Pros and cons of dental veneer types; Myths for patients
The beginning of the global phenomenon known as "cosmetic" dentistry“ really began with the invention of the porcelain veneer in the early 1980s. This was a way to change the shape, size, and color of a tooth or teeth by placing a thin layer of hand-crafted porcelain on the tooth and bonding it directly to the tooth structure. The concept and design were somewhat similar to an acrylic false nail. This created an incredibly durable bond, especially if the bonding was done to the enamel (and not the softer dentin beneath the enamel).
Initially, this was designed to try to improve a tooth without any preparation or “reduction” of the tooth itself. However, the thickness of the porcelain needed to be durable and prevent fracturing (thin-section porcelain is very brittle) meant that this often resulted in a thicker tooth than desired, and gum health suffered due to the porcelain being too bulky and trapping plaque bacteria.
Thus, the concepts of Smile Design and Minimal Tooth Preparation, which allowed the cosmetic dentist to design a smile with the most ideal shapes, following the ancient Greek concept of the golden ratio.
They soon followed simulation and "modeling" techniques“, which allowed the dentist and patient to “predict” the expected result, thus ensuring that the chosen design matched the patient’s smile and face. The simulations could be done using digital software, modifying a digital photograph of the patient’s teeth.
As the technique became more and more popular, the limits of what the treatment could offer were pushed and the concept of “same day orthodontics”. This was at a time when adults rarely underwent orthodontic treatment to straighten their teeth (wasn't it for children?) and, in fact, little was known about how effective straightening could be for adult patients. The unfortunate side effect of “"straightening" crooked teeth with veneers was that, often, severe tooth reduction was required. This was an irreversible procedure that resulted in the permanent loss of tooth structure and in some cases, with the severe tooth reduction required to achieve the patient's desired outcome, it endangered the nerves of the teeth and in some cases, root canal treatments were an unfortunate side effect.
Fortunately, the revolution of adult orthodontics meant that many patients could either straighten and whiten their teeth themselves to achieve a beautiful smile, or some of the straightening was done beforehand to allow for very minimal “contact lens” dental preparation.
More recently, there was a fashionable evolution that moved away from porcelain veneers towards “bonding”, which uses composite resin (a white filling material) to add or completely cover (veneer) teeth to improve smiles. Indeed, composite resin can be used as an alternative to porcelain and can create the same smile design results in many cases.
Poorly made porcelain veneers can also give teeth a very “fake” appearance.
BONDING
Composite resins and their “polishability” and ability to mimic natural, shiny tooth enamel have improved greatly over the past 10-15 years, and now these materials can in some cases look as good, and sometimes even better, than porcelain veneers. Often, these does not require much or no tooth reduction, because the material is applied almost like thick paint or putty to the teeth and can thus be kept very thin. It does not normally require a dental ceramic technician to construct the veneer and therefore, saves both the patient and the dentist time and money; composite veneers are typically about 50% less expensive as an investment compared to porcelain veneers! Sounds great, right? Why would you want porcelain if they are so good?
The truth is that no treatment option or system is infallible and both have their own characteristic benefits, as well as disadvantages, risks, and potential complications. In general terms, composite is cheaper and less “invasive,” but it will stain over time; it is also much less biologically compatible. This means that it will collect plaque bacteria much more easily and be responsible for much more gum inflammation than most porcelains, even if placed with great care and polished well.
facet
Composite resin is, by its nature, porous (has small holes and voids in its surface). Porcelain does not stain, is much healthier for the gums (as long as it is placed correctly and proper tooth reduction is done when necessary). Well-placed porcelain veneers, in a stable and gentle bite, can last 20 years before needing to be replaced. Composite veneers may need to be refinished or even completely replaced after only 3-4 years.
In general, I personally tend to prefer Composite bonding/plating for young patients. This is primarily due to the desire to avoid tooth preparation, even if it is very minimal. However, this is a generalization, as I have performed many porcelain veneers on patients under 25, but usually in this case no or very minimal tooth preparation is required (these patients usually have very small and often “bare” teeth).
If the patient already has many porcelain crowns or veneers, then composite bonding is not an option and porcelain veneers are the treatment of choice.
Budget is an important factor, but of course, the long-term costs of having to continually renew or replace composite often outweigh the short-term savings.
“Choose your aesthetic or cosmetic dentist carefully. Look at their own portfolios of work from their clinics – don’t always trust what Instagram shows you!”
The skill of the dentist is also a huge factor when deciding on composite bonding. – this is one of the most difficult treatments to perform in cosmetic dentistry and only a handful of dentists have the natural abilities or have learned the skills necessary to produce excellent long-term results with these types of veneers.
Competence and experience are, of course, also a factor when choosing a dentist to make your smile change with. porcelain veneers. Two key people are involved here, the cosmetic dentist and the dental ceramic technician. The best and most natural and “aesthetic” results seen with porcelain veneer treatments require a very high level of skill on the part of these two key professionals. The final “look” or style of the veneers comes largely from the ceramist who, in his field, is considered to be both an artist and a craftsman.
The key message is that there is no one size fits all., one option may or may not be right for you, and it is important to discuss all options carefully and choose a cosmetic or aesthetic dentist who has a lot of experience and skill before deciding what is right for you.
Look at their own portfolios of work (at their clinics – don’t always trust what Instagram shows you!), their experience, their level of “accreditation” with cosmetic dentistry academies, their qualifications, and any additional dental training they have done in these specific areas.
Source: enlightensmiles.com
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