur and finish with a paper disc making sure not to touch the incisal edge (Fig. 12). The veneers have retention tabs put on by the GlamSmile lab to ensure proper tray placement. Follow with a final light cure (3 seconds palatal/ lingual and 3 seconds buccal/facial) for each veneer (Remecure from Remedent). Check occlusion and adjust if necessary. Continue finishing and complete with polishing.

The “after” photo shows a happy smile featuring 10 veneers delivered in less than one hour!

Editor’s Note: The accompanying case presentation and photos are the property of and were exclusively provided by Dr. Evelyne Jacquemyns for DPR. All rights reserved. For more information regarding the GlamSmile Veneer Delivery System, go to http://72.233.34.110:8080/articles/dpr/edit/http/www.glamsmile.com or e-mail Dr. Jacquemyns at info@glamsmile.com. Exclusive programs are available to select practices in your region.