Dental veneers, also known as porcelain veneers or dental porcelain laminates, are custom made shells which are wafer-thin and bonded to the front surface of the teeth. Their purpose is to improve the appearance of the natural teeth. Veneers can be made of porcelain or from tooth colored resin composite materials. Veneers comprised of porcelain are generally the preferred material since gum tissue tolerates them; they are more resistant to stains and mimic the teeth’s natural sheen with light reflection. Nevertheless, both types of material can provide an improvement in the shape, size, length and/or color of a patient’s natural teeth.
Candidates for dental veneers are generally patients who are unhappy with the appearance of their teeth and smile. In general, ideal candidates for dental veneers are people with:
Patients, who do not like the shape of their teeth, have teeth that are crooked or those with gaps between the teeth can usually benefit from dental veneers.
Other patients who may benefit from dental veneers include people with teeth that are stained or discolored from:
Patients with excessive misalignment of the teeth may not be appropriate for veneers and may benefit from braces to correct their issue prior to veneers. Patients who clench and grind their teeth at night may not be suitable candidates for dental veneers unless they wear a special nightguard to protect the teeth since the grinding motion can cause the veneers to break. Veneers are not a suitable choice for individuals who have weakened teeth or active gum disease. Patients with insufficient enamel on the surface of the teeth may not benefit from dental veneers.
A dental veneer procedure can address one tooth, or many teeth, at the same time. The procedure generally requires 2-3 appointments for placing the veneers and this includes the consultation, preparation and bonding. If the patient has cavities, or other dental issues which need to be addressed prior to the placement of veneers, additional appointments will need to be scheduled first.
At the consultation, the dentist will discuss the concerns of the patient, the types of veneers and the methods for creating them. There are currently two methods for manufacturing dental veneers and they are direct and indirect. Depending on the method used, the dentist may also take x-rays and/or impressions of the teeth.
Although tooth preparation is less invasive than placing a crown, the dentist may still have to remove about ½ millimeter of the natural enamel on the tooth’s surface to make room for the veneer. This is approximately the same amount of thickness which will be added to the tooth by the veneer. Local anesthetic, via an injection, is usually provided to numb the treatment area and keep the patient comfortable. Patients with crooked teeth may need to have the portion of the tooth which is sticking out more than the rest shaved down. Some dentists will only prepare the front of the tooth, down to the biting end, since this is where the veneer will end. Other dentists use a technique which wraps the veneer to the backside of the tooth. If the dentist uses this technique, the biting edge of the tooth will also need to be trimmed a little shorter.
Temporary veneers - Dental veneers can take one to three weeks to come back from the lab so many patients have temporary veneers placed. Having the surface layer of the tooth trimmed off can increase sensitivity with hot and cold consumption. The teeth will also feel strangely rough to the tongue and lips. The temporary veneer is made with a mold filled with plastic and is slipped over the natural teeth prior to any preparation. It then becomes a wax/plaster mock-up of the original teeth. Patients who had very little of the tooth structure removed may not need temporary veneers.
Fitting - Prior to bonding, the dentist will momentarily place the veneer on the tooth for examination of the color and fitting. The veneer will be removed and trimmed until it achieves a proper fit. The color of the veneer can be adjusted with the shade of cement to be used. Once the veneer is sculpted accurately, the natural tooth or teeth will be cleaned, polished and etched to create a stronger bond. The dentist will apply special cement to the veneer and position the veneer on the tooth. A special light beam is utilized to activate the chemicals in the cement and cause them to quickly harden. Excess cement will be removed and the dentist will evaluate the patient’s bite and make any necessary adjustments. A follow-up visit may be scheduled, one week after the procedure, to check how the gums are responding to the veneers.
Combined with other procedures - Veneers can be a stand-alone procedure or they can be combined with other cosmetic dentistry treatments. Patients with small surface cavities may be able to have the tooth shaved down just a little further to remove the cavity. Any patient with a white colored filling on the tooth receiving a veneer may opt to have a new filling placed, prior to veneers, to make a stronger bond. Patients with severely discolored teeth may seek teeth whitening treatments to lighten the shade of their teeth prior to placing veneers. The veneers will then be colored to meet the new shade of the teeth.
Alternative procedures to dental veneers may include dental bonding or crowns. Dental bonding is a less invasive procedure designed for subtle changes with the teeth. Dental crowns are more durable than veneers but they require maximum destruction to the natural tooth’s structure for placement.
Dental veneers are considered a cosmetic procedure and may not be covered under dental insurance. Veneers can offer a conservative method for altering the color and shape of the teeth without extensive tooth shaping prior to placement. The cost of veneers varies depending on the skill of the dentist, the geographic location of the office and the extent of the procedure. In general, veneers can cost $925 to $2500.
There is essentially no recovery or downtime after veneers. Patients can return to work and resume all activities the same day. The curing light the dentist uses to attach the veneer to the natural teeth makes an immediate and sturdy bond. Therefore, the patient can resume immediate use of their teeth but should be careful at first since the shape might be slightly different than it was earlier. Furthermore, the anesthetic used during the procedure may still have a portion of the mouth numb and may result in biting down incorrectly.
The jaw may feel a little stiff from remaining open during the procedure but this is temporary and will resolve itself within the first day. Patients may feel like their bite is abnormal over the first few days but this normally lessens after a few days. If the bite continues to feel abnormal, it is best to speak with a dentist and allow him or her to reevaluate the bite. Tooth sensitivity where the veneers were placed can last a few days. If sensitivity continues to be an issue, patients should discuss this with their dentist. Most dentists will recommend wearing a nightguard to protect the veneers while sleeping. Veneers are susceptible to fracture if there are constant forces such as tooth clenching and grinding.
The results after veneer placement can be seen immediately. Patients should maintain proper oral hygiene including brushing at least twice a day, flossing daily and rinsing with an antiseptic mouthwash. The dentist may recommend that patients avoid the consumption of stain-causing foods and beverages. Over time, dental veneers will need to be replaced due to discoloration, chipping, cracking or wearing down from daily use. Overall, dental veneers can last between 7 to 15 years if properly cared for by patients.
Veneers are limited to only being a partial restoration of the front teeth but they can give a patient a better smile. Patients wanting whiter teeth all around should have a whitening treatment prior to placing veneers. Excessively crooked teeth may be limited from veneers and may require wearing braces prior to getting veneers. Patients who have veneers placed over excessively crooked teeth usually end up chipping the veneers early on. In many cases, wearing braces for at least 4-6 months provides sufficient alignment to bond veneers with less risk of breakage.
Sensitivity - One of the common risks associated with veneers is a sensitivity to hot and cold food and beverages due to the enamel being thinned down. This sensitivity can be present during the preparation of the teeth, following the preparation and after the veneers are placed. The dentist will attempt to keep the treatment area numb during the procedure and temporary veneers can assist with the sensitivity while the actual veneers are being created. Some sensitivity after the bonding process is common since the tooth and soft tissue have been manipulated but should resolve on its own.
Root damage - When preparing crooked teeth for veneers by shaving down the tooth, the underlying dentin may become damaged and can lead to root damage. Trauma to the tooth’s root can also occur which can increase the risk of needing a root canal.
Color mismatch - While the dentist will attempt to match the veneers with the color of the patient’s teeth, the color may not be the same and may make the natural teeth appear darker since the veneers may be lighter. Once the veneers are in place, the color cannot be altered.
Bite problem - A poorly fitted veneer can result in a change to the patient’s bite. This change can lead to sensitivity, discomfort while eating, bruxism (teeth grinding or clenching) and jaw pain.
Dislodge and breakage - Since veneers require a thinning down of the enamel, they are irreversible but they are not invincible or irreplaceable. It is rare for veneers to dislodge and fall off but it is also a possible risk. Although porcelain veneers are very strong, it is a material made of glass and can be brittle. To avoid the risk of breakage, patients should not use their teeth to open packages, chew on pencils or bite into foods like candy apples.
While dental veneers restore the teeth and smile, it is important to gather all the facts before choosing veneers over other cosmetic dentistry procedures. Permanent veneers are a lifelong commitment, so patients need to consult with a dentist before making the decision to get veneers. Doing proper research, and learning the different options for tooth repair, can help patients determine the best choice for their dental needs.
Written by Cosmetic Town Editorial Team - MA
Based on an exclusive interview with Gevik Marcarian, DDS in Encino, CA