Is Porcelain Veneers Dentistry Right for You?

1. Introduction

There are certain cases that are more appropriate for veneers over other types of restorations such as full crowns or composite bonding. These cases generally involve teeth that have intact enamel surfaces but are discolored, malpositioned, or fractured. Other relative indications for veneers include closing diastemas or spaces between teeth, providing a more aesthetic and functional result than composite bonding, and in cases where tooth whitening alone is not a satisfactory long-term solution. Although veneers can be fabricated from a composite resin, the superior aesthetic results that can be achieved with porcelain make them the material of choice.

Porcelain veneers are one option in cosmetic dentistry to improve the aesthetics of the teeth. A veneer is a thin shell of porcelain that is bonded to the tooth surface. There are two types of porcelain that are commonly used to fabricate a veneer, which are feldspathic porcelain and pressed ceramic. Aesthetic results can be provided in a relatively short time, with a minimally invasive procedure. These attributes have made veneers a popular choice for patients seeking the best aesthetic results.

1.1 What are porcelain veneers?

The process begins with the patient initiating the idea that they would like to have a more cosmetic smile. The patient should have a clear objective in mind of what it is they would like and go over this with their dentist. At this point, the dentist will formulate a treatment plan. The treatment plan is a step-by-step list of procedures that will occur beginning with the first dental visit and ending with the completion of the patient’s smile.

At this point, the dentist and possibly even the dental laboratory will need to examine the patient’s case and decide whether or not the placement of veneers is best solution in achieving this goal. In the event that another treatment is agreed to better suit the patient’s desire, the process can be stopped here and the actual treatment may never be initiated. Assuming that porcelain veneers is the treatment of choice, the dentist must then figure out the number of teeth involved. Many people only desire to improve the appearance of the teeth that are exposed when they smile. A generalized rule for most is six to eight teeth.

Porcelain is a tooth-colored material that is used to cover the front surface of teeth. The veneer is a covering or shell that is very thin, usually less than 1.5 mm. The benefit of porcelain veneers is that porcelain possesses light reflecting properties not unlike that of natural teeth. Porcelain has translucence (this is due to the fact that it is a ceramic material) which can help make it look as if the veneer is your natural tooth. Veneers can be used to change the shape and color of teeth.

In some cases, when the underlying problem is too much misalignment or tooth discoloration, braces or tooth whitening may be a more appropriate solution. Many dentists consider teeth that are in many cases severely misaligned to be better suited for orthodontics. Though moderate irregularities can be camouflaged with veneers which are generally easier and quicker to complete. Overall, the ideal candidate for veneers is someone who is already satisfied with the shape and alignment of his or her teeth, but is looking to improve the cosmetic appearance of their smile.

1.2 Benefits of porcelain veneers

Color: A great deal of teeth fall into the unfortunate category of end of the line teeth. Over the years dentitions wear out as a result of the bite, diet, or trauma. Root canaled teeth are grey, and silver fillings cast a shadow on a tooth’s overall appearance. Some of the worst discolorations occur as a result drug induced tetracycline stains. It is difficult to think of another method which has such a dramatic impact on esthetics as veneers. They can totally change the color and shade of a tooth, which is something never achieved with a full crown. Meticulous planning with a skilled dentist can produce a new brilliant color, thus dramatically improving the patient’s self-image.

Benefit from a natural, healthful look: In general, the sole trait that can endure the pure wear and tear of 24 hours a day, seven days a week consumption is a full crown. As strong as crowns may be, the much more dental structure is removed, the less favorable the long term prognosis. Ultimately a full crown can be a solution sometime in your lifetime. For the meantime, 10-20-30 years, the amount of dentistry achievable = amount of dental disease + trauma. Material life expectancy and wear rate is factored into the equation.

Porcelain (and facings) the super material of the future has an amazing wear rate and endurance unmatched by any other material be it metal/porcelain, gold, amalgam, composite, or any other substance. The natural look of a healthy tooth is the result. Stains do not readily sink into porcelain and huge advances have taken place in the ability to bond porcelain to enamel. The more conservative a restoration, the better the long term prospects. Veneers are ultra conservative in the fact that a minimal amount of tooth structure is removed. Bonding is virtually a reversible procedure. In today’s world the future is never certain and retaining the greatest amount of healthy, natural tooth structure should always be the top priority.

1.3 Considerations before getting porcelain veneers

Finally, the expense of porcelain veneers is not possible for everyone. Since veneers are generally not covered by insurance, the cost must come out-of-pocket. Usually, the price is a high one. If you decide that veneers are right for you, be sure to shop around for a competent dentist who may be able to do them for a lower price. But remember that to find a good dentist to do the veneers at a lower price may be worth it to save in the long run.

Colour is also a consideration. If you are getting only a few veneers, then you may want to have your natural teeth whitened to match the colour of the veneers. On the other hand, if you are getting a number of veneers, you may want to have all of your teeth whitened to provide an overall whiter smile. The dentist can only whiten the colour of your natural teeth to match the colour of the veneers. If you decide in the future to get your teeth whitened, you will have to do so to the colour of the veneers.

Given the permanent nature of laminates, it is usually not a good idea to place them in situations where the patient’s bite is not normal. For example, a person with a severe overbite or a person who tends to clench or grind his or her teeth may not be good candidates for porcelain veneers. This is because the veneers can chip or break under pressure. The dentist must take a look at the bite and determine whether or not this is a good idea for the patient.

2. Candidacy for porcelain veneers

2.1 Dental conditions suitable for porcelain veneers – Candidates should have generally good oral health. Those with conditions such as gum disease or active decay are poor candidates since these problems first need to be addressed before veneer placement. In the case of active decay, it may be possible for a candidate to first receive appropriate treatment following which they may become suitable candidates. Individuals with a habit of clenching or grinding their teeth are poor candidates unless the habit can be resolved.

Such a habit can cause the veneers to chip or break and addressing this issue usually requires treatment with a plastic teeth grinder or use of a stress reduction method. A small number of adults with healthy teeth have experienced inadequate tooth position or tooth wear which has compromised their bite and appearance. These individuals may have had orthodontic treatment in the past but experienced relapse, or they never chose orthodontics. Such cases are usually quite suitable for veneers and this can be a valuable resource for the patient to discuss before committing to veneer treatment.

Good candidates for porcelain veneers receive the greatest rewards. These individuals are seeking a long-term option for a more attractive smile. Since veneers are an aesthetic solution, candidates should have generally good oral health as well as habits that promote a healthy mouth. For the few who do not make good candidates, alternative treatments can be the solution.

2.1 Dental conditions suitable for porcelain veneers

Tooth decay weakens the teeth, and this may not be the best cosmetic solution by covering the entire front surface of the tooth. They are more prone to decay. Veneers are not a good option for individuals with unhealthy teeth (for example, those with cavities or active gum disease), weakened teeth (as a result of decay, fracture, large dental fillings), or for those who have an inadequate amount of existing enamel on the tooth surface. Individuals who clench or grind their teeth are poor candidates for porcelain veneers, as this can cause the veneers to chip or break off. Lastly, this procedure is not reversible. Because a little enamel is removed to accommodate the shell, a patient will have to wear some type of dental restoration at all times. In some cases, removal of the enamel may also expose the inner pulp of the tooth, causing irritation and extreme discomfort.

2.2 Factors that may affect candidacy

It is possible for us to do the treatment at a sooner rate, however this will be in sacrificing the time it takes to construct the best possible veneer that is tailored specifically for you. These are known as ‘direct veneers’ and can often be made in just one session. The choice between a quick result and a better looking veneer must be made by you. This too will affect the cost of the treatment and it is important to consult your dentist in regard to your situation.”

The next step of the treatment is to make an impression of the tooth and surrounding teeth to send to the lab. You will decide if the veneer is to be made from porcelain or resin and the advantages of both will be discussed in a later session. An interpretation as to the result of the veneer will often be made by your dentist at this point. This may involve the use of computer imaging to enhance the final result of the case. The time taken for the lab to construct the veneer can be between 2-4 weeks.

“The success of the treatment will depend largely on the difference between your original tooth color and the color you desire. Keep in mind that the thinner a layer of the porcelain is, the more it will look like your normal tooth. If you are attaching the veneers to whiten the teeth, the difference will not have to be significant. Porcelain veneers are best suited for patients who want to make slight position alterations or change tooth shape, size and/or color.

3. The porcelain veneers procedure

The diagnostic wax-up This is an important step if you are extremely particular or unsure about exactly what you will be gaining from porcelain veneer treatment. The ceramist can create a mock-up of the desired end result for you to “trial” in your mouth to give you some insight into the finished product before we even touch your teeth. This is a reversible, cost-effective way to know exactly what you’re getting.

We will spend time discussing the shape, length, type, and color of veneers that would suit your smile best. Once we get an idea we are both happy with, we will then articulate this to the ceramist using study models, photos, and precise instructions.

Initial consultation and treatment planning Your involvement is critical in this step. Try to be specific about what you like or dislike about your smile. As high impact as possible, photographs of your smile will be obtained for use in the planning and designing of your case.

3.1 Initial consultation and treatment planning

An essential part of the process before deciding to have a porcelain veneer fitted is to have a full consultation with the cosmetic dentist. It is important for you to express what it is that you want and do not like about your smile. During this visit, the dentist will explain the procedure and what the veneer will do for your tooth. He will inform you of its limitations and the risk factors. Finally, the dentist may take x-rays and possibly make impressions of your mouth and teeth. The other type of diagnostic preparation involves a “mock-up”. This is a process where the dentist actually creates a model of your teeth how you would like them to be. The dentist may take impressions of this and possibly take some photographs of your teeth to help him plan the case. This is a rare procedure and usually is only used in situations where the dentist is unsure as to whether the veneer will do what the patient desires.

3.2 Tooth preparation and temporary veneers

The teeth are prepared for the veneers by lightly buffing the front surface to about half a millimeter in order to allow for the added thickness of the veneer. A mold is taken of the teeth, which is sent to the laboratory for the fabrication of the veneers. This process usually takes about one to two weeks. Temporary veneers can be placed for very unsightly teeth. (Please notice that not all dentists will offer temporary veneers). A temporary veneer is a prototype of the final veneer. It is placed in the mouth to allow while the final permanent veneer is being fabricated. Temporary veneers are not strongly bonded, and are designed to be easily removed at your next appointment.

Temporary veneers will not be as resistant to chipping or staining as the permanent veneers. The recent evolution of minimally intrusive techniques has made the use of no-prep veneers and minimal prep veneers more popular. The quality and strength of these types of veneers have improved dramatically. It can be expected that soon, these types of veneers will account for between 70% – 80% of all veneer cases. This depends on the relevant ability to predict the final aesthetic result using the no-prep technique. For now, the best advice is to seek a professional consultation with a qualified cosmetic dental practitioner. He or she will be able to advise whether a particular type of veneer can give you the result that you desire.

3.3 Final veneer placement and adjustments

The insignificance of this stage of the procedure seems to make it the most poorly understood. Recent research has demonstrated that a comfortable fit at the time the veneers are bonded is essential in enhancing long-term success. An ultra-conservative cutting of the enamel, which would remove approximately 0.3 mm or less, is associated with a higher risk of bond failure, debonding, discoloration, cusp fracture, and the development of cracks. These problems will ultimately result in restoration failure and re-intervention with the need for more tooth reduction.

Once the veneers are made, try-in is achieved using a variety of try-in paste or glycerine insertion technique. Glycerine achieves an authentic try-in due to its refractive index being similar to water; the latter method will only provide a color match. The tooth is then cleaned a final time and the veneers are bonded using a high strength cement that will provide a tight marginal seal to prevent microleakage. Excess cement is removed and the veneers are adjusted with the use of fine and ultra-fine diamond burs. Any adjustments made in the mouth are an addendum to those made on the study casts.

An increase in chair time devoted to adjusting the occlusal and proximal surface of the veneer with a 30 micrometer particle size diamond bur has been shown to increase the strength of the restoration. High heat and pressure during firing of the crystallized layer will give the veneers a crystalline microstructure and 50% translucency similar to enamel, with a flexural strength measurement of 110-115 MPa. Due to the minimal invasiveness and high aesthetic results, porcelain veneers have become an important procedure in conservative cosmetic dentistry. With correct case selection and the use of well-developed techniques and materials, it can provide an exceedingly predictable and satisfying long-term results.

3.4 Post-treatment care and maintenance

After your teeth have been prepared and your porcelain veneers have been placed, you will need to return to your dentist for a follow-up visit. This appointment is vital to your oral health. It gives your dentist the opportunity to evaluate the placement of the porcelain veneers. To enhance the longevity of your restorations and the health of your gums, it is important to keep regular dental appointments and cleanings. Usually it takes a few weeks to get used to the porcelain veneers. During this time, if you feel that the veneers are protruding when you floss, you may trim the areas with a single-sided razor blade.

Use the blade to smooth the veneer edge until it feels right. Then resume flossing as usual. This will not harm the veneer. Any adjustments to the veneer made after a few weeks will usually require polishing and ultrasonic etching to achieve the same smooth surface. The placement of your porcelain veneers is finished! Now the real test begins.

Can you make them last 10-15 years? The decision is up to you. How you care for them will ultimately determine how long they last. It is no longer possible to get cavities in the teeth that have been treated with porcelain veneers, but it is still possible to damage the veneer or get cavities in the teeth that have not been treated. These teeth should be maintained just like any other teeth in your mouth. This includes regular flossing, brushing, and dental check-ups. It is also important to chip out any unbalanced bites in treated teeth. An unbalanced bite can cause the veneers to fracture or cause the teeth to which the veneers are attached to become stressed.

4. Alternatives to porcelain veneers

Instead of getting porcelain veneers, one of the alternative methods you could use is dental bonding. This is a procedure where the dentist applies a resin to your teeth and then hardens it using UV light. The dentist then trims, shapes, and polishes the resin so that it blends in with your other teeth. This is a cheaper alternative to porcelain veneers. The benefits of dental bonding are that the healthy part of the tooth enamel can be maintained and it is relatively painless.

However, the resin can become stained after a period of time and may need repairing. Also, dental bonding does not last as long as porcelain veneers. Another alternative to getting veneers is dental crowns. This is a tooth-shaped cap that is placed over a tooth. Crowns can be made out of metal, ceramics, resin, porcelain, or a combination of any of these materials. They are used to restore the shape and size of the original tooth and also to provide strength and resilience. Crowns will last longer than porcelain veneers; however, it is a more destructive method as more of the original tooth structure will need to be removed.

Crowns are generally more expensive than veneers, and if you are looking to cover up discolored teeth, it is advised to use a different method as the color may be slightly darker. Lastly, orthodontic treatments are a great alternative to getting veneers. Methods such as braces and retainers can help improve the position of crowded or overlapping teeth and also help align the teeth into the correct position. This will maintain the natural tooth structure, and after treatment, you will not be at risk of damaged veneers or teeth. Although orthodontic treatments are an effective long-term investment, it is a slower process compared to veneers and often more costly.

4.1 Dental bonding as an alternative

Next, the advantages and disadvantages of dental bonding in comparison to dental porcelain veneers. Bonding advantages include cost, as the use of bonding as an alternative will cost less than veneers. Although the cost will vary depending on how much work needs to be done and the location of the procedure since different procedures have different costs and living costs differ as well.

Bonding also requires little to no enamel removal. Bonding disadvantages include that it is not as strong as porcelain and is more susceptible to chipping and staining. Although both bonding and veneers are prone to staining if good oral hygiene is not maintained. Maintenance with bonding is required more often, usually after three to four years from the initial procedure. Bonding also does not last as long as veneers normally last from four to eight years. This requires the bonding procedure to be done again until eventually veneers or a different procedure are used.

Dental bonding involves adhering composite resin material that is matched to the colour of the tooth, to the front of the tooth. This is done to restore damaged, broken or discoloured teeth. Unlike veneers, dental bonding can be done in one visit to the dentist office. The application of dental bonding is a very straightforward procedure and is often painless. On arrival, the dentist will isolate the tooth and use a conditioning gel to prepare the surface of the tooth to help the bonding material adhere. The resin is then applied, moulded and smoothed to the desired shape. A laser or ultraviolet light is then used to harden the material. After the material is set, the dentist will trim and shape the material before polishing the resin to a high gloss finish. The enamel is minimally affected, which is very beneficial. Bonding may not last as long as veneers, but with good care, it can last several years.

4.2 Dental crowns as an alternative

As an alternative for orthodontic patients, porcelain crowns can be used to “change” the shape of a tooth. Often the shape, angle, and position of these teeth will not allow for placement of a crown or veneer on their surface allowing the only change to be orthodontic in nature. In these situations altering the vertical dimension of the tooth will allow for its proper alignment and manipulation. This can frequently be accomplished in one appointment. The results can and should be very conservative with treatment usually limited to the removal of 2mm or less of tooth structure.

Porcelain crowns are an excellent alternative to porcelain veneers for many patients. If you have a bite that has worn down the cusps of your teeth, a crown can rebuild the tooth to its original shape and prevent further wear. Crowns are indicated for teeth that have large defective fillings, teeth that have undergone root canal treatment, or have fracture lines. It is for these reasons that crowns are a more durable treatment option than veneers. When veneers are placed on teeth with many of the above conditions, it can frequently lead to their failure.

4.3 Orthodontic treatments as an alternative

This should always be considered as an alternative to altering the position and shape of teeth by grinding them away to make way for the veneers. It is ideal for younger patients with healthy teeth and those who do not want to undertake the long-term maintenance associated with veneers. The treatment usually takes approximately 6-18 months and can also help with jaw alignment and the function of teeth. There are different options for orthodontic treatment available with new technologies making them more discrete and less noticeable to wear.

Invisalign is a system of clear aligners that are worn and changed every 2 weeks to gradually move the teeth into a more aligned position. Lingual braces are similar to traditional metal fixed braces but are placed on the back of teeth so they are not visible. These are now available in a modern design using smaller metal brackets to reduce discomfort and treatment time. The traditional methods are still considered to be the most effective at moving teeth and results can often be achieved quicker than with other methods.

5 Conclusion

It is absolutely crucial that before a patient takes the leap into getting porcelain veneers, he/she has weighed all of the pros and cons against alternate choices. The help of a trusted dentist can make this decision significantly easier. Unfortunately, once teeth have been prepared for veneers, there is no turning back. The process is irreversible. Post-preparation, a patient may experience a degree of discomfort or sensitivity, but this isn’t expected to last very long. If a patient is unhappy with a veneered tooth, options are still available. Usually, the surface of the veneer can be etched to improve the bond of the new veneer. Though pricey and not always covered by insurance, veneers are a very plausible way to achieving the smile that you’ve always wanted.

In conclusion, porcelain veneers may be right for you if you have permanently stained or discolored teeth, malpositioned teeth, teeth with spaces between them, or teeth that are chipped or broken. Porcelain veneers can greatly improve your smile as well as improve your self-esteem. In comparison to bleaching and bonding, the color of a porcelain veneer is highly customizable. Veneers are more resistant to staining from coffee, tea, or smoking. Bonding is susceptible to staining and will have to be redone numerous times. Veneers are also very adaptable in that they can be used to straighten, close, widen, or lengthen teeth. However, this is just one option of many in correcting these various conditions. 

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