What Are Porcelain Veneers?
Porcelain 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 corrections, ranging from teeth whitening to orthodontic
adjustments. Thanks to their lifelike appearance and wide array of
functions, porcelain veneers rank among the most trusted and popular
procedures in cosmetic dentistry.
History
Although veneers have become especially
popular in the past couple of decades, they originated nearly one
hundred years ago during the early days of the film industry. In the
late 1920s, Dr. Charles Pincus, a famed Hollywood dentist, conceived
of veneers as a way to enhance actors' and actresses' smiles on
the screen. He would temporarily apply false fronts to the stars'
teeth, giving them the stunning smiles that quickly became a
trademark of Hollywood beauty. However, he lacked the technology to
permanently affix the porcelain. In the late 1960s, Dr. Michael
Bunocore ushered in the modern era of adhesive dentistry; by lightly
etching teeth with a mild acidic solution, he created a stronger
bonding surface for dental sealants and restorations. In 1982, J.R.
Calamia and R.J. Simonsen applied Dr. Bunocore's techniques to the
application of porcelain veneers. Suddenly, everyone had access to
the stunning Hollywood smiles of days past.
RELATED: Find a qualified cosmetic dentist in your area
Veneers Today
Over the past 30 years, developing
dental technology has made veneers more lifelike and convenient than
ever before. New types of porcelain are stronger and reflect light
similarly to natural dental enamel. Digital imaging systems enable
many dentists to create same-day restorations that are a near-perfect
match to the natural shape and color of patients' teeth.
Additionally, other advanced dental treatments such as teeth
whitening and dental crowns can be combined with veneers
to provide patients with comprehensive cosmetic results and truly
stunning smiles.
Visit the DocShop gallery to view porcelain veneers before and after photos.
Photo credit: Ruth E. Bailey D.D.S.
Candidates
Signs That Veneers May Be the Optimal Choice
Patients who are considering porcelain
veneers are typically looking to address multiple structural or
cosmetic issues with their teeth, such as:
Chips
Cracks
Gaps between teeth
Minor misalignment
Discoloration
In order to have porcelain veneers
placed, patients should:
Have good periodontal and overall
oral health
Be committed to proper oral care
and hygiene
Have specific cosmetic goals,
which they can articulate to their dentists at their initial
consultations, as well as realistic expectations
Have a sufficient amount of
healthy enamel, as dentists usually remove a thin layer of enamel
before placing veneers
Signs That Veneers May Not Be the Right Choice
As stated above, patients must have
healthy teeth and gums to qualify for dental veneers. Patients with
conditions such as tooth decay, gum disease, and root
canal infection typically do not qualify for veneers.
However, after a dentist successfully treats these issues, patients
are usually cleared for cosmetic enhancement.
Those who are considering porcelain
veneers should remember that the procedure is typically a permanent
one. Because the dentist usually removes a layer of enamel before
attaching the porcelain, patients will eventually need to replace
their veneers or choose an alternative restoration to take their
place. Therefore, no one should receive veneers unless they are
certain about their decision.
Some patients who habitually grind
their teeth and clinch their jaw may be disqualified from receiving
veneers. Although dental porcelain is quite strong and durable, the
forces of bruxism can put incredible strain on veneers, causing them
to break or come off entirely. In many cases, however, a dentist may
be able to treat the underlying causes of bruxism, eventually
enabling patients to receive veneers. Additionally, newly developed
dental materials allow ceramists to create stronger restorations that
may be suitable for such patients.
Determining Candidacy
The only way a patient can fully
determine his or her candidacy for veneers is by scheduling an
appointment with a skilled cosmetic dentist. After evaluating health
history, current dental health, and the condition of a patient's
enamel, a dentist can make an informed decision regarding a patient's
suitability for this treatment. He or she can also recommend
alternative treatments for non-qualifying patients.
Cost
Factors that Affect the Cost of Veneers
The cost of porcelain veneers varies from patient to patient, although costs typically hover around
several hundred dollars per tooth. Besides the number of veneers a
patient chooses to have placed, there are several issues that can
impact the full cost of veneers placement. These factors include:
Type of veneers: Veneers
can be made from several types of dental porcelain. The newest, most
realistic and durable materials typically cost more than older
products. In addition, there are advanced placement procedures which
can impact the cost of veneers. For example, no-prep veneers or
CEREC® fabricated veneers often carry a higher price tag.
Geographic location: As
with most aspects of living, the cost of dental treatment varies
across the country. If patients receive veneers in a major
metropolitan area on the east or west coast, they will typically
cost more than veneers in a less populated location in the middle of
the country.
Experience of the dentist: Normally, highly qualified cosmetic dentists charge more to
place veneers than their less experienced colleagues.
Veneers as a Dental Investment
Although veneers typically cost more
than other cosmetic treatments, most patients who receive these
enhancements consider them to be a very worthwhile investment.
Because veneers have so many applications, by choosing this single
treatment, patients can enjoy the benefits of teeth whitening,
orthodontic treatment, and dental crowns, all at once. In addition,
veneers offer incredibly lifelike results. After placement, many
patients feel more confident than they have felt in years.
Payment
Does Insurance Cover Veneers?
Because veneers are considered a
cosmetic procedure, insurance typically does not cover this
treatment. However, there are some occasions when a health care plan
will cover at least part of the cost. For example, if a patient has
had a filling or a similar restorative procedure, insurance may
provide some coverage, as it falls under the label of
"post-procedural care." A patient will be more likely to receive
help from an insurance company if his or her dentist submits a
preauthorization, along with photographs, x-rays, and a narrative,
explaining how veneers will improve dental health and quality of
life. A patient may also qualify for insurance coverage if he or she
wants to replace an old, deteriorating veneer.
Financing Options
Even when a patient is unable to obtain
insurance coverage, there are a number of medical financing
companies, such as CareCreditTM, SpringstoneSM,
and ARAMARKTM, which exist specifically to make medical
and dental care affordable for a wider range of patients. These
companies offer several repayment options, including fixed-interest
plans. Most dentists also accept all major credit cards, and many
offer in-house repayment schedules to qualified individuals. Patients
should discuss their financing options at their initial consultation.
How to Choose a Dentist
Past Experience
When placed by a qualified and
experienced cosmetic dentist, veneers have a stunning natural look.
To better ensure a satisfactory outcome, patients should be highly
selective in choosing their dentist. Although many dentists offer
veneers, the best results are more likely to come from those who have
an extensive background in cosmetic dentistry in general and veneers
in particular.
Training and Accreditations
Looking at professional affiliations is
one of the most reliable ways to choose a qualified cosmetic dentist.
The American Academy of Cosmetic Dentistry® (AACD) offers several levels of membership, starting at the lowest level
with General Members. Dentists with this title do not have to be
accredited and must simply express an interest in continuing
education in cosmetic dentistry. An Accredited Member has passed the
entire accreditation process, including a written and oral exam. An
Accredited Fellow has achieved the highest level of membership,
having demonstrated cosmetic excellence and ability in clinical
practice. Patients should also look for dentists who are members of
the American Dental Association.
Approach to Cosmetic Dentistry
Patients are more likely to be
satisfied with their treatment when they choose a practitioner who
takes an artistic approach to dentistry. Most dentists will have
galleries of their past cosmetic work, and potential patients should
take a close look at these pictures. They should ask themselves, "Do
these results look natural? Is this what I want my smile to look like
after treatment?"
A dentist's clinical technology can
also impact their work. For example, digital x-rays and intraoral
cameras can give more accurate images than older imaging systems.
Additionally, because there are several advanced types of veneers,
interested patients should ask about specific procedures, such as
no-prep veneers or CEREC® (Chairside Economical
Restoration of Esthetic Ceramics) fabrication.
Interaction with Patients
While clinical excellence and artistic
integrity are perhaps the most important factors in choosing a
cosmetic dentist, a dental practitioner should also have a good
chairside manner. Veneers are completely personalized restorations
that have an enormous impact on a patient's smile and
self-confidence. Therefore, it is important to choose a dentist who
truly welcomes patient input and makes them an active participant in
their treatment. Individuals should never choose a dentist with whom
they feel ill at ease.
The Ceramist
Unless a dentist creates his or her own
veneers using CEREC® technology, dental patients should also ask
practitioners about the ceramist or dental lab that they work with.
Ultimately, the cosmetic results will depend on top-quality
fabrication. Whenever possible, patients should select dentists who
work with top-rated craftspeople.
RELATED: Find a qualified cosmetic dentist in your area
The Initial Consultation
Analysis
Before undergoing any dental procedure,
patients should have a thorough consultation with their dentist.
However, because veneers placement is so highly personalized, for
this treatment, the initial consultation takes on special importance.
At the first appointment, a dentist analyzes a patient's oral
health to ensure that he or she is a good candidate for veneers. This
first visit typically includes x-rays, photographs, and
dental impressions. The patient explains his or her cosmetic
goals so that the dentist can determine whether veneers are the
optimal treatment to achieve those objectives.
Mock-Up
Before a patient makes the final
decision to receive porcelain veneers, the dentist creates a mock-up,
displaying what the patient's smile will look like following
treatment. Dentists use varying methods to create these models. Some
dentists use old fashioned impressions to create wax-ups, while other
dentists use state-of-the-art technology to create advanced
three-dimensional computer images. Neither method is better than the
other; the important thing is that a dentist works with care and
precision to create an accurate and beautifully rendered
representation.
Types of Porcelain Veneers
Veneers Materials
Veneers can actually be made from
several types of ceramic, including:
Pressed ceramic: Veneers
made from this kind of ceramic are quite strong, but they are
typically thicker than other types of veneers.
Stacked ceramic: Stacked
ceramic veneers allow ceramists to create veneers that are more
precisely customized for each patient.
Lithium disilicate: This
new type of dental porcelain is so strong that even severe bruxers
may be candidates for veneers made from this material. Lithium
disilicate veneers can only be created with CAD/CAM technology.
Veneers Brands
There are also a number of trusted
veneers manufacturers. Some of the most popular brands include:
daVinciTM:
daVinici is one of the most trusted veneers brands in the country,
leading the industry for over 30 years. daVinci veneers are highly
stain resistant and come with a "Limited Lifetime Guarantee"1
IPS Empress®: Empress
Veneers come in 12 shades for maximum personalization. Worldwide,
over 25 million restorations have been made from Empress porcelain.2
IPS e.max®: e.max veneers are made from advanced lithium disilicate.
According to worldwide clinical studies, they have an astonishing
99% success rate.3
Each of these brands offers its own
advantages, and many outstanding dentists favor different brands. If
patients feel very strongly about enhancing their smile with a
particular brand or type of porcelain, they should discuss it at
their initial consultations.
Traditional vs. No-Prep Veneers
The most notable distinction among
different types of veneers is the difference between traditional and
no-prep veneers. To place traditional veneers, a dentist removes a
thin layer of enamel from a patient's teeth. No-prep or
minimal-prep veneers, on the other hand, are much thinner, meaning
that a dentist must remove little enamel, if any. Many dentists can
fabricate and place no-prep veneers in a single day.
While no-prep veneers are more
convenient and affect less of the tooth structure, not all patients
are candidates for these restorations. In some cases, they can look
bulky, so patients with proportionately large teeth may not benefit
from no-prep veneers. Additionally, because the porcelain is thinner
and thus more transparent, they may not be the best option for
patients who want to close gaps between their teeth. Ultimately,
patients should only make their final choice with the help of their
cosmetic dentist.
Preparing the Teeth
Enamel Removal
When patients select traditional
veneers, the preparation process is extremely important. Proper
groundwork helps to ensure a natural look and a strong bond between
the teeth and the porcelain. First, the dentist removes a fine layer
of enamel from the front of the teeth to be treated. The exact amount
of enamel depends on the patient's individual needs and the type of
veneers being placed. However, in most cases, the dentist typically
removes about .5 mm to .7 mm of dental material from the front of the
teeth. In many cases, the amount is so small that no anesthetic is
required.
Dental Impressions
When this first step is complete, the
dentist takes impressions of the teeth. Traditionally, he or she will
do this by placing soft putty into a tray. As the tray rests in the
mouth, it hardens around the teeth. Then the dentist sends these
impressions to an off-site dental lab.
If a dentist uses advanced CEREC®
technology, he or she takes a detailed sequence of pictures, which
feeds into a chairside computer. Dental software generates a
three-dimensional picture of a patient's mouth, and an in-office
milling system fabricates veneers using these highly precise images.
Temporary Veneers
If a dentist works with an off-site
lab, it typically takes one to two weeks before the veneers are
delivered to the office. In these cases, the dentist may provide
patients with a set of temporary veneers. Sometimes, patients are
troubled by the appearance of their smile following the enamel
removal. More often, dentists place temporary veneers to protect the
underlying dentin and prevent sensitivity. Usually they determine
whether temporary veneers are necessary based on the amount of enamel
removed.
Fabricating the Veneers
Fabrication at a Dental Lab
The veneers fabrication process varies
slightly, depending on the specific type of porcelain used, but for
the most part, the procedure remains largely the same. Using the
impressions sent by the dentist, a ceramist creates a working model.
Inside this replica, he or she builds up multiple layers of
porcelain, using intense heat or pressure to increase the strength of
the material. All layers of porcelain may be the same shade, or the
ceramist may hand-paint each layer for the most lifelike appearance
possible.
Single-Visit Fabrication
When a dentist uses CEREC®
technology to fabricate dental veneers, the process is much
quicker. After analyzing the computer images and making any necessary
adjustments, the dentist sends the images to a milling system. Much
like a 3-D printer, the machine creates customized veneers from a
single block of porcelain in a matter of minutes. The dentist selects
the shade of porcelain that most closely matches a patient's teeth.
He or she can further personalize the restorations by painting or
polishing the material.
Placing the Veneers
Veneers Assessment
When the veneers are complete, the
dentist double checks their shape and appearance. In particular, he
or she makes certain that the porcelain does not affect the patient's
bite or cause any alignment issues. If necessary, he or she can trim
down and reshape the porcelain. The dentist also checks the color of
the veneers against the natural shade of the patient's smile.
Although veneers are already made of custom-matched porcelain, the
dentist can often fine-tune their appearance by selecting the right
shade of bonding material. During this assessment process, patients
should work closely with their dental practitioners to ensure their
desired outcome.
Etching the Tooth
Immediately before placing veneers, the
dentist applies an acid gel to the teeth. The gel dissolves some of
the minerals on the surface of the teeth, creating a rough surface on
the microscopic level. Then he or she coats the teeth in a bonding
agent, and the solution adheres inside the tiny fissures on their
surface. This process creates a strong base for the porcelain
veneers.
Cementing the Veneers
Finally, the dentist spreads dental
cement on the back of the veneers and affixes the porcelain on the
front of the teeth. As stated above, the color of cement is
specifically chosen to coordinate with the veneers and match the
natural color of a patient's smile. After applying a gentle force
to set the porcelain in place, the dentist uses a curing light to
harden the cement. The light stimulates a chemical reaction in the
bonding agent, causing the cement to set in a matter of minutes.
Combining Porcelain Veneers with Other Treatments
Teeth Whitening
Although veneers are often used to
cover up dental stains, they are typically considered a solution for
intrinsic tetracycline stains. When patients use veneers to cover up
one or two intrinsically stained teeth, their other teeth may appear
discolored in comparison. By selecting professional teeth
whitening, they can harmonize the color of their smiles.
Professional teeth whitening can be performed at home or in the
office, and a cosmetic dentist will help patients select the right
option for their budget and lifestyle.
Gum Reshaping
Gum reshaping, also
known as gum recontouring, is one of the procedures
most commonly combined with veneers. Together, the two procedures are
an excellent solution for a "gummy smile," characterized by
disproportionately small teeth and large gums. Typically, a cosmetic
dentist plans both procedures together to ensure a beautiful,
well-proportioned smile. Gum reshaping can be performed using manual
instruments or a surgical laser. The latter method is becoming
increasingly popular, thanks to its minimal discomfort and recovery
time. After carefully planning the new shape of a patient's gum
line, a cosmetic dentist carefully remove excess tissue and smoothes
ragged edges for a smoothly contoured appearance.
Restorative Treatment
Veneers are an excellent way to restore
teeth with minor structural damage. However, the thin porcelain is
not strong enough to restore severely damaged teeth. If a patient has
a large crack, a broken tooth, or extensive dental decay, a crown may
be the best way to repair these injuries. Missing teeth can be
replaced
with dental implants or bridges. When combined with restorative treatment, veneers
can help to reinstate a patient's smile and dental functionality.
Smile Makeovers
Although veneers can completely enhance
a person's smile, for the most comprehensive results, patients
often choose to undergo smile makeovers, combining two or more
cosmetic procedures. This treatment is completely customized based a
patient's individual needs and goals. When patients come in for
their initial veneers consultation, they should mention their
interest in a smile makeover so the dentist can create a single
treatment plan that includes all procedures.
Results
Immediate Transformation
Following their second appointment,
patients who choose veneers leave the office with a completely
enhanced smile. In the case of no-prep veneers, many people enjoy a
one-day transformation.
Recovery
After receiving porcelain veneers,
there is no recovery time. Unless patients have opted for
dental sedation, they will be able to drive themselves home from the
office, and they can immediately go about their daily routine,
including physical activity. Following the enamel removal, patients
may temporarily experience some mild discomfort. For about a week,
they may want to avoid very hot or cold foods, as well as extremely
chewy, hard, or crunchy food. When this initial sensitivity wears
off, however, patients should be able to return to their normal
dietary habits.
Durability
On average, veneers last about 10
years, and as dental porcelain becomes stronger and more durable,
their lifespan may increase significantly over the next several
years. Of course, veneers, like natural teeth, are still susceptible
to damage. If a veneer breaks or comes off, patients should carefully
store any missing pieces and bring them to the office as soon as
possible for repair and/or reattachment. When this is not possible,
there are several alternative
options, including dental crowns or cosmetic bonding.
Fortunately, patients typically do not experience any discomfort if
their veneer breaks or comes off.
Caring for Porcelain Veneers
Preventing Decay
With proper care, veneers are much more
likely to reach the 20 year mark. Along with making regular visits to
a general dentist, routine brushing and flossing is the most
important thing that patients can do to protect the longevity of
their veneers. Although the porcelain itself is not subject to decay,
when the underlying tooth structure is damaged by cavities, this can
damage the veneer. In many cases, after the cavity is repaired, the
tooth is no longer able to support a new veneer.
Protecting Gum Health
Good oral care is also important
because it helps prevent gum disease and receding gums, which can
compromise the appearance of veneers. Because the porcelain ends at
the gum line, if the tissue recedes, the edge of the veneer will
become visible, and the entire restoration may need to be replaced.
Patients should be diligent about frequent brushing and flossing, but
they should also be careful to avoid overly vigorous brushing, as
this can also compromise periodontal health.
Avoiding Excessive Force
Habits such as nail biting, chewing
ice, and using teeth to open packages are already harmful to teeth,
leading to cracks, chips, and dental erosion. Although porcelain is
quite strong, it is not quite as tough as natural teeth, so these
habits are even more detrimental to patients with veneers. Those with
bruxism should also seek treatment before getting veneers or as soon
as the condition develops. Although lithium disilicate veneers have
proven to be durable even for habitual teeth grinders, treating this
condition can further extend their lifespan and protect against
related health conditions.
Maintaining the Color of Veneers
Because porcelain is not porous, dental
veneers are highly stain resistant. However, the dental cement that
holds them in place is still subject to discoloration. When this
becomes stained, the edge of a veneer can appear yellowed and
unnatural. To protect the color of their smile, dental patients
should avoid stain-producing substances such as coffee, tea,
wine, berries, soy sauce, and tomato sauce.
Smoking is perhaps the most notorious culprit for dental
staining.
RELATED: Find a qualified cosmetic dentist in your area
Aesthetic Benefits
Various Applications
Few cosmetic dental treatments offer
the comprehensive results that veneers can provide. In a single
treatment, veneers can correct surface flaws such as chips and
cracks. As mentioned above, they can also conceal dark tetracycline
stains, which cannot be treated with traditional teeth whitening
procedures. Veneers can also change the shape of teeth, often making
these enhancements an ideal solution for patients with
proportionately small, worn, irregularly shaped, or pointed teeth.
Veneers and Light Reflection
Natural dental enamel is translucent.
Light shines through this layer and bounces off the underlying
dentin, giving smiles their healthy sheen. Dental porcelain is also
semi-translucent, meaning that light reflects off of the restorations
just as it does off of dental enamel. Thanks to the highly customized
fabrication process described above and the way light interacts with
the restorations, porcelain veneers are virtually indistinguishable
from enamel. Patients can enjoy a thoroughly enhanced but completely
natural smile.
Advantages over Other Procedures
In addition to the comprehensive nature
of veneers, this treatment offers a number of advantages over similar
alternatives:
Veneers are stain resistant and last for years at a time. When patients choose teeth whitening
treatment, they often receive less dramatic results and must undergo
touchup treatments approximately twice a year.
Veneers look more lifelike than similar enhancements. Cosmetic
dental bonding can correct similar flaws, but the
material is opaque, meaning it does not reflect light the way
porcelain does.
Veneers are stronger than
composite resin.
Although veneers typically cost
more than bonding or teeth whitening, they usually have a smaller
price tag than dental crowns.
Increased Confidence and Happiness
One of the biggest advantages of
porcelain veneers is the effect they can have on a patient's
self-assurance and emotional wellness. When patients feel good about
the appearance of their teeth, they are more likely to smile. In
turn, this can increase their mood, social life, and even
professional success. Multiple studies have proven that smiling
directly impacts emotion; a landmark study conducted by Dr. Robert
Zajonc in 1989 found that even a forced smile could actually make
people feel happier. Zajonc theorized that the when people activate
the muscles needed for smiling, it actually raises the temperature of
blood travelling to the brain. In turn, these higher temperatures
stimulate the parts of the brain that control emotion.4 Not
only are veneers a great investment in a patient's appearance, they
could also be an investment in their overall wellbeing.
Visit the DocShop gallery to view porcelain veneers before and after photos.
Photo credit: Ruth E. Bailey D.D.S.
Oral Health Benefits
Strengthen Damaged Teeth
The primary benefits of veneers are
cosmetic; however, there are several ways that they can boost
overall dental health. First, they can lend some strength to
damaged teeth. Patients should note, however, that veneers cannot
restore a severely damaged or weakened tooth. In these cases, a
dental crown will provide better protection for a patient's oral
health.
Encouraging Oral Hygiene
Veneers can also promote good dental
hygiene. When patients have a beautifully enhanced, natural
smile, they are more likely to practice outstanding care and
maintenance. At their initial consultation or at any time during the
placement process, patients should ask their dentist about the best
way to care for their veneers and protect the underlying teeth.
Health Advantages over Other Dental Procedures
Although veneers typically require some
enamel removal, this procedure leaves the majority of the tooth
structure intact. In contrast, to place a crown, a dentist must
reshape the entire tooth, removing a significant amount of dental
material. For patients looking for a more conservative option with
minimal tooth modification, veneers may be the ideal alternative.
Instant Orthodontics
Repairs for Gapped Teeth
Diastema, or gapped teeth, can occur
for a number of reasons, including genetics, gum disease, an
incorrect swallowing reflex and irregularly sized teeth. Many
patients assume that the only way to correct gaps in their smile is
to undergo several years of orthodontic treatment. While this may
have been true in the past, today veneers offer an immediate
solution. By creating veneers that are slightly larger than the
underlying teeth, a cosmetic dentist can close in this space with
porcelain restorations.
Enhancing Crooked Teeth
Patients with only slightly misaligned
teeth or with a single severely crooked tooth are understandably
reluctant to wear braces for several years. Fortunately, veneers are
an effective and fast alternative. By placing a new façade, a
cosmetic dentist can mask irregularly rotated or positioned teeth. At
the same time, the restorations can mask other flaws for instant
orthodontics with additional cosmetic benefits.
Veneers and Severe Orthodontic Issues
Patients who are considering veneers
for instant orthodontics should note that this treatment is not
considered an effective option for severely crooked teeth or
malocclusion. Because veneers do not actually correct the underlying
tooth structure, patients with serious orthodontic issues should
address these problems to prevent complications such as dental
erosion or TMJ. Additionally, when patients who have malocclusion
receive veneers, the restorations often have a very short lifetime;
the porcelain faces constant pressure from the dental misalignment.
In a relatively short time, this can lead to structural damage, or a
veneer can come off entirely.
Risks
Tooth Sensitivity
Veneers are considered a very low-risk
treatment. However, as with any medical or dental procedure, there is
some chance of complications. Because this treatment often involves
enamel removal, the biggest risk is that a patient will experience
permanent tooth sensitivity, especially to hot or cold temperatures.
Typically, if sensitivity lasts for more than 3 to 6 months after
veneers placement, this indicates an underlying problem with the
procedure. For example, the dental cement may be leaking or the nerve
may have been exposed and infected during placement.
Dental Damage
There is also a slight risk that the
underlying dentin may become damaged during the enamel removal
process. Alternatively, a poorly fitting veneer could change the
alignment of a patient's bite, leading to dental sensitivity,
discomfort while eating, or, in more extreme cases, bruxism and jaw
pain.
Future Replacement
Although veneers can last several
decades, they must eventually be replaced, and the second placement
process will involve another round of enamel removal. Those who
already have some enamel erosion before their first treatment may not
have enough material for a second placement. In these cases, they
will require an alternative restoration such as cosmetic bonding or a
dental crown. Patients should discuss their replacement options
before receiving their first set of veneers. If they are not willing
to consider alternative treatments in the future, they should not
choose a procedure that will permanently alter their teeth.
Minimizing the Risks
As stated above, veneers are considered
to be a very safe dental treatment, and there are several things that
patients can do to further reduce their risks. First, they should be
cautious when choosing their cosmetic dentist, following the
guidelines listed above. By reading reviews from past patients, they
can determine whether a particular dentist has a history of case
complications. Second, if they are truly concerned about dental
sensitivity or the permanent nature of veneers, patients may opt for
no-prep veneers. Because they require little enamel removal, if any,
the risk of sensitivity is lower. Patients should be aware, however,
that some dentists believe no-prep veneers look less natural than
traditional veneers.
Temporary Side Effects
Dental Sensitivity
While permanent sensitivity following
veneers placement is uncommon, many patients do experience some mild
temporary discomfort. Typically this sensitivity is most apparent
during the first 1 to 3 weeks after veneers placement. Patients can
control sensitivity by avoiding very hot and cold foods, especially
in close succession. Patients should also try using desensitizing
toothpaste for up 6 months after treatment.
Safety Data
Longevity and Low Complication Rates
In 2007, D.M. Layton and T. Walton
conducted a seminal study on the durability and complication rates of
veneers. Tracing the lifespan of 304 veneers placed by the same
dentist in 100 dental patients, Layton and Walton found that
approximately 96% of the veneers lasted 5 to 6 years, 93% lasted 10
to 11 years, 91% survived 12 to 13 years, and 73% lasted 15 to 16
years. Only 16 of the veneers failed. These failures were attributed
to unsatisfactory aesthetic results, structural damage, loss of
retention, and dental decay.5 A more recent study, published in the
International Journal of Prosthodontics in 2012, traced the
lifespan of 318 veneers placed in 84 patients between 1987 and 2009.
The study concluded that 94.4% of the veneers survived 5 years, 93.5%
lasted 10 years, and 82.93% lasted 20 years. Participants included 42
patients with bruxism and 23 smokers, indicating that veneers are a
long-lasting option, even for these high-risk groups. 6 Neither of the studies reported any
significant complications for the participants' overall dental or
physical health.
Alternatives to Porcelain Veneers
Bonding
For patients with insufficient dental
enamel or for those who are hesitant to permanently alter the
structure of their teeth, dental bonding, often called
composite veneers, may the optimal solution. A dentist applies dental
composite to the front of a patient's teeth. This material is
carefully selected to match the natural color of his or her smile. By
carefully sculpting the material, the dentist can achieve many of the
same results possible with veneers. Like veneers, bonding can correct
severe stains, cracks, misaligned teeth, and gaps between teeth.
Unlike veneers, however, composite resin is opaque and does not offer
the natural sheen of porcelain.
Teeth Whitening
Patients who are looking to enhance the
color of their smile may opt for teeth whitening. By
chemically breaking down the bonds that hold dental stains together,
both in-office and at-home treatment can lighten teeth by up to eight
shades. However, this treatment is only suitable for extrinsic
stains, such as those caused by food or smoking. Whitening treatment
will not affect tetracycline stains or the discoloration caused by
decay or an old dental filling.
Dental Crowns
In some ways, dental crowns are
very similar to veneers. Custom-made to match a patient's natural
teeth, these tooth-shaped porcelain caps fit over a damaged tooth.
However, unlike veneers, a crown extends all the way around a tooth,
meaning the dentist must remove a significant amount of the dental
structure. Crowns are an excellent option for patients who have
considerable damage that affects the strength or structural integrity
of a tooth. However, for patients who are simply seeking cosmetic
enhancements, veneers are an effective, less invasive option.
Orthodontics
As stated above, those with severely
crooked teeth or malocclusion may not be good candidates for veneers.
Rather, they may want to consider more comprehensive orthodontic
treatment. Thanks to modern dental advances, patients are not limited
to traditional metal braces; they can also choose tooth-colored
brackets, clear aligner trays, and accelerated treatment options.
Frequently Asked Questions
Does the placement procedure hurt?
The placement of porcelain veneers is
typically a pain-free procedure. Dentists usually numb the tooth and
the surrounding area before removing the dental enamel. In many
cases, this amount of enamel is so small that patients do not even
require anesthesia. Once the enamel is removed, patients may
experience some sensitivity, particularly before the veneers are
attached; once the porcelain is in place, this discomfort should
disappear within a few weeks. The attachment of veneers involves no
discomfort, although patients may need a few weeks to adjust to the
feel of the veneers in their mouths.
How long does the placement
procedure take?
Traditional veneers placement takes
place over two visits. The length of time required for each of these
visits will depend on how many veneers a patient chooses to have
placed. Following enamel removal and dental impressions, it typically
takes between 1 and 2 weeks for patients to receive their new
veneers. When dentists use CEREC technology to fabricate veneers in
the office, patients could enjoy a dramatically enhanced smile in
just a few hours.
How do I know if veneers are right
for me?
The only way to know if porcelain
veneers are a viable option is through a complete evaluation and
exam. A cosmetic dentist will examine a patient's dental history,
as well as his or her current dental health and the condition of the
dental enamel. The dentist will also explain other cosmetic
treatments, so that the patient can make a fully informed decision
about his or her dental care.
Do veneers look natural?
Veneers are among the most realistic
dental enhancements available. Because they are custom-made for each
patient, they will match the shape and color of the surrounding
teeth. Additionally, because they are translucent, veneers interact
with light just like natural dental enamel.
How many veneers should I get?
Veneers are intended to enhance the
teeth that show when a patient smiles, so the number of veneers a
patient needs partially depends on how wide their smile is. Some
people only show six teeth when they grin, while others may display
up to twelve teeth. Of course, a patient's specific cosmetic goals
will also determine how many veneers he or she should receive. For
example, if someone wants to treat a single chipped tooth, he may
only require one veneer. On the other hand, if another patient wants
to conceal widespread tetracycline stains, she could require as many
as ten or twelve veneers. Patients will also need to consider their
budget; because veneers are individually priced, the number of
veneers is the biggest factor in determining the overall cost of
treatment.
What happens if I only get veneers
on my upper teeth?
Because veneers are custom-created to
match the surrounding teeth, veneers can be an effective way to treat
only the upper (or lower) teeth. However, many
patients choose to have teeth whitening performed on
the other dental arch for more comprehensive, uniform enhancement.
What should I do if a veneer breaks
or comes off?
In the unlikely event that this
happens, patients should gather any pieces and store them in safe
place before calling their dentist. They should never try to glue the
porcelain back in place, although, if they feel extremely
self-conscious without the restoration, they can temporarily apply it
with drug store adhesive. Many times, a dentist can reapply a broken
or loosened veneer. In other cases, a dentist may need to replace the
veneer or restore the tooth with another treatment such as a dental
crown.
Can I get veneers if I have gum
disease or dental decay?
Before receiving veneers, patients
should have good dental and periodontal health. Although cavities or
gum disease do not permanently disqualify patients from veneers, a
dentist must treat these conditions before a patient undergoes any
cosmetic enhancements. Veneers can be an excellent option for
restoring a patient's smile after it is compromised by decay or a
similar condition.
Is one type of veneers better than
another kind?
Each type of veneers has its own
advantages, and certain dentists prefer to work exclusively with
particular brands or types of porcelain. Ultimately, the type of
veneers patients choose will be based on their specific needs and the
recommendations of their dentist.
RELATED: Find a qualified cosmetic dentist in your area