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Case Presentation
Joseph J. Porcu, DDS
Temporization has always been a challenge for both clinicians and patients. The ability to eliminate the need for time-consuming and unreliable multi-unit veneer temporaries from the treatment plan greatly improves the patient’s experience, while optimizing the clinician’s workflow. The FirstFit Guided Veneers Delivery System saves valuable chair time by allowing the veneers to be prepped for and inserted in the same visit. Using this innovative technique, the case discussed here was completed in under 2 hours—from prep to insertion to cleanup.
Treatment Planning
The patient, a 29-year-old man, presented for a consultation and shared that he was unhappy with his smile.
He had undergone orthodontic treatment as a teenager, and although his body continued to grow to a height of 6-feet, 4-inches, he felt that his smile had not caught up. After a full evaluation, it was determined that he had an edge-to-edge anterior bite that would require clear aligner correction prior to veneer placement.
The treatment plan included a soft-tissue laser crown lengthening of tooth No. 9 and placement of 8 FirstFit veneers (IPS e.max Press, Ivoclar Vivadent). At the first operative appointment, a full-arch intraoral scan (TRIOS, 3Shape) was taken along with a final shade and new photo protocol. All records were sent to Town & Country Dental Studios in Freeport, NY—an exclusive FirstFit Authorized Lab Provider. With their assistance, a digital design file was created and emailed to me so I could review it and make any necessary adjustments.
3D-Printed Preparation
After 15 working days in the lab, I received everything needed to achieve the necessary preparations-- the 3D-printed preparation guides, a model, ready-to-seat veneers in a tray, and 2 burs. The series of 3D-printed guides were used in sequence to achieve the exact digital design that the veneers were made to fit. Once the teeth were prepped, I tried in all the veneers at once using the delivery tray, which ensured proper fit and placement.
Same-Day Placement
After the fit and appearance of the veneers were verified, the teeth were pumiced and then etched with 37% phosphoric acid gel and coated with a bonding agent (OptiBond Solo Plus, KaVo Kerr). The bonding agent was not light-cured because it would polymerize when the cement was cured. Prior to placement, the intaglio surface of the veneers was rinsed, lightly etched, and rinsed again. A silane primer was placed on the intaglio surface of the veneers and then air-dried, followed by a thin coat of bonding agent. Light-cured resin cement (NX3 Nexus, KaVo Kerr) was placed on the intaglio surface of the veneers and then all veneers were seated at one time using the delivery tray.
Prior to curing, I did an initial cleanup and then tacked each veneer in place before gently removing the delivery tray. After the final cure, we made sure all contacts were clear and flossable, and then evaluated the final occlusion for any necessary adjustments. The veneers were then polished with fine pumice and porcelain polish. FirstFit Technology now makes it possible to predictably prep and insert custom-fabricated porcelain veneers in one visit without placing temporaries, while also reducing overall chair time. The FirstFit guided delivery system streamlines the veneer process—making the procedure more efficient, less invasive, and more rewarding for both clinician and patient.
Go-To Product Used in this Case
FirstFit is a revolutionary system that uses innovative digital technology and a series of 3D-printed prep guides to enable clinicians to prepare and seat a bridge or veneers in a single visit. Each 3D-printed prep guide is custom-designed and enables minimal tooth reduction during treatment, resulting in a highly esthetic, precise-fitting restoration. FirstFit represents a minimally invasive, temporary-free solution for patients who don’t have time for multiple office visits, and can minimize chair time.
About the Doctor
Dr. Porcu graduated from Georgetown University Dental School in 1984 and has been in private practice for 35 years. In his Syosset, NY, practice, where he treats patients ranging in age from 3 years old to their nineties, he places an emphasis on crown-and-bridge, implant, and cosmetic dentistry. He is passionate about using the latest technology in his practice, such as digital x-rays and lasers, and maintains professional affiliations with the American Dental Association, New York State Dental Association, and Nassau County Dental Association.
