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27 Mar 2018

By Veronica Morris

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Veronica Morris reviews Dr Basil Mizrahi's 'live patient' course on veneers

I attended a two-day course with Dr Basil Mizrahi at his dental practice/ teaching centre in the West End of London, demonstrating the preparation and fit of veneers on a patient with 14 other delegates.

I have been to lots of lectures on veneers and placed many veneers myself, but I found this course to be unique.You can watch the step-by-step procedure of a patient from start to finish, having veneers prepared, to the fit of the veneers with microscope magnification on the screens in front of you.

Most lectures show the beautiful results, but you are never sure how they actually achieved them.

Initial analysis

The first morning consisted of a short introduction where Dr Mizrahi showed us pictures of the case at the initial examination. The patient had existing composite veneers, which she was not happy with. The gingival positions of the teeth and the incisal edges were not coincident and we discussed different options for the treatment plan. He discussed smile analysis, tools such as the digital smile system, examined photographs at looked at the proportions of the teeth and models. As Dr Mizrahi explained, the key to a successful case is in preplanning and the technician must be involved. Furthermore, it is crucial to make a wax up of the veneers and visualise the veneers in the mouth with a mock up.

This patient had already had orthodontic treatment to improve the position of the teeth before preparing them. The teeth were then placed slightly palatal to allow less tooth to be prepped. The orthodontist who carried out the treatment was there to discuss the patient’s treatment plan. It was important to prep facially to preserve the enamel and a butt fit incisally. We were advised to use two hands when prepping to keep the angle. We considered the temporaries, how they were made and how they were fitted in the last four weeks. This is a common problem with veneers. The different types of porcelain materials that could be used were also talked about.

Real patient examination

The patient arrived in the late morning and we were then able to see everything that we had discussed put into practice. The technician, Simon Newbold arrived to take the shade and used a Vita 3D shade guide and polarised light. He explained what colours he was going to use and showed his detailed laboratory drawing.

This patient had had an accident on her upper front teeth and the upper right central incisor tooth was root filled. As Dr Mizrahi removed the composite, he noted that the prepped tooth was very discoloured. This prompted the technician to come back to take pictures and examine the shade. You really do need a technician on site for a successful outcome. With the prepping of veneers with microscopic magnification, you can really see every detail. It was recommended that if you do not have a microscope, you should use loupes of 3.5 to 4x magnification. Dr Mizrahi also used a speed increasing handpiece for prepping the teeth. We saw the impression technique with a special tray and the temporisation of the teeth. This concluded the first day.

Post treatment 

Three weeks later we came back again for the fit appointment. In the morning we had a short talk on rubber dam placement which can be tricky around upper centrals and how to fit each veneer individually and meticulously. Dr Mizrahi showed us all the instruments and materials that he used. The patient arrived later in the morning with the temporaries intact. He showed us his local anaesthetic technique for numbing the palatal painlessly. We then saw at microscopic magnification, the placement of the rubber dam removal of the temporary veneers, and placement and polishing of the permanent veneers. The results were amazing and the veneers looked very natural. This is a great result for what I consider in dentistry a very sensitive and fiddly technique . My nurse also attended on the second day so that she could see the materials and how they were handled. She was able to observe how Dr Mizrahi’s nurse worked with which was very useful. We then spent the afternoon discussing other veneer cases and some of the participants brought models and pictures of cases to show the group.

I highly recommend this course. You will learn a lot and have a list of materials and burs that you will want to buy. The loupes are the first thing on my shopping list. You definitely cannot do this quality of work without good vision.

 

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