Porcelain veneers are thin, custom made dental restorations that resemble your natural teeth. They are cemented to the labial (facial) surface of your teeth to hide issues such as discoloration, gaps, misalignment and misshapen teeth. Veneers can be used in lieu of orthodontics or more invasive restorations like crowns to restore a smile to its natural beauty. Advancements in cosmetic dentistry have allowed for better color matching, more natural emergence profiles, and better long-term retention of porcelain veneers.
A good candidate for veneers should present with a need to transform their smile that cannot be met with less invasive treatment in the time allotted. Permanent alteration of existing tooth structure is often required to accommodate veneers, and this is why the decision should not be taken lightly. Cosmetic dentists often exercise extreme caution in case selection to ensure the final outcome will meet the patient’s aesthetic goals in the long term. Some examples of issues that might exclude a patient from treatment include:
• Missing/loose teeth
• Severely rotated teeth
• Severe decay
• Pre-existing oral conditions
Many of these issues can be resolved and the patient re-evaluated for veneers after treatment is complete.
Porcelain veneers cost approximately $1,500 per tooth. They are not covered by insurance and are often financed instead. Due to the enormous expense, some patients may opt to first pursue alternative treatments. These may include:
• Teeth whitening
• Tooth bonding
• Orthodontic Braces
• Removable cosmetic appliances (ie. Snap-on Smile)
Proper tooth reduction in preparation for dental veneers is essential for minimizing healthy tooth structure loss, promoting optimal veneer adhesion and achieving excellent aesthetics. Several factors must be considered in determining the extent of enamel removal such as the thickness of the restorations, emergence profile of the tooth, and the patient’s aesthetic goals. Failure to address each of these areas often results in unsatisfactory treatment outcomes, including veneers that fall off prematurely or a “bulky,” chicklet-like smile. Even relatively minor problems such as staining along the gingival margin can leave patients dissatisfied.
How Does the Process Begin?
The first step in the preparation process begins with an assessment by a cosmetic dentist. The dentist will be able to evaluate the patient’s problem areas and determine whether veneers are appropriate. Beyond some of the obvious considerations mentioned above, a history of certain oral conditions like bruxism may rule out veneers. Furthermore, it may be determined that porcelain restorations are unnecessary. A tooth whitening session or simple composite bonding may be sufficient to address aesthetic concerns. A qualified cosmetic dentist will be very careful with case selection to ensure satisfactory results.
Tooth Enamel Removal
A few millimeters of the hard, outer covering of your tooth known as the enamel will need to be removed before veneers can be installed. The cosmetic dentist will carefully reshape the labial (facial), incisal (biting edge), and interproximal (between teeth) portions of the tooth to make room for the veneers. Enamel reduction along the gingival margin (gum line) will also be required.
This initial sequence of steps will result in a depth groove on the tooth that the dentist will use to finish preparing the labial surface while preserving enamel. The depth of these channels will depend on the thickness requirements of the veneers as well as the translucency desired.
Is Tooth Reduction Painful?
The patient should experience very little if any pain during the preparation process. If the extent of enamel removal is sufficient, the patient may be given anesthesia. Some post-operative tooth sensitivity should be expected that will diminish once the permanent veneers are cemented and some time is allowed to lapse.
Once the teeth are prepared, the cosmetic dentist will take an impression of the teeth for the permanent veneers (and temporaries if applicable). This impression will be sent to a dental lab for fabrication of the veneers. The dentist should first prepare the gingival margin using a retraction cord, which will help ensure that the impression captures subgingival areas of the tooth such that the veneer integrates nicely with the gum line. An identical technique is used when preparing teeth for dental crowns.
The exposed tooth structure remaining after preparation may require temporary veneers. The dentist will fabricate these temporaries in-office based on a mold taken earlier in the appointment. The temporaries will not mimic the aesthetic quality of the permanent veneers and will only need to be worn for a few weeks (depending on how quickly the veneers return from the lab). During the patient’s delivery appointment, the temporary veneers will be removed by making a single groove (of appropriate depth as to not remove further tooth structure) in the center of the labial surface. The temporaries can then be pried off. Once all the provisionals have been removed, the teeth are polished in preparation for the cementation process.
The cosmetic dentist can begin installing your veneers once they have returned from the lab. The painstaking part of the process has already been completed in the preparation phase.
A test fitting is first conducted to ensure that the veneers have been made to specification. The dentist will now bond the veneers in place using a special cement. A tint may need to be mixed with the bonding cement to achieve superior color matching. Once the veneers are in place, the cement is cured using a special light and excess bonding agent is carefully removed around the margins.
The life longevity of dental veneers can vary greatly as a function of several factors. In general, porcelain veneers can last ten years or more. Composite veneers can last three years or more.
What is Veneer Failure?
Porcelain veneer failure can occur in a number of ways. These include veneers that have:
• Fallen off
• Become fractured
• Sustained surface wear
• Been ground down
These issues often necessitate complete replacement of the veneers. This process is expensive and requires another round of tooth structure removal.
Composite or Porcelain?
Porcelain veneers tend to outperform composite veneers in terms of lifespan. Composite veneers are expected to last no more than a few years. If the tooth bonding is confined to a small area, then it could be expected that the lifespan might be more acceptable. A cost-benefit analysis is in order when deciding between the two. If you have a minor deformity like a tooth chip without additional issues, then composite might be optimal. Composite veneers stain but have the advantage of being easily and inexpensively repaired when damaged.
Do You Clench your Teeth?
Untreated bruxism can severely impair the lifespan of dental restorations. Bruxism is characterized by the clenching and grinding of the teeth at night. Your dentist should be able to alert you to outward signs of the condition (ie. incisal wear) and prescribe you a mouthguard.
Gum disease or its precursor gingivitis can present problems in successful long-term treatment with veneers. These conditions can cause a retraction of the gums, exposing the edge of the veneers creating an unsightly outline effect. In a progressed state, gum disease can even weaken the structural integrity of teeth. Regular dental check-ups will help ward off these issues and treat them such that your veneers remain intact.
Making prudent dietary choices can make your investment in dental veneers go a long way. As a general rule of good oral hygiene, avoid constant consumption of sugary foods to avoid attracting cavity-causing bacteria. Although porcelain itself does not decay, the prepared tooth structure underneath the restoration does. Hard foods should also be consumed with caution as they can place excess strain on the veneers.
Tooth discoloration is one of the factors that drive people to get veneers in the first place. However, they are not a free ticket to excess coffee and wine consumption. Your untreated teeth can still stain, making the veneers look out of place and thus requiring more rapid replacement. If excess bonding cement was left on the incisal areas (edges) of the treated teeth, it can become discolored compromising the aesthetic appeal of the veneers. This should not be a concern if proper installation was undertaken but a precaution worth noting.
Visits with Your Dental Professional
Having your teeth examined by a general dentist every six months will help ensure ongoing satisfaction with your veneers. Brushing and flossing is not enough for removing all plaque deposits. Furthermore, plaque is constantly accumulating in interproximal areas which are difficult to reach. Maintaining a plaque-free environment prevents decay and gum disease.