1. Introduction
The use of porcelain veneers is not a reversible treatment. This is because the process involves removing some enamel from the tooth surface, thus requiring a veneer for protection. It should also be noted that veneers cannot be repaired, and so any fracture requires a new veneer. Care of a patient with veneers involves maintenance of good oral hygiene around the margin of the veneer, especially in patients with a high caries risk. Failure usually occurs when the veneer becomes debonded due to inadequate tooth preparation or patient factors.
Purpose of porcelain veneers: The primary purpose of a veneer is to improve the aesthetics of a tooth or several teeth. It is rare for a veneer to be placed for a functional reason. The most common functional cause is a lost incisal edge. This allows for a relatively straightforward restoration. The primary aesthetic cause is discoloration or staining. This can be as a result of intrinsic factors such as fluorosis or tetracycline staining or extrinsic factors such as diet and lifestyle. Veneers can be used to improve the shape of a tooth, especially when it is out of alignment with the rest. Other indications include closing diastemas, i.e., small gaps between the teeth, mending broken teeth, and improving the “toothiness” of an old crown.
Definition of porcelain veneers: Veneer is defined as a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth or to protect a damaged tooth surface. Porcelain is a ceramic material that is baked in a furnace. It is a material in which a high proportion of the glass phase produces an enamel-like surface. The term “porcelain veneer” often is used to refer to any veneer type. The pure porcelain veneer is widely considered the most successful in terms of aesthetics since it is the most translucent.
1.1. Definition of Porcelain Veneers
Veneer term comes from a Latin word which refers to ‘cover’ or ‘thin layer’. Porcelain veneers were first introduced by Dr. Charles Pincus in the late 1920s and then reestablished by a dentist in California, Dr. Richard Simons, in early 1982 until now. All of them came up with the idea of giving an aesthetic look to the smile of the patient. He established a method where he can apply veneers temporarily on the teeth of actors and actresses to give an instant change in their smile through his treatment, ‘Smile Design’. Later in 1982, he started using porcelain veneers. According to the American Academy of Cosmetic Dentistry (AACD), the veneer is a thin layer of restorative material usually bonded on the surface of natural teeth with the purpose of providing a change in color, size, and shape of the teeth, thus improving the appearance. Mainly there are two types of material used for making a veneer.
The first type is direct, which is made from composite, and the second is indirect veneer generally constructed at a dental laboratory and then later given to the patient. Usually, porcelain veneers are referred to as indirect veneers and composite to direct ones. Porcelain veneer is more accepted due to its long-lasting and more reliable nature of the material. Coming on to the porcelain veneers, the various types of porcelain material used for constructing veneers were porcelain (feldspathic porcelain), glass porcelain, and sintered. These materials were used at one time or another and are now outdated. Due to this, they were having some of the rejection and failure rates. In earlier days, the porcelain veneers were prepared with the thinking of concealing the underlying discolored or malpositioned teeth, which were used for aesthetic purposes only.
1.2. Purpose of Porcelain Veneers
The patient with cosmetic dentistry problems seeks the purpose of porcelain veneers for the smile makeover. If the teeth are discoloured, malpositioned, chipped, have space between them, or the patient is unhappy with the existing composite resin, the porcelain veneer is the ideal thing. A porcelain veneer does not, what a crown does. Crowns cover the whole tooth and are not just a cosmetic procedure. A porcelain veneer is more conservative and still has a dramatic effect on a person’s smile. The dentist must understand what the desired end result is and most importantly the patient shade change. This can be determined by getting the patient to provide photos of smiles they like and do not like. Also the dentist can provide the patient with photos of the expected treatment changes to ensure they are aware of what is being done and get the desired result.
On the initial appointment the dentist must listen to the patient to ensure they get an understanding of what is needed. An important thing with porcelain veneers is the dentist must stop any active gum disease or decay before starting treatment as it does affect the end results. If the patient has any cosmetic concerns it is usually addressed with no-prep veneers, minimal prep veneers, or traditional veneers. A traditional porcelain veneer has 0.5mm to 0.75mm thickness of porcelain and are a for malady that more intrusive to the tooth, the no-preps and minimal preps are recommended for teeth that have small rotations or discolorations, they involve less reduction of the tooth surface and are made of ultra thin porcelain.
2. Candidates for Porcelain Veneers
Porcelain veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooth’s color, size, or shape. Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline and damage due to an injury or as a result of a root-canal procedure. They are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers. Typically, veneers will last for many years, and the technique has shown remarkable longevity when properly performed.
Porcelain dental veneers are thin shells of medical-grade ceramic that are attached to the front surfaces of teeth for an immediate smile transformation. Individually crafted for each patient, these cosmetic enhancements are made from advanced material that closely resembles the appearance of natural dental enamel. Dentists can use veneers for an impressive number of cosmetic changes, ranging from teeth whitening to orthodontic adjustments. Because of their lifelike appearance and the minimal amount of tooth preparation needed, veneers often are the treatment of choice for improving the appearance of the front teeth.
2.1. Individuals with Discolored Teeth
A key factor in assessing the success of porcelain veneers for an individual patient is case selection. Patients with veneers generally have one or more of the following presenting conditions, which detract from the appearance of their teeth. Often patients have teeth with a discolored appearance. This can be the result of root canal treatment, stains from tetracycline or other drugs, excessive fluoride or other causes; the result is single or multiple teeth that are unaesthetic in appearance. In other cases, patients may have teeth with an abnormal shape, contour, or malformation. This can be the result of genetic defects or environmental trauma to the teeth. It is also common for patients to have chipped teeth.
Pitting and grooves in the teeth can also detract from a healthy tooth appearance. All of these are indications that direct or indirect restoration is needed to return the teeth to a natural appearance. Erosion of the tooth structure from tooth grinding, acid reflux (wear on palatal surfaces), and dietary influence (i.e., sodas, sports drinks, citrus foods) can also alter tooth appearance and increase the amount of staining and discoloration. These conditions can affect large numbers of teeth and create a general need to restore the appearance of the teeth with some form of restoration. Veneers are well suited to restore the appearance of teeth. Veneer placements also have the advantage that only minimal tooth preparation is needed. Being a conservative restoration, minimal tooth movement is needed to return teeth to proper form and function with veneer placement.
2.2. Individuals with Chipped or Cracked Teeth
Individuals with chipped or cracked teeth can benefit from porcelain veneers. Porcelain is the perfect material for repairing chips or cracks. It has the same shine and translucency as natural tooth enamel, it wears at the same rate, and best of all, it will not decay. If the chip is small, a veneer can be placed over the front of the tooth to hide the chip. If the chip or crack is more extensive, and the tooth is in danger of damage or infection, a porcelain crown may be indicated. This is still a viable option if the damage is more severe. Crowns are similar to veneers, but they encase the whole tooth and are therefore more durable. Crowns usually involve removing more of the natural tooth, and are therefore more destructive to the natural tooth and should be replaced or updated as infrequently as possible.
If you are wanting to hide some of the imperfections in your mouth, ask your dentist if a partial or full set of crowns can be done in conjunction with upgrading your smile with veneers. One of the great advantages of tests involving restorations of front teeth is that it can be done as a trial, since the laboratory fabricated materials can be tried in the mouth before they are permanently set in place. A mock-up of a veneer or crown can be made in temporary materials at little cost to give a good idea of what the end product will look like. This can be easily modified or adjusted until it meets the patient’s satisfaction, and then duplicated in the permanent material. Compared with the total number of teeth in the mouth, the restoration of only a few front teeth is an inexpensive and very satisfying way to upgrade the smile.
2.3. Individuals with Misaligned Teeth
Porcelain veneers can effectively fill in the gaps between teeth better than bonding because of the porcelain’s strength and durability. The result is longer lasting, as the veneer becomes one solid piece of porcelain adhered to the tooth. This consequence of bonding has been shown to faithfully mimic the light handling and even translucency of dental enamel. When the veneers are placed on the teeth, it results in a smooth and attractive smile. Those with structural damage or large fillings in teeth that are strong enough to support and hold the veneer, as well as people with good oral and general health, are candidates for porcelain veneers. Similar to individuals who have had orthodontics but do not want to go through a second round of treatment, veneers can aesthetically adjust the position of teeth, making it a perfect alternative to braces. Better yet, those who believe their teeth have an unnatural alignment and unsymmetrical smile can greatly benefit from porcelain veneers. The shapes and positions of the veneers can be specifically fabricated to give these patients a new, attractive, and often confidence-boosting smile.
2.4. Individuals with Gaps between Teeth
For individuals who do not naturally have gaps between their teeth, it can be a problem. These people may see gaps as unsightly and embarrassing because they believe others think they have had teeth removed. This can lower self-esteem and confidence. In such cases, porcelain veneers can provide an instant solution to the problem of gaps between the front teeth. The physical structure and function of the back teeth are generally good in these cases. The treatment of choice would be direct bonding or orthodontics. However, if the patient only needs improvement in the front teeth, porcelain veneers can be a successful option. By repairing the front two teeth with porcelain veneers, the teeth can be made wider, closing the gap between them. The veneers can also be made in a lighter shade, giving the patient a mini smile makeover.
3. Benefits of Porcelain Veneers
Secondly, veneers can provide the patient with an even and symmetrical smile. This occurs when the veneer is used to improve imperfections on the surface of a tooth. Imperfections often do not affect the function of the tooth, but it makes the tooth look unattractive. The imperfections can be a result of wear and tear, genetic defects, damage, or root canal therapy. The veneers can hide the imperfections because they resemble the look of the natural tooth and they have a very polished and glassy appearance. Imperfections on the edge of the tooth can now be improved with new bonding techniques. Often, the veneer can be applied with very little tooth preparation. This contrasts greatly with a crown, which requires far more tooth reduction and is a more aggressive treatment to the tooth.
The most obvious advantage of veneers is a visually pleasing smile. This is achieved in two ways. Firstly, the color of a patient’s natural teeth can be improved with veneers. This is done when patients have discolored teeth. This can be a result of a root canal, stains from tetracycline or other drugs, excessive fluoride, and other causes. It can also be a result of large resin fillings that have discolored the tooth. Depending on the extent of the discoloration, the veneer can bond to the tooth with very little tooth preparation. This can be both an advantage and a disadvantage. It is an advantage because very little of the natural tooth is removed. It is a disadvantage if discoloration is severe since the end result might not be completely opaque. This might result in the discoloration showing through the veneer. Because the veneer is a progression of the discolored tooth, it is recommended that patients and dentists take a picture of the discoloration (preferably an x-ray of a resin filling and discolored area) and send it to the laboratory technician to assess whether or not the veneer will mask the discoloration.
The advantages of veneers are numerous. As a result, veneers are one of the most popular treatments in cosmetic dentistry. This section will generally explain some of the benefits of veneers, although it should be remembered that the benefits will vary from patient to patient.
3.1. Improved Aesthetics and Smile Confidence
Adhesive dentistry has progressed significantly in recent years and has given patients the chance to reinforce and lighten their teeth. Adhesive form of dentistry is a procedure where a tooth-colored ‘adhesive’ filling accomplished to a tooth can restore the functionality and esteem of a tooth. The adhesive filling is tightly connected to the tooth, and studies have shown that an adhesive filling will have up to 95% of the strength of a natural healthy tooth. The adhesive filling is not limited to repairing broken and decayed teeth, it also can change the color of a tooth. Gone are the days where amalgam fillings are the only option. A dark tooth with staining or discoloration can be notably improved simply by removing the old filling and replacing it with a tooth-colored adhesive filling.
Porcelain laminate veneers are amongst the most esthetic means of creating a more pleasing and beautiful smile. They require a much smaller amount of tooth reduction than crowns (caps) and therefore are a more conservative restoration. Porcelain laminate veneers allow us to alter tooth position, shape, size, and color to make slight position alterations, to closing spaces, to straightening, to lengthening, and to whiten. The porcelain veneer is highly resistant to permanent staining from coffee, tea, or smoking. This makes veneers a perfect choice for those who have discolored teeth. When teeth are chipped or beginning to wear, veneers can protect them from damage and restore their original looks. It was also shown in a previous article how important a smile is towards making a successful impression on someone. The dentist and the laboratory technician play a key role in the success of a smile design.
3.2. Enhanced Tooth Strength and Durability
Good oral hygiene and using the right dental treatment are crucial elements for maintaining the health of your teeth. But remineralization of a tooth back to its natural state is ideal. Once a tooth has been restored with composite, a crown, or a porcelain inlay/onlay, it is more likely to end up requiring additional dental work. Partial crowns, full crowns, and porcelain inlay/onlays have a much higher incidence of needing additional dental work compared to teeth that have never been restored. Teeth restored with gold inlay/onlays will require additional dental work 62% of the time, teeth restored with partial crowns 63% of the time, and teeth restored with full crowns 54% of the time. Teeth that have never been restored are statistically far less likely to require additional dental work. After approximately 7-8 years, the incidence of requiring additional dental work on a tooth that has never been restored drops to around 10% and stays low.
3.3. Minimally Invasive Procedure
This particular type of veneer is so thin and strong that in some cases, the treatment may not even require the dentist to grind down the tooth, thus preserving your natural tooth structure. If the teeth do need to be altered to place the veneers, the patient will not have to wait for the veneers to be made, as they will be fitted on the very same day. Local anesthetic can be given to the patient to make the experience as comfortable as possible and to reduce any pain, but it is relatively unnecessary as the procedure is usually pain free. Traditional veneers are much thicker, and thus more forceful in the way of grinding down the teeth and creating space within the mouth. Given the option, this type of veneer is preferable in most cases, as the procedure is faster and far more comfortable. The less intrusive the treatment, the less discomfort suffered by the patient and the greater the relief for those with dental phobia.
3.4. Long-lasting Results
The most satisfying reward for a job well done is that it lasts. After completing the porcelain veneer procedures, it is so exciting to see the looks on our clients’ faces when they realize their new smiles are going to be with them for a very long time. Although the endurance of veneers can be difficult to measure because it hasn’t been forty or fifty years since their inception, it’s safe to say it’s as good as it gets for the current time. The primary reason for such a believable statement lies within the fact that there will be much less decay occurring with these veneered teeth.
With the enamel being totally intact and veneers being 100% impervious to decay, your risk of suffering from cavities will decrease substantially. High success rates are often reported for veneer procedures and it’s not uncommon for your beautiful new smile to still be intact 20 years later. An added bonus for the preservation of porcelain veneers can be credited to the avoidance of bad habits. We often hear from clients that previously had issues with nail biting, opening objects with their teeth, etc. that they have entirely stopped these practices in order to maintain their great smiles. Whether consciously or subconsciously, the increased care for their teeth has gone a long way in oral health preservation.
4. Considerations and Limitations of Porcelain Veneers
A procedural report on direct and indirect porcelain veneers based on clinical experience. Indirect veneers are typically more cost-effective than crowns and orthodontics but can be quite costly. Patients should be educated on the life expectancy of their veneers so they can have an accurate understanding of future costs. In general, porcelain veneers are strong and highly resistant to fractures from normal use. An ongoing study over 10 years found a 92% survival rate for porcelain laminate veneers. “A clinical evaluation of survival and success of porcelain laminate veneers over 10 years.” This is a subjective analysis under controlled conditions.
Cosmetic dentistry, if utilized correctly, has the potential to dramatically shape a patient’s smile and increase confidence and self-esteem. While this holds true for various procedures in the field, costs and benefits are always a factor to be weighed. Compared to alternative procedures, direct and indirect (lab-fabricated) porcelain veneers may be the most cost-effective in the long and short term.
4.1. Cost and Financial Considerations
No matter how you spin it, porcelain veneers are costly. You should only begin researching the procedure if you are financially secure. If you are trying to invest money that isn’t there, you should consider dental bonding or saving up until you can afford the best treatment. This will be easier to say after reading about the irreversible nature of the procedure, but more on that later.
General dentists often tout porcelain veneers dentistry as the premier solution for people who want to improve the appearance of their smile. However, there is a strict criteria to be a good candidate. The bottom-line consideration is cost. Porcelain veneers are not a small investment. Most dental professionals charge between $1100 and $2000 per tooth. Any lower cost and you should start to question the quality of the work being done. At $1100 per tooth, a six-tooth case will be $6600, an investment that is large enough to require a significant amount of research. To get a better idea of what it might cost you, research cosmetic dentists in your area and request the cost of a six-tooth porcelain veneer case on the front teeth. Many dentists have payment plans. If the cost is too great, ask your dentist if he or she can offer a payment plan to complete the work. Many patients put aside a small amount of money each week until they are able to afford treatment.
4.2. Irreversible Nature of the Procedure
In more recent times, non-reversible adhesive has been used in the bonding process for veneers in an attempt to make them more durable. While this can be seen as a positive for people seeking a long-term solution for their teeth, it also means that further damage can be caused to the teeth if the veneer is removed for any reason at a later stage.
Enamel, a thin hard layer that acts as a shell for your teeth, does not grow back or regenerate. Without this layer of protection, teeth can become sensitive and discolored, something that can only be covered up by the veneer itself. The removal of enamel can also result in the exposure of the dentine in teeth, which can require further dental work. The nature of this irreversibility means that there is a possibility of veneers being required at all times in the future, depending on the age and maintenance of the patient.
The process of applying porcelain veneers is quite often irreversible. It involves the removal of a thin layer of enamel from the front of the teeth, a similar thickness to the veneer that is to be bonded.
4.3. Maintenance and Care of Porcelain Veneers
The noticeable advantage of veneers in the conservation of tooth tissue is at times it is possible to bond the veneer straight on to the existing enamel of the tooth, in turn preserving the need to prepare the tooth to a greater extent. Steps will be the same as usual, which begin with the wax up. Should it be the case that a veneer needs to be made bigger or straighter, a slight adjustment to the tooth surface may be needed. A fabricated guide for tooth preparation can be made from the wax up, from which only the necessary amount of tooth tissue can be removed. An improvement within dental technology is the option to prepare the tooth at a later date, having the temporary veneer stay in place for a couple of weeks after the first appointment.
Be watchful of habits that could risk fracturing your veneers, for example, opening packets with your teeth. In many instances, a front crown or cap would be more effective than a veneer, but every case is different and depends on the extent of conservation of tooth tissue.
Porcelain is a glass-like material and in contrast to our own enamel, it doesn’t ever darken. Because of this, it is crucial that your natural teeth are kept free from plaque, otherwise your own teeth will start to stain the place they meet the veneer. Take note that veneers can as well, as time goes on, start to take on a slight stain close to the gum line. If this develops, the staining can be easily eradicated with mild acid washes or some form of treatment on the back of a dentist’s smoothing strip. Recurrent habitual check-ups and cleanings can evade this from forming a difficulty. High-quality oral hygiene will keep teeth and gums in fine form.
Most frequently, porcelain veneers are unproblematic to control. In getting the best from your veneers, it’s most vital to maintain them in fine form. By ensuring so, you can amplify their life period and enjoy their remuneration.
5 conclusion
We should also remember that despite the great benefits offered by the veneers, it will make a smile that much better. The user should still be responsible in maintaining their dental hygiene, both of natural and veneered teeth. This is because veneers also have a limited lifespan, ranging from 5-10 years, before they must be replaced. Although the removal of veneers is possible, it is best to have them replaced. This is because during the removal, it was found that the amount of reduction done to the teeth prior to veneer installation was small, leaving the teeth hollow and not really good to look at. And also remember that despite veneers offering cures for various teeth problems, it is best to prevent them from happening. Veneers can be considered as a last solution to various teeth problems.
So, around the “porcelain veneers” topic, we come to the conclusion about the types of persons who can benefit the most from it. It is mentioned earlier that porcelain veneers are best applied to solve various cosmetic problems regarding teeth, for persons of various ages. It is said that persons who are in the show business will gain the most benefits from using veneers, as it will greatly help their appearances. An example is given from a singer who must look good when he/she is singing.
Persons with discolored, stained teeth and those with gaps or crooked teeth will also gain from using veneers, as they provide rapid orthodontics which can solve the crooked teeth problem quickly. And persons who have previously undergone root canal treatment will also gain from using veneers, as it will enshroud the discoloration caused by the treatment from inside the tooth, providing a better outlook to the teeth. Last but not least, it is for persons with psychological problems due to unsightly teeth appearances. Using veneers will make a lot of difference. And these types of persons are various, ranging from youths to old persons.
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