Ajay Juneja

Dr. Ajay Juneja completed his BDS in the year 1995. He then went on to do his MDS from the University of Mumbai which he then completed in the year 1998. From then on he worked as a Senior Resident at the Oral Health Sciences Center, PGIMER till 2001. He taught in a private college for a little more then a year. From 2002 he has been working as a Specialist Prosthodontist in Dubai. He completed a one years masters program at UCLA, USA in2011 and passed with top honors. He has been a winner of 6 awards in the past 4 year, winning each year in different categories of Esthetic and Restorative Dentistry at the Middle East and North Africa Esthetic Dentistry(MENA) awards. He has lectured at various national and international conferences and is an opinion leader in the Middle East for some companies. He currently works at the Dental Studio in Dubai, which is one of the Leading Dental Ceters of the World limiting his practice to restorative, implant and prosthetic dentistry.
Dr. Ajay Juneja completed his BDS in the year 1995. He then went on to do his MDS from the University of Mumbai which he then completed in the year 1998. From then on he worked as a Senior Resident at the Oral Health Sciences Center, PGIMER till 2001. He taught in a private college for a little more then a year. From 2002 he has been working as a Specialist Prosthodontist in Dubai. He completed a one years masters program at UCLA, USA in2011 and passed with top honors. He has been a winner of 6 awards in the past 4 year, winning each year in different categories of Esthetic and Restorative Dentistry at the Middle East and North Africa Esthetic Dentistry(MENA) awards. He has lectured at various national and international conferences and is an opinion leader in the Middle East for some companies. He currently works at the Dental Studio in Dubai, which is one of the Leading Dental Ceters of the World limiting his practice to restorative, implant and prosthetic dentistry.

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ARTICLES PUBLISHED BY THIS AUTHOR

The ideal situation for a clinician to bond bonding ceramic veneers is to bond them all on enamel. This, however, is not always the case and one often comes across Class V lesions or dentinal areas that need to be covered or bonded onto. This could be necessary for reasons of aesthetics, function, preservation of the tooth or a combination of these. 3 cases are here presented to suggest different modalities that one can employ to facilitate such coverage. The author would like to thank MDT Lamberto Villani for the ceramic work in these cases.
It has been now an established entity for more then two decades since No Preparation Ceramic Veneers are being used. The very ideology of preserving enamel, and bonding to it, is in order to have minimally invasive restorations and also to have the best possible bond to the tooth tissue. The cases where this is genuinely possible have to be carefully selected. Teeth which require addition or have gaps are the ones that benefit from these techniques. Teeth which are rather discolored and need compensatory reduction cannot benifit from these, unless adequate and effective bleaching of the teeth is carried out. The ideology entails the addition of ceramic, irrespective of brand or type, of up to 0.5 mm. There has been a lot stated and more so for reasons of marketing where the term No Prep has been glorified. It has also been suggested that these are reversible which, in the true sense, is debatable. There is however no doubt that the objective of having indirect ceramic veneers bonded to enamel should be the goal of every clinician. There are 3 cases being presented to show what is it that can be achieved by minimal invasive veneers. A set of guidelines and protocols are suggested as well. The first one presents a No Preparation Case which the author suggests is lasting well after a 3 year follow up, but it is advised that Minimal Alteration of the tooth tissues is a better alternative in order to have ease of fabrication, cementation and long term stability. The laboratory part of the 3 cases was performed by Lamberto Villani, Oral Design, Dubai. Protocols and Guidelines: 1) Teeth should be in the right position 2) Teeth should not have severe inter-proximal undercuts 3) The shade should be close to what the patient wants. If you want to lighten them or increase value, bleach beforehand 4) The shape of the teeth should be more squarish and not very triangular 5) In case of recessions, if you want to perform root coverage, this design may be very difficult to implement due to undercuts in the root area 6) Use of translucent or clear cement gives most predictable results Advantages: 1) Tooth tissue preservation 2) The best bond you can get, as it is bonded to enamel 3) No post operative sensitivity 4) Most of the times no need for temporization 5) No need for anesthetic to cement 6) Greater patient satisfaction: the WOW factor Disadvantages: 1) This is not a method used for extreme corrections of crowding 2) Cannot be used if there are deep interproximal undercuts 3) One cannot change the colour tremendously, remember we need 0.2 mm of ceramic for every shade change 4) Difficult to cement. 5) Are more expensive to produce, so add to the treatment cost
The rationale of having minimal preparation and having ceramic veneers cemented to enamel in order for the most predicable bonding is well documented. It is also seen that still a lot of practitioners world wide prepare the tooth with the tooth as the starting point. There is a significant benefit in bleaching which one must not ignore as well. The fundamentals of minimal and step by step tooth preparation are highlighted keeping in mind the preservation of the tooth tissues is presented following contemporary protocols into consideration.
It is a know entity that bulimia nervosa can cause quite a rapid deterioration of tooth tissues. This is also happening as we see in the modern world, as a sort of an epidemy, due to the amount of acid to which teeth are exposed. This is due to high consumption of fizzy beverages containing acids, high sugar content drinks like fruit juices and also individuals with very frequent consumption of low pH food like chewing and sucking on lemons. Quite often, dentists are the first health professionals to recognize the effects of bulimia nervosa. The teeth become thin, chipped, weak, fragile and sensitive. It affects the well being and self esteem of an individual. In severe cases, full-coverage crowns may be the only option. But if detected earlier they can be treated more conservatively. AN ADHESIVE APPROACH As an alternative to preparing and placing full coverage crowns, one can place facial and palatal veneers as a conservative approach. This enables a clinician to preserve a fair bit of interproximal and incisal tooth tissue which is the goal in today's world of conservative dentistry.

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