Porcelain Veneers

What are porcelain veneers?

Porcelain veneers are ultra-thin shells of ceramics, which are bonded to the front of teeth. This virtually painless procedure requires little or no anesthesia, and can be the ideal choice for improving the appearance of the front teeth. Becoming increasingly popular in the past 12 years, tens of thousands of porcelain veneers have been placed to mask discolorations, to brighten teeth, and to improve a smile. Highly resistant to permanent staining from coffee, tea, or even cigarette smoking, the wafer-thin porcelain veneers can achieve a tenacious bond to the tooth, resulting in an esthetically pleasing naturalness that is unsurpassed by other restorative options.

Why would you recommend a porcelain veneer?

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, by an injury, or as a result of a rootcanal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are misshaped, chipped, or worn may consider porcelain veneers.

Are they a substitute for braces?
Porcelain veneers are not "instant orthodontics," and in most instances, they are not a substitute for braces. Patients with very crooked teeth should consider braces first. However, patients with teeth that need minor movement may be suitable for porcelain veneers. The appearance of crowded front teeth can be corrected with porcelain veneers when the back teeth have a good bite.

Am I a candidate for porcelain veneers?

Patients must have fairly sound tooth structure. Those with periodontal disease or whose teeth are severely broken down, or have little or no enamel remaining are not ideal candidates for porcelain veneers  If you clench or grind your teeth, porcelain veneers can fracture on their edges, and clenchers or bruxers (grinders) should definitely wear a night guard while sleeping. Veneers might not last as long for these patients.

How long will they last?
One dentist reported a 93 percent success rate over 10 years. Generally, veneers will last for many years, and the technique has really shown remarkable longevity when properly performed. In some instances, a porcelain veneer may even last longer than a porcelain crown from an esthetic point of view. Porcelain veneers achieve virtually invisible edges next to the gums, and remain almost undetectable, even if the gums move. Crowns, on the other hand, may have to be replaced every few years because as the gums recede, a dark margin may become apparent, particularly in young patients.

What happens during the procedure?

Generally, patients need three appointments for the entire procedure: diagnosis and treatment planning, preparation, and bonding.

Diagnosis and treatment planning
It's critical that you take an active role in the smile design. Spend time in the decision-making and planning of the smile. Have more than one consultation if necessary to feel comfortable that your dentist understands your objectives. The consultation includes an evaluation of the present conditions, a visual examination, and sometimes X-rays. Some dentists take color photographs to show other patients or colleagues the "before-and-after" results of this procedure.

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Preparation of teeth
This appointment will take from one to two hours. To prepare the teeth for the porcelain veneers, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about a half a millimeter of the tooth is removed, which usually does not require a local anesthetic. At this appointment, a mould is taken of the teeth. Accompanied with a prescription and a detailed plan, the mold is sent to the laboratory for the fabrication of the veneers, which takes about one to two weeks. Because the teeth are buffed or reduced, they will look a little different until the next appointment when the veneers will be placed. If the teeth are too unaesthetic for the patient, a temporary veneer can be placed at an additional cost. However, since the time is generally short between the two appointments, many patients do not opt for a temporary. Until the next appointment, you should avoid extreme temperatures, as these teeth may be more sensitive than usual.

Bonding of veneers
This appointment will take about one to two hours. First, the dentist places the veneers with water or glycerine on the teeth to check their fit and to get a sense of the shade or color. While the veneers are resting on your teeth, view the esthetic results, and pay particular attention to the color. To help make your decision, look at your teeth from different positions, under different lighting, while sitting and standing. Ask for a full-face mirror, and examine your smile as part of your entire face. At this point, the color of the veneers can still be adjusted with the shade of the cement to be used. Make your decision carefully, because color cannot be altered after veneers are cemented. If the veneer must be removed after it is bonded, more of the tooth structure may be lost, and the second veneer may not bond as well as the first.

Once the final decision on color is made, the tooth is cleansed with specific chemicals to achieve a bond. A special cement is sandwiched between the veneer and tooth. Then a visible light beam initiates the release of a catalyst to harden the cement. Excess cement is removed.

How about maintenance?
For about a week or two, you will go through a period of adjustment as you get used to your "new" teeth that have been changed in size and shape. Follow normal hygiene procedures by brushing and flossing daily. At first, flossing may seem "tight" because of tiny amounts of excess cement that may remain. After one or two weeks, you may return for a follow-up appointment for minor adjustments of the veneers and additional cement removal, if necessary.

Be an informed consumer
Before choosing the dentist to place your porcelain veneers, request information about the dentist's experience. Before-and-after photographs of previous treatment will give you an idea of the dentist's esthetic skill. Ask your dentist about the laboratory technician's expertise with porcelain veneers. Other questions you might ask are: Is there any way to preview what I will look like? What if I don't like the results? What complications do you foresee?

Have realistic expectation
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Porcelain veneers are reasonable facsimiles of natural teeth, but there is no such thing as perfect with veneers. It's not uncommon to see slight variations in the color of porcelain veneers upon close inspection, as this occurs even in natural teeth. In many situations, this procedure can greatly enhance a patient's smile, which is so important in our society, and can heighten inner satisfaction and self-esteem.

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Send comments to:Dr. Jay Last Update February 16, 2006