Veneer (dentistry)

Veneers are a prosthetic device, by prescription only, used by the cosmetic dentist. A dentist may use one veneer to restore a single tooth or veneer with high quality that may have been fractured or discolored, or in most cases multiple teeth on the upper arch to create a big bright "Hollywood" type of smile makeover. Many people have small teeth resulting in spaces that may not be easily closed by orthodontics. Some people have worn away the edges of their teeth resulting in a prematurely aged appearance, while others may have malpositioned tooth/teeth that appear crooked. Multiple veneers can close these spaces, lengthen teeth that have been shortened by wear, fill the black triangles between teeth caused by gum recession, provide a uniform color, shape, and symmetry, and make the teeth appear straight.[2] Dentists also recommend using thin porcelain veneers to strengthen worn teeth.[3] It is also applied to yellow teeth that won't whiten. Thin veneers are an effective option for aging patients with worn dentition. In many cases, minimal to no tooth preparation is needed when using porcelain veneers.

When preparing, in between prep and fit appointments of the veneer, you can make temporaries, usually out of composite. These are not normally indicated but can be used if the patient is complaining of sensitivity or aesthetics.[1] According to a leading Beverly Hills Cosmetic Dentist, temporaries are really important to design and finalize the aesthetics of the final veneers. Temporaries help patients and the dentist decide on the right color, length and shape of the veneers. [4]

Discoloured teeth, malformed teeth, enamel hypoplasia (not enough enamel), enamel hypocalcification (enamel not fully mineralised), fluorosis, tetracycline staining, non-vital tooth discolouration, malposition, enamel fractures, enamel loss by erosion, modify shape of tooth.[5]

In a controversial opinion, Dr. Michael Zuk, a Canadian DDS, profiles in his opinion and problems of overuse of porcelain veneers by certain cosmetic dentists in 'Confessions of a Former Cosmetic Dentist'. He suggests that the use of veneers for 'instant orthodontics' or simulated straightening of the teeth can be harmful, especially for younger people with healthy teeth. Leading dentists[6] caution that minor superficial damage or normal wear to the teeth is not justification for porcelain or ceramic veneers. This is because the preparation needed to apply a veneer may in some cases destroy 3–30% [1]of the tooth's surface if performed by an inexperienced dentist. It has been found that after 10 years, 50% of veneers are either displaced, need re-treatment, or are no longer in satisfactory condition.[7]

Some cosmetic dentists may push unnecessarily for prosthodontic treatment in adolescents or young to middle-aged adults who have otherwise healthy teeth that only necessitate whitening or more routine cleaning. As preparation for veneers requires shaving down the tooth in some cases, sensitivity and decay may become a problem if this procedure is not properly performed. In addition, a veneer's maintenance cost can also be prohibitive for many individuals. Veneer placement should be limited to individuals with significant aesthetic problems, such as badly cracked or broken teeth, that do not meet the requirements for a crown or full replacement.

Also, poor oral hygiene, uncontrolled gingival disease, high caries rate, parafunction, no enamel, unreasonable patient expectations, large existing restorations. [1]

There are different types of classification for veneers. One of the recently suggested veneer classification (2012) is called Nankali Veneer Classification and divides the veneers as follows:

• Labial Surface Coverage

a) No incisal involvement

b) Feathered incisal edge

c) Incisal overlap

• Interproximal preparations

a) No contact point involvement

b) Contact point level

c) Passed contact point

• Methods of production

a) Indirect veneers

b) Direct veneers

• Materials

a) Ceramic

b) Lithium disilicate (very thin and relatively very strong porcelain)

c) Da Vinci (Very thin porcelain)

d) Mac (High resistance to stains and relatively strong)

e) Acrylic (No longer in use for quality work)

f) Composite

g) Nano Ceramic

There are four basic preparation designs for porcelain laminate veneers;[8]

a) Window

b) Feather

c) Bevel

d) Incisal Overlap

Recent technological advances have been made, which allow the construction of ultra-thin porcelain laminate veneers. These veneers require only very modest, or in some instances, no reduction of the tooth structure. There are often referred to as "non-prep" veneers.

a) Lumineers

b) Smile Infinity®

Comparison between a porcelain-metal dental crown, an all-porcelain dental crown and a porcelain veneer laminate

In the past, the only way to correct dental imperfections was to cover the tooth with a crown. Today, in most cases, there are several possibilities from which to pick: crown, composite resin bonding, cosmetic contouring or orthodontics.

Non-permanent dental veneers, which are molded to existing teeth, are a feasible option as well. These dental veneers are removable and reusable, and are made from a flexible resin material. Do-it-yourself kits are available for the impression-taking process, and then the actual veneers are made in a lab and sent to the wearer through the mail.

Veneers were invented by California dentist Charles Pincus in 1928 to be used for a film shoot for temporarily changing the appearance of actors' teeth.[9] Later, in 1937 he fabricated acrylic veneers to be retained by denture adhesive, which were only cemented temporarily because there was very little adhesion. The introduction of etching in 1959 by Dr. Michael Buonocore aimed to follow a line of investigation of bonding porcelain veneers to etched enamel. Research in 1982 by Simonsen and Calamia[10] revealed that porcelain could be etched with hydrofluoric acid, and bond strengths could be achieved between composite resins and porcelain that were predicted to be able to hold porcelain veneers on to the surface of a tooth permanently. This was confirmed by Calamia[11] in an article describing a technique for fabrication, and placement of Etched Bonded Porcelain Veneers using a refractory model technique and Horn[12] describing a platinum foil technique for veneer fabrication. Additional articles have proven the long-term reliability of this technique.[13][14][15][16][17][18][19][20][21]

Today, with improved cements and bonding agents, they typically last 10–30 years. They may have to be replaced in this time due to cracking, leaking, chipping, discoloration, decay, shrinkage of the gum line and damage from injury or tooth grinding. The cost of veneers can vary depending on the experience and location of the dentist. In the US, costs range anywhere from $1000 a tooth upwards to $3000 a tooth as of 2011. Porcelain veneers are more durable and less likely to stain than veneers made of composite.[22]

• Cosmetic dentistry
• Crown (dentistry)
• Dental restoration
• CAD/CAM Dentistry
• Light activated resin