Types of Dental Veneers

Dental veneers are also known as porcelain veneers, or porcelain laminates, even though they are not always made of porcelain. They are custom-made and custom-fit shells of tooth colored materials designed to cover the front surface of the teeth to improve their appearance. Dental veneers are bonded to the teeth using various adhesives/resins and they can significantly change the color, shape and size of the teeth. Veneers can be fabricated from various ceramics and porcelains, composites and zirconia.  However, the majority of veneers are typically made from highly refined porcelains. Some porcelain ceramics are much better than others at masking very dark teeth.  Some ceramics are stronger than others, some are more translucent and some require more tooth preparation than others. The choice of which porcelain to use, as well how much tooth preparation may or may not be required, depends on the specific case as well as the skills of the dentist and ceramist working on the case.

Am I a Good Candidate for Dental Veneers?

Patients who are GOOD CANDIDATES for porcelain veneers include:

• People who want to correct a cosmetic problem with their teeth such as poor tooth shapes, discolored or dark teeth, and teeth with defects of one type or another
• Someone with spaces or gaps between their teeth (diastema)
• Teeth that are crooked or misaligned (can often be corrected without braces)
• Patients who suffer from tooth acid erosion due to acid reflux or eating disorders

People who are NOT GOOD CANDIDATES may include situations such as:

• The teeth are not fully erupted or the patient is too young for veneers
• Patients with gum disease in the area where the veneers would be placed
• A person with teeth that are extremely crowded  (often orthodontics is required first)
• Teeth that have lots of existing filings or are extremely broken down (these teeth may need crowns)
• Cases where tooth grinding is excessive

How is Dental Veneers Performed?

The preparation and placement of dental veneers typically requires 2-3 appointments.  Any active problems such as cavities or periodontal (gum) problems will need to be addressed prior to the preparation and placement of the veneers.

There are two methods for manufacturing dental veneers:

• Direct Method – The dentist directly applies and sculpts a composite resin (tooth colored material) to the front surface of the tooth. This method does not involve a laboratory fabrication of the veneer so it can be completed in one office visit.
• Indirect Method – The dentist typically prepares the teeth and takes an impression that is sent to an outside laboratory where the veneers are fabricated.   They are then bonded to the surface of the teeth.

Before fabricating and placing veneers, the dentist often needs to remove some tooth structure to make room for the veneers and ensure the final result does not look bulky. The amount of tooth structure removed depends on the specific situation and treatment goals. Local anesthetic is typically used to numb the treatment area before the teeth are prepared.

The dentist then takes an impression of the prepared teeth using impression putty or an optical scanner in order to make a precise model of the teeth. The model made from the impression is used to create and custom fit the veneers.

After the teeth are prepared, and before the patient leaves, the dentist will usually make and place temporary veneers.  These help protect the teeth and ensure the teeth look good between appointments.  They are also used as a guide in designing the final veneers made at the lab.

On the day the final veneers are to be placed, the dentist will remove the temporaries and try the final veneers to make sure they look good and fit properly.  If the patient and dentist approve, the veneers are bonded to the teeth with special resins and adhesives.  A special bonding light is used to activate the chemicals in the resin cements causing them to quickly harden.  This strongly bonds each veneer to the tooth underneath.

No Prep Veneers

In the majority of cases where veneers are being placed, some tooth preparation is generally required to achieve an optimal result. However, very minimal tooth preparation, or no tooth preparation, is possible in some cases.  It is up to the dentist to determine how much tooth preparation is required depending on the existing clinical situation and the goals of the treatment. Each case is unique and must be carefully evaluated to determine the amount of tooth preparation required to give the best results. More often than not, the teeth have to be prepared to some degree to deliver the most aesthetic porcelain veneer possible.

Alternative to Veneers

A less expensive option to lab made porcelain veneers can sometimes be used as an alternative.  "Free-hand bonding" is usually a single visit procedure where the dentist places tooth colored composites (polymers) directly on the surface of the teeth to shape and sculpt them to a desired shape, form and color. Once the desired form and shape is achieved, the composite is hardened with a special bonding light.

A dental crown (also called a "cap" by some) is often used when veneers are not an option.  There are many reasons why veneers may not be a predictable option and crowns are a better alternative.  Properly done crowns, like veneers, can be quite beautiful and can restore teeth that have badly broken down.  As every case is different, a dentist will help the patient decide if crowns or veneers are the best option.

What is the Cost of Dental Veneers?

Since dental veneers are considered a cosmetic procedure, they are usually not covered by dental insurance. The cost varies according to the skills and reputation of the dentist, the dental lab that is used, geographic location of the treatment and the extent of the procedure.  In general, indirect veneers (labs made in a dental laboratory) cost anywhere from $900-$2500 per tooth.

Recovery and Downtime

There is really not much in the way of RECOVERY or DOWNTIME after getting dental veneers. Patients can generally return to work the same day and resume normal activities. Patients can resume immediate use of their teeth.  The teeth may be sensitive for a few days after veneers are placed but most patients experience little to no post-operative sensitivity. Some dentists recommend night guards after veneers are placed in case the patient grinds or clenches their teeth at night.

Results

The results after placing the veneers are seen immediately. All patients will be given a list of instructions on proper care and maintenance as well as instructions on proper brushing and flossing.  Proper oral hygiene is critical to the longevity of porcelain veneers.  Patients with veneers should abstain from any habits destructive to the teeth such as fingernail and cuticle biting or using the teeth to open packages. Quite often, the reason the teeth are being restored to begin with is due to destructive oral habits. Dental veneers sometimes need to be replaced or repaired because of chipping, cracking, discoloration and wear and tear over time.  Properly prepared, placed and maintained dental veneers can last 7 to 20 years.

Limitations of Dental Veneers

Some of the limitations of dental veneers include:

• Veneers are limited to only being a partial restoration of the front teeth
• Excessively crooked teeth may require wearing braces prior to getting veneers
• Porcelain veneers are not suitable for teeth that are heavily restored with lots of fillings
• Porcelain veneers are not suitable for teeth that are badly broken or worn down with little remaining enamel

Risks of Dental Veneers

Common risks of dental veneers include:

• Sensitivity to cold and hot beverages
• Cracking or chipping
• Veneers can come loose from the teeth
• Color mismatch with the natural teeth
• Root damage
• Changes in the bite of the patient

Proper Research is Important

Patients seeking cosmetic improvements to their teeth and smile should look for an experienced dentist knowledgeable in all aspects of functional and cosmetic dentistry. In addition, patients should do their own research to determine if veneers will correct their dental issues. Scheduling a consultation appointment with a qualified dentist allows the patient to learn the different options available to them. Veneers are a long lasting dental solution that can improve the smile and self-confidence of patients.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Gary Alex, DDS in Huntington, NY