Dr. Jeff Blank DMD

	Throughout a workday, dentists see patients for many different treatments, from simple hygiene appointments to more complicated restorative procedures. One of the most common procedures is a direct composite restoration. 

The ultimate goal in a direct composite restoration is to provide the patient with a pain-free and esthetically pleasing result. Although this procedure is common and often relatively simple, the patient may feel discomfort if the correct products are not used together. 

One problem often associated with direct composite restorations is post-operative sensitivity. Several factors can cause this sensitivity, including the etching mode and amount of residual moisture in the tooth when applying an adhesive. 

In the past, the chosen etching mode often relied on the brand of adhesive, with some requiring one specific etching mode. Now, dentists can choose between self-, selective- or total-etch techniques, all from the same 

. One such universal adhesive, 3M™ ESPE™ Scotchbond™ Universal Adhesive, gives dentists the ability to use several different etching modes. With Scotchbond, dentists don’t need to be concerned with post-operative sensitivity because of the unique chemical makeup of the product. 

Another advantage of a universal adhesive is that dentists don’t need to worry as much about the residual moisture left in the dentin after rinsing off the etchant, thanks to the adhesive’s high moisture or dehydration tolerance. Dentists are given a larger window to place the adhesive and no longer need to risk overdrying of the restoration, which can contribute to post-operative sensitivity. 

The following case demonstrates how using a universal adhesive in a direct restorative procedure provides the efficiency to complete the procedure in less than 30 minutes.

A 35-year-old male presented with pain in tooth No. 20 and was diagnosed with recurrent decay beneath an existing conservative occlusal composite restoration. A direct composite restoration was chosen due to the size and location of the decay.

Check out the following video to see how the case was handled:

The existing decay on tooth No. 20 is removed. A Garrison FenderWedge® protects surrounding soft tissue and enamel from the high-speed drill.

 The restoration is etched in total-etch mode using 

 A total-etch mode is selected due to a majority of the restoration being in the enamel portion of the tooth and to ensure high bond strength with the existing enamel. The etchant sits for 15 seconds and is rinsed off, leaving the restoration slightly moist.

 Scotchbond™ Universal Adhesive is applied to the restoration and scrubbed for 20 seconds. The adhesive is dried using oil- and moisture-free air for five seconds and light cured using the 3M™ ESPE™ 

 A thin layer of flowable liner, 3M™ ESPE™ Filtek™ Supreme Ultra Flowable Restorative in shade A1B, is placed to decrease the likelihood of voids when additional composite is layered and is light cured for 10 seconds.

 The restoration is filled using a two-stage incremental technique, with a dual-shade technique chosen to offer a higher level of esthetics. To recreate the dentin layer, 3M™ ESPE™ Filtek™ Supreme Ultra Universal Restorative in shade A1B is first applied. The composite material is placed in a vertical incremental layering technique to combat polymerization shrinkage and shaped using a Hu-Friedy® Mini 4 Composite Instrument.

 The composite material is light cured for 10 seconds.

 A second layer of restorative is placed using Filtek Supreme Ultra in shade A2E, chosen to mimic the esthetic of the existing enamel and to provide a more seamless integration. The restorative is shaped and then light cured for 10 seconds.

Using a finishing bur, the restoration is adjusted for proper occlusion.

To complete the restoration, 3M™ ESPE™ Sof-Lex™ Spiral Finishing and Polishing Wheels are used to provide a natural luster and shine to the restoration.

When completing a direct composite restoration, it’s important to use materials that provide the longest-lasting and most comfortable results. Two years of personal clinical experience using a universal adhesive have resulted in zero adhesive-related post-operative sensitivity complaints. Universal adhesives give dentists the flexibility to choose their preferred etch mode, while providing confidence that the likelihood of post-operative sensitivity is greatly diminished.

Dr. Jeff Blank graduated from the Medical University of South Carolina College of Dental Medicine in 1989 and maintains a full-time private practice in Fort Mill, S.C., where he emphasizes complex restorative reconstruction and cosmetic enhancement procedures. He holds an adjunct instructor post in the Department of General Dentistry at the Medical University of South Carolina College of Dental Medicine and has authored dozens of clinical manuscripts on a variety of clinical techniques and materials. He is a fellow in the Academy of Comprehensive Esthetics and the International Academy of Dental Facial Esthetics and an active member of the International Association for Dental Research, the Academy of Operative Dentistry, the American Academy of Cosmetic Dentistry, the Pierre Fauchard Academy, the American Dental Association and the Academy of General Dentistry. 

Articles

How to achieve clinical confidence with universal adhesives

the cementation of indirect restorations, there are many factors to consider. Sufficient working time, handling properties, ease of residual cement clean-up, color stability and overall esthetics, in addition to patient comfort during the process, are all important. However, the most essential attribute a cement must have is outstanding bond strength and durability. 

In general, resin cements offer the most optimal results when considering retention rates, as they are the least soluble, most durable and provide the highest bond strength to both the tooth substrate and restorative material. 

is an industry leader with regards to bond strength when compared to other cements. When paired with a universal adhesive, such as 3M™ ESPE™ 

, cementation becomes a simple two-component process, regardless of the indirect restorative material. Since Scotchbond Universal adhesive contains silane and MDP, the need for additional ceramic, zirconia and metal primers is eliminated.  

When selecting a cement, it’s important to consider the overall case to determine the right cement for the particular indication. Some cements are universal and are approved for all types of clinical indications, including all-ceramic veneers, glass/ceramic restorations and CAD/CAM restorations, as well as PFMs and full-metal restorations. Dentists should also consider the method of polymerization. Resin cements are available in light-cured only, self/auto-cured only and dual-cure systems. Many dentists prefer dual-cure resin cements because they can be light-cured when using thin or more transparent ceramic materials, yet also offer the assurance of definitive dark-cure polymerization when cementing restorations that are either too thick, dense or opaque for light polymerization alone.  

It’s also important to think about patient comfort after the restorations are cemented, and select a resin cement/adhesive combination that will eliminate as much post-operative sensitivity as possible. Finally, an important factor of a cement is the end esthetic result; therefore choosing a cement that offers a range of shades and opacities, remains color-stable long-term, and offers optical properties such as fluorescence that mimic natural tooth structure is vital to overall clinical success. The world-class esthetics – when combined with durability, fewer components and a shortened procedure time – made RelyX Ultimate an ideal cement choice for the presented case.

In this presented case, a 41-year-old female presented with failing restorations with open margins, the beginning of recurrent decay and subsequent fractures on tooth Nos. 18 and 19. She was experiencing sensitivity and discomfort and elected to have crowns placed on both teeth.

Watch this video to see Dr. Blank complete the presented case using 3M ESPE cements.

Cementation is a critical component in the indirect restoration procedure. The author had ample time to complete the procedure with the materials selected, and the new restorations had improved esthetic quality and eliminated the sensitivity the patient was experiencing prior to the procedure.

Selection of the hardest-working materials available helps to ensure restorations reach the highest possible bond strength, providing patients with the security of a strong and long-lasting restoration.

As was mentioned, a 41-year-old female presented with failing restorations with open margins, the beginning of recurrent decay and subsequent fractures on tooth Nos. 18 and 19 (

). She was experiencing sensitivity and discomfort and elected to have crowns placed on both teeth.

 A preliminary impression was taken of the unrestored teeth using a triple-tray with 3M™ ESPE™ 

Imprint™ 4 VPS Preliminary Impression Material

. This was taken for use in the fabrication of the provisional restorations (

 shows the completed all-ceramic crown preparations. A final impression was taken with 3M™ ESPE™ Imprint™ 4 VPS Super Quick Impression Material.

in Shade A was injected into the preliminary impression (

) The preliminary impression was then re-seated in the patient’s mouth for two minutes (

The completed provisional restorations were cemented in a conventional fashion with temporary cement (

). They were worn until the all-ceramic crowns (

) were delivered from the lab and ready to be cemented (

The provisional restorations were removed and the preparations were cleaned with a non-fluorinated pumice (Premier Dental Products) using a prophy cup (

). The restorations were then checked for accurate fit and the cementation materials (RelyX Ultimate in Trans shade, Scotchbond Universal adhesive) were selected.

The adhesive was applied to the preparations, dwelled for 20 seconds for complete saturation, thinned and solvents evaporated with 5 seconds of air-thinning (

 Simultaneously, the adhesive was applied to coat the entire intaglio surface of the restorations after they were cleaned with acetone (

). No additional silane was required. The adhesive was air-thinned to prevent pooling and evaporate the solvents (

 The cement was injected into the restorations and onto the margins with a spiral mixing tip, ensuring an even mixture while dispensing (

). The crowns were then seated with pressure.

 shows partial polymerization was initiated during 1 to 3 seconds of exposure using a curing light (3M™ ESPE™ 

 Do not prolong this wave-technique for more than 3 seconds or the excess cement will harden before removal.

 The residual cement was removed during the gel state with a sickle scaler and floss (

A final post-operative X-ray demonstrates excellent fit and seal of the seated crowns. The patient reported no post-operative sensitivity and was happy with the final result. 

Dr. Jeff Blank graduated from the Medical University of South  Carolina, College of Dental Medicine in 1989 and maintains a full-time private practice at the Carolina Smile Center in Fort Mill, S.C. He is the founder of New Millennium Education, which offers personalized mentoring programs for those seeking to advance their skills in esthetic and complex restorative dentistry. He has lectured extensively both domestically and abroad since 1998, published numerous clinical manuscripts and dental research, and is a Fellow and active member of numerous dental societies. For questions, comments, or to arrange for Dr. Blank to speak at your upcoming local, regional or national dental program, he can be reached at jblank@comporium.net or by visiting www.newmillenniumedu.com and www.carolinasmilecenter.com.

 When it comes to the cementation of indirect restorations, there are many factors to consider. Sufficient working time, handling properties, ease of residual cement clean-up, color stability and overall esthetics, in addition to patient comfort during the process, are all important. However, the most essential attribute a cement must have is outstanding bond strength and durability. 

How to cement posterior crowns with 3M ESPE cements [VIDEO]

The benefits of 3M ESPE’s RelyX Ultimate Adhesive Resin Cement and why you might want to incorporate it into your practice.

It is perhaps an inelegant phrase to call something the “duct tape of dentistry,” but when a product comes along that is well suited for so many applications, it may actually be appropriate. For me, that product is 3M™ ESPE™ RelyX™ Ultimate Adhesive Resin Cement, coupled with 3M™ ESPE™ Scotchbond™ Universal Adhesive. Since I began using this cement when it was first introduced a year ago, I have transitioned to using it almost exclusively.

The reasons for this are many. Most notably, this cement is compatible with any indirect indication. It can be used for all-ceramic, composite or metal inlays, onlays crowns and bridges; for all-ceramic or composite veneers; for cementing all-ceramic, composite or metal restorations to implant abutments; and for posts and screws.

 Etchant applied to teeth prior to placement of veneers. When there is a significant amount of enamel remaining in the preparations, I prefer using the total-etch mode to ensure maximum bond strength without fear of post-operative sensitivity.

A number of practical features help explain why RelyX Ultimate is so useful. The product is dual-cure and comes in a base paste/catalyst paste system. It can be dispensed conveniently through a spiral mixing tip, which helps ensure the proper mix ratio of the two pastes. It handles well and cleans up well. It is available in four shades-translucent, bleach, A1 and A3 Opaque, and I have been impressed with the fact that the translucent is indeed translucent, which is not the case with some other products. When placing an inlay or onlay, the last thing you want is a white line around the margin, and this cement eliminates any worry about that.

Of course, a primary consideration for any cement is its bond strength, and RelyX Ultimate cement performs very well in this area, with strong test data on its adhesion to both dentin and enamel, in self-etch and total-etch modes. In studies of its adhesion to restorative materials, the cement has shown confidence-building results in tests with glass ceramics, zirconia, titanium and nonprecious alloy. This underscores an important point about using products from major companies like 3M ESPE. Dentists can be assured products have been thoroughly studied before their release and that their claims will be accurate.

ScotchbondUniversal Adhesive is applied to teeth and scrubbed for 20 seconds.

The cement is designed to work in tandem with Scotchbond Universal adhesive, and the combination of these products provides a great way to streamline the adhesion process. Scotchbond Universal adhesive functions as a silane agent for glass ceramics, and as a primer for zirconia and metal restorations, eliminating the need for a separate component. Furthermore, RelyX Ultimate cement has an integrated dark cure activator designed to work with the adhesive. This combination means there are fewer working steps, and also helps streamline inventory. Not only does this eliminate problems with seldom used products expiring on your shelf, but it saves time and confusion in the operatory.

The universal concept also carries over to Scotchbond Universal adhesive-as indicated by its name. This adhesive bonds to all surfaces, and can be used in total-etch, self-etch or selective-etch mode. It provides consistent bond strengths to dentin, whether it is moist or dry etched. All of these characteristics are made possible by the adhesive’s optimized chemistry, which is based on three components.

RelyX Ultimate cement is easily removed during the gel phase.
	 

First is the acidulated monomer MDP. This provides the product with self-etching properties and the ability to bond to zirconia, alumina, metals and metal alloys.

Second, 3M ESPE’s Vitrebond Copolymer is incorporated into the formula. This substance is a methacrylate modified polyalkenoic acid polymer, which gives the adhesive the ability to bond consistently to dentin in the presence of a variety of moisture levels.

Finally, as mentioned, silane is incorporated as well, allowing a chemical bond to glass ceramic restorations without the need for an additional ceramic primer.

This optimized chemistry allows the adhesive to form a distinct hybrid layer, whether dentin is moist or dry, which translates to less technique sensitivity and almost no post-operative sensitivity. The near-elimination of sensitivity is a key benefit for this combination of adhesive and cement. If we are truly honest, even dentists like me-who teach adhesion, and who carefully follow directions when placing adhesive-have sometimes had issues with sensitivity.

Final result showing placement of veneers for a patient with severe wear.

However, since implementing these products into my practice I can honestly say I have had no complaints of sensitivity at all, which in the past was pretty much unheard of, given the wide range of health in the teeth that I treat. This factor alone makes it difficult for me to even consider picking up another cement/adhesive combination.

Check out how one dentist uses the 3M True Definition Scanner and the Trifecta Method by 3M ESPE in his practice:

One of the points I often emphasize in my teaching is that dentists should not mix and match cements and adhesives from different manufacturers.

There are simply too many opportunities for incompatibilities or unforeseen issues to arise, and there is no way for any one manufacturer to test their product with any given product from another manufacturer. However, dentists can generally feel confident using an adhesive and cement from the same manufacturer, and 3M ESPE has given the industry a combination that is difficult to pass up.

The unique properties of RelyX Ultimate cement and Scotchbond Universal adhesive provide technique insurance, with a greater tolerance for errors than other combinations on the market. In addition, they also dramatically streamline the restorative process.

Dentists who are tired of stocking multiple resin cements and adhesive systems-as well as learning the various techniques for all of these products-now have a go-to system that eliminates these issues. With just two components, we now have an outstanding tool for virtually any indirect prosthetic restoration.

3M ESPE’s RelyX Ultimate Adhesive Resin Cement: A cement for nearly any indirect indication

Until recently, all “Sixth Generation” self-etching/priming adhesives contained volatile solvents that must be evaporated prior to light curing to provide consistent bond strengths. Now a solvent-free self-etching, single-bottled system has been introduced by 

. Bond-1 SF Adhesive uses a proprietary formulation said to eliminate the need for commonly used solvents such as acetone, alcohol and water. This not only reduces the number of steps in application, but removes the ambiguity of air-volatilizing residual solvents prior to light curing.

Because residual solvents can reduce bond strengths and disrupt the hermetic seal needed to eliminate water transportation from the underlying dentin, the potential for “water-treeing” effected by osmosis is reduced. This breakthrough in technology renders an adhesive system that defies the typical label of the self-etching primer/adhesive “

In-vitro clinical studies indicate that bond strengths exhibited by Bond-1 SF Adhesive are as high as results obtained when using traditional total-etch and self-etch adhesives, and restoration microleakage is comparable or superior when compared to four other bonding agents.

By eliminating solvents from the formulation, evaporation during storage and before application is prevented. The resulting longer working times provide a greater margin for error compared to similar products. The material is self-leveling and requires only one coat with no air-thinning prior to light curing. Bond-1 SF Adhesive is indicated for use on direct composite restorations, and can be used with dual cure materials when the initial layer of the dual-cure composite is light cured.

A patient presents with the desire to remove an unsightly amalgam restoration on tooth No.19 

. After anesthetization, rubber dam isolation is achieved, and the amalgam is removed 

. For this case, the syringe delivery system of Bond-1 SF Adhesive is used. The screw cap is removed and the provided flocked tip is twisted onto the syringe. Because Bond-1 SF Adhesive is a self-etching system, no phosphoric acid conditioning is necessary.

. Slight pressure is exerted on the plunger of the syringe to begin the flow of material through the flocked needle. The material is applied to dentin 

 and the enamel cavosurface with a scrubbing motion for 20 seconds. The handling properties permit a smooth, even coat of material across the interface with a low film thickness. There is no need for air-thinning or volatilization of any solvents 

. Using Pentron’s Avante halogen light, Bond-1 SF Adhesive is light cured for 10 seconds 

. A dentin body shade of composite (Pentron’s Artiste Shade A2 Dentin Body) is applied and filled to the dentinoenamel junction in 2 mm increments without connecting opposing lateral walls to manage polymerization stress on the bond 

. This layer is sculpted to replicate the cuspal slopes of the cavosurface and light cured for 20 seconds 

. A final layer of enamel composite (Pentron’s Artiste Shade A Enamel) is applied and blended to the margins of the restoration with a ball burnisher to assure full adaptation into the primary and secondary grooves 

. This layer is sculpted to match the existing cavosurface anatomy and light cured for 20 seconds 

. The rubber dam is removed and the occlusion is adjusted. The final result is shown in 

 and chemical formulations have advanced for the last 60 years, the classification of dental adhesives have been commonly segregated into “generations.” The latest, so called “Sixth Generation” materials, are well accepted for their easy use and reduction in post-operative sensitivity. Until the release of Bond-1 SF Adhesive, other materials in this class have contained solvents that must be completely evaporated before light curing. Bond-1 SF Adhesive bridges the “generation gap” by offering a formulation that defies categorization as any “generation,” dramatically reducing chair time and the chance for post-operative sensitivity.

Dr. Blank maintains a private practice in Fort Mill, S.C. He is an adjunct instructor in the Dept. of General Dentistry at Medical University of South Carolina, College of Dental Medicine.

Until recently, all “Sixth Generation” self-etching/priming adhesives contained volatile solvents that must be evaporated prior to light curing to provide consistent bond strengths. Now a solvent-free self-etching, single-bottled system has been introduced by Pentron Clinical Technologies. Bond-1 SF Adhesive uses a proprietary formulation said to eliminate the need for commonly used solvents such as acetone, alcohol and water.

How to: Bridge the generation gap

	Creating long-lasting, vital restorations while minimizing tooth preparation is the primary objective in modern cosmetic dentistry. Clinicians and patients continue to be concerned with the reduction required for some ceramic systems, and this has led to the evolution of “ultra-thin” ceramics options. These new systems impart both beauty and strength and often permit “no-prep” and “low-prep” veneering options. Numerous advantages are inherent in using ultra-thin ceramics, including the ability to remain in enamel to ensure maximum bond strength while allowing the natural vitality of the underlying tooth to permeate the restoration.

	Compared with thicker, more opacious ceramic systems, ultra-thin ceramics can be influenced by the underlying tooth color as well as the color of resin cement. When cementing ultra-thin ceramics, the physical stability and optical qualities of the final resin cement system chosen are tantamount. Light-cure-only veneer cements have proven to be the best option for cementing ultra-thin veneers because unlike their dual-cure counterparts, they do not use a redox initiating system as part of their polymerization mechanism.

 Most self-curing and dual-curing (light- and self-cure) resins depend on a benzoyl peroxide reaction with aromatic tertiary amines as a coinitiator and produce a tetraammonium salt as a byproduct.  This salt typically degrades with time and visibly changes from an invisible compound to a more yellow/orange substance. This color shift of the dual-cure resin cement can cause ultra-thin veneers to negatively change color over time, and therefore these systems are discouraged for use.

	Imperative qualities of resin cement systems used for cementation of veneers include the necessity for the try-in gels to optically match the light-cured resin cement in each shade class, an intuitive nomenclature for each shade and the need for a truly “clear” translucent resin cement. Other desirable qualities in a resin cement system used for luting veneers are a medium to high viscosity to facilitate placement and clean up using the “wave” technique for light curing, and the appropriate physical properties required to provide a long-lasting bond to the tooth substrate.

	Mojo Veneer Cement, a veneer luting resin from Pentron Clinical Technologies, incorporates all the requirements for even the most demanding ultra-thin veneer cases and for any type of veneer case where full light penetration is expected. Mojo comes in four simple and highly intuitive shades: Clear, Light, Dark and Movie Star White. Each shade comes with a try-in gel that matches the final, light-cured shade of the corresponding resin cement to ensure there will be no surprises with the final appearance of each restoration.

	Each shade class of Mojo Cement permits the alteration of the final color of the veneer for various scenarios. If the restoration is too dark, the Light Shade can be used to brighten or warm the color of the restoration. If the restoration is light, the Dark Shade can be used to darken or cool the cured appearance of the restoration. Mojo “Movie Star White” is an absolute essential for clinicians treating single teeth or full cosmetic cases where the patient has bleached his or her natural teeth, demanding a “whiter than white” final color. The clear offers a truly transparent shade that allows light to pass through the veneer and cement, creating a life-like, vital restoration that mimics the natural light progression found in the healthy, non-restored dentition.

	A 16-year-old patient presents after four years of orthodontic therapy to correct malocclusion and align the anterior maxillary incisors. Ultra-thin porcelain veneers on tooth Nos. 5–12 are planned to correct a severe Bolton discrepancy that prevented diastema closure via traditional orthodontics.

. Without anesthesia, tooth Nos. 6–11 were recontoured to remove undercuts and facilitate porcelain margins on the mesial and distal line angles to ensure proper diastema closure. No preparation was used for tooth Nos. 5 and 12. Fig. 1 shows the minimally invasive preparations.

. Impressions were taken with DENTSPLY Caulk’s Aquasil polyvinyl siloxane impression material and a clear Essix Retainer was used for temporization to stabilize the teeth while fabricating the restorations. Eight Ivoclar Vivadent IPS e.max ultra-thin veneers (ivoclarvivadent.com) were fabricated by the laboratory. Each restoration ranged in thickness from 0.3 – 0.5 mm. (Fig. 2).

. Without anesthesia, the Essix retainer was removed and the restorations were filled with the Mojo Light Try-In Gel (Fig. 3). The restorations were seated on each tooth and the color assessed (Fig. 4).

. The appropriate bonding sequence was initiated. The teeth were cleaned with a fluoride-free pumice, etched for 15 seconds with phosphoric acid and thoroughly rinsed. In this case, no dentin was exposed so the etched enamel was desiccated to reveal an ideal frosty etch pattern. Fresh silane (included in the Mojo Kit) was applied to the previously hydrofluoric acid-etched internal veneer surface, evaporated and allowed to stand for 60 seconds.

. Pentron’s Bond 1 Adhesive was applied to the restoration and air-thinned. Simultaneously, the adhesive was applied to the teeth and air-thinned to ensure a low film thickness and to volatilize the solvents. The adhesive on the teeth was then light cured for 10 seconds per tooth surface (Fig. 5).

. The corresponding Mojo Resin Cement (Shade Light) was injected into the veneers using the plastic applicator tip (Fig. 6).

. Each restoration was fully seated and checked for marginal adaptation with an explorer (Fig. 7). 

. The “wave-technique” for initial polymerization was used, whereby the undisturbed residual excess was briefly initiated by waving an LED curing light over the margins. Once polymerization had begun, the firm but not fully hardened residual excess was removed with floss and sickle scaler (Figs. 8 and 9).

. Once all of the residual cement was removed, each tooth was additionally light cured for 20 seconds per surface to ensure complete photo-polymerization of the Mojo Resin Cement.

. Fig. 10 shows the one week final appearance of the eight ultra-thin veneers placed. Note the lack of color variation from try-in, to resin cement placement and the one week appearance. The restorations appear vital and esthetic because of the semi-translucent light conduction of the Mojo Light Resin cement. Both the clinician and the patient were very pleased with the result. 

	With the popularity of ultra-thin veneers on the rise, clinicians recognize the important role of the resin cement systems. By using a veneer resin cement such as Mojo Veneer Cement, dentists are able to place veneers with a reliable, color-stable system that ensures excellent physical properties, easy handling and clean-up, as well as try-in gels that match the final polymerized shade of the resin. These properties relieve guess-work and facilitate exquisite results no matter how complicated the veneer case may be.

 Creating long-lasting, vital restorations while minimizing tooth preparation is the primary objective in modern cosmetic dentistry. Clinicians and patients continue to be concerned with the reduction required for some ceramic systems, and this has led to the evolution of “ultra-thin” ceramics options. These new systems impart both beauty and strength and often permit “no-prep” and “low-prep” veneering options.