Dental Veneers

Dental veneers are thin, custom-made shells made from tooth-colored material that are cemented onto the surface of teeth to cover dental irregularities. Usually, the tooth’s surface is slightly reduced to make room for the dental veneer.

Dental veneers serve a mostly cosmetic purpose; they are used when:

  • teeth are discolored from staining, tetracycline use, fluorosis, etc., and bleaching was ineffective
     
  • teeth are worn down, chipped or broken on the surface
     
  • teeth are misaligned, uneven, or irregularly shaped and orthodontics is not required
     
  • teeth have gaps between them (diastema) that need closure
  
Some "before" and "after" photos showcasing simple changes possible with veneers.

Veneers or teeth whitening/orthodontics?

If your teeth are mildly discolored or misaligned, your dentist is likely to suggest teeth whitening procedures or simple orthodontics prior to dental veneers.

Dental veneers require that teeth be reduced or trimmed on the surface to make room for the tooth-colored shell that is cemented on.  This permanently changes your natural teeth unlike whitening and orthodontic procedures. For this reason, your dentist should use veneers as a final option.

If you have severely discolored teeth though, your dentist may steer you towards dental veneers. They have the benefit of being very aesthetic, long lasting, and can cover most forms of staining and accommodate mildly uneven, misaligned or irregularly shaped teeth.  Always ask your dentist about the suggested therapy and why other therapeutic options were excluded.

Types of veneers

Dental veneers are commonly manufactured from either composite resin or ceramic porcelain.  Additionally, in the United States, a form of feldspathic porcelain named “Lumineers” has become increasingly popular among cosmetic dentists.

Porcelain and Lumineers veneers are manufactured in an outisde dental laboratory using impressions of your teeth provided by your dentist. Alternatively, your dentist can make composite resin veneers by the dental chair, effectively bypassing the dental laboratory and saving you the additional appointment and money.

So why are porcelain veneers still more common and popular than composite resin veneers? Although porcelain veneers take longer to manufacture and cost more, they last longer. Composite resin veneers may require touch-ups over years, and wear down more quickly. Porcelain not only lasts longer, but because it is manufactured at a dental lab, time is taken to make them nearly indistinguishable from natural teeth, whereas the appearance of composite resin veneers depends on the handiwork of your dentist.

Traditional porcelain has its drawbacks though. Aside from its high cost, a considerable amount of enamel needs to be removed from the surface of the teeth – up to even 1 mm in depth – to make room for the bonded porcelain. Lumineers is the commercial name for a porcelain product that claims to be “contact lenses for teeth”. The company that produces it, Cerinate, fabricates thin veneers that can be cemented onto teeth without requiring any surface reduction. They claim their patented feldspathic porcelain is hard enough to resist fracture even though it is remarkably thin. Researchers have not proven or disproven this claim yet, but without a doubt, the popularity of lumineers is growing among cosmetic dentists.

Dental Veneer Procedure

  

From start to finish, receiving dental veneers will likely take 3 to 4 appointments. The first session with your dentist will likely be a consultation meeting. Your dentist will examine your teeth, take x-rays, impressions and suggest whether veneers are applicable. It is important to tell your dentist all of your expectations – and similarly, your dentist should outline any limitations. Your dentist will suggest either composite resin or porcelain veneers and will go through the process of helping you select a color and shade that fits you well.

For your second appointment, you will receive a local anesthetic injection so that pain is not felt during the procedure. The surface of teeth receiving the veneers are then reduced using drills and another dental impression is taken. The reduction in depth will vary from 0.5 to 1 mm depending on the severity of the dental irregularity. The dental impression will be sent to a dental laboratory for porcelain veneers to be fabricated.

For minor cases, your dentist may place a composite resin veneer. In that case, your dentist will apply and shape the tooth-colored material to the reduced tooth surface, and shine a light that hardens it. Some minor polishing is required, but your composite resin veneer is essentially complete. For the more common porcelain veneer, your dentist may place temporary veneers on while you wait 1 to 2 weeks for the next appointment.

During the third appointment, your dentist will place the ceramic veneer in place and ensure that it fits well and does not impinge on any gum tissue. Once approved, it is permanently cemented in place and allowed to set for a few minutes. Using drills, your dentist may then polish and smooth over any rough edges so that the veneer blends effortlessly with the natural tooth.

The final or fourth appointment should be booked a few weeks after the veneers have been placed to ensure everything is going well. Take note of any complaints you have during the weeks leading up to the appointment and outline them in detail to your dentist. Minor adjustments can be made at this point, but going back to the start is no longer possible.

Chair-side CAD/CAM procedure

Some dental offices use CAD/CAM (computer aided design/manufacturing) to produce ceramic veneers. Chair-side CAD/CAM technology allows the dentist to professionally fabricate the porcelain veneer in the office as opposed to relying on a dental laboratory. This provides you the benefit of receiving porcelain veneers and having them cemented in one appointment, similar to composite resin veneers.

Aside from the reduced appointment time, there is no real added benefit. Most dental offices still rely on dental laboratories for fabricating porcelain veneers.

Choosing the proper veneer color & shade

During your first dental consultation, you will have to choose the color of the veneer. Most patients are quick to select the whitest shade possible, only to realize their blunder afterwards.

Since most dentists only veneer the front teeth, and rarely place veneers on molars or even premolars, it is important that the chosen shade blend with your remaining teeth. Selecting a shade that is pure white, but which doesn’t fit your profile, only helps to identify the veneers. The goal for everyone is to achieve his or her individual optimum whiteness while still looking natural.

When selecting shades, do so under natural light. Artificial room lighting often changes how a shade truly appears.  Teeth are not monochromatic, so more than one color is used in making veneers. If needed, ask whether the dental laboratory offers custom staining - this helps to make them appear authentic, but for an added cost.

There is no one standard system in the dental field to measure and determine tooth color. The most often heard about, however, is the Vita shade guide. This guide divides tooth color into four basic shade ranges. The guide accommodates for the fact that the front teeth are typically the whitest, and the remaining teeth are more stained and darker as they advance backwards to the molars. Most dentists will show you a shade chart (like the above mentioned Vita Shade Guide) for you to pick from. Keep in mind, with a good cosmetic dentist this is merely a starting point. Other considerations when determining the color of veneers for each patient are your complexion, hair color, the color of your natural teeth and even your eye color.

Cost

As stated earlier, composite resin veneers are cheaper – expect to pay around $250 and more per tooth. Traditional porcelain veneers will cost $900 to $2500 per tooth. Lumineers are $700 to $1000 per tooth.

Factors that determine cost, other than the material used, include:

  • Insurance coverage – most insurance companies do not cover veneers if they are for cosmetic reasons
     
  • Fees of the cosmetic dentist – shopping around may be beneficial if your dentist is quoting you figures that are outside of the norm, but remember, not all dentists are equally skilled
     
  • Number of teeth requiring veneers – when most people smile, only the front 5-6 teeth are visible, so consider only placing veneers on those teeth at the very most

Longevity

     Composite resin veneers have been shown to last around 7 to 8 years, and require the occasional touchup. Porcelain veneers can last a lifetime with proper care, but on average last for 10 to 15 years. The manufacturer behind lumineers claims their product lasts as long as traditional porcelain veneers, and offers a 5-year limited warranty.

Post-treatment care

No real additional care needs to be taken after having veneers placed, except for maintaining excellent oral health. Anytime an artificial appliance is bonded to teeth, the likelihood of decay occurring increases, so brushing and regular flossing is essential for the longevity of the veneer.

Some patients may complain of sensitivity afterwards, but this should pass with time. If sensitivity becomes a long-term issue, please consult your dentist.

Disadvantages of dental veneers

While dental veneers have exploded in popularity in recent years, there are still some concerns you should be aware of:

  • They are permanent and non-reversible. This is an advantage if you are happy with the end result, but a disadvantage if you are disappointed with your new appearance.
     
  • Porcelain veneers cannot be restored if they fracture or chip – they need to be replaced altogether.
     
  • Color of the veneers cannot be alerted once they are fabricated. If you plan on bleaching your remaining teeth, your veneers will stay the same color, so bleach first and get veneers second.
     
  • Veneered teeth have a higher incidence of decay if oral hygiene is not optimal.
     
  • Porcelain is harder than the enamel of natural teeth, so patients who grind their teeth may find that the veneered teeth wear down the surface of their natural teeth. If you grind your teeth at night, you may need to wear a night guard.
     
  • Some patients complain of hot or cold sensitivity following veneer placement because enamel had to be removed during the procedure.
  
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