Veneer (dentistry)

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Porcelain Veneers
Comparison - Crowns and veneer.jpg
Comparison between a porcelain-metal dental crown, an all-porcelain dental crown and a porcelain veneer laminate
MeSH D003801

In dentistry, a veneer is a layer of material placed over a tooth. Veneers can improve the aesthetics and function of a smile and protect the tooth's surface from damage.

Contents

There are two main types of material used to fabricate a veneer: composite and dental porcelain. A composite veneer may be directly placed (built-up in the mouth), or indirectly fabricated by a dental technician in a dental lab, and later bonded to the tooth, typically using a resin cement. They are commonly used for treatment of adolescent patients who will require a more permanent design once they are fully grown. The lifespan of a composite veneer is approximately four years. [1] In contrast, a porcelain veneer may only be indirectly fabricated. A full veneer crown is described as "a restoration that covers all the coronal tooth surfaces (mesial, distal, facial, lingual and occlusal)".[ citation needed ] Laminate veneer, on the other hand, is a thin layer that covers only the surface of the tooth and is generally used for aesthetic purposes. These typically have better performance and aesthetics and are less plaque retentive. [1]

Medical uses

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 a malpositioned tooth or 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] They are 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.

While the final veneers are being created, the dentist 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] Temporaries act as a trial-run for the final veneers, allowing the dentist to observe the patient's ability to eat and talk with veneers, as well as the patient's satisfaction with the veneers. This trial-run is overall used to assist in the final installation of veneers by allowing the patient to be sure of what result they would like to achieve. [4]

Indications

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, attrition or abfraction, modifying the shape of the tooth. [5] [6]

Contraindications

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 [7] 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. [8]

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 will be a problem even if the procedure is 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.

Additional contraindications include but are not limited to the following: poor oral hygiene, uncontrolled gingival disease, high cavities rate, parafunction, no enamel, unreasonable patient expectations, large existing restorations. [1]

Classification

Several classification systems are possible for veneers. One system suggested in 2012 is called the Nankali Veneer Classification and divides the veneers as follows:

Types of veneer preparations

There are four basic preparation designs for porcelain laminate veneers: [9] window, feather, bevel, and 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. These are often referred to as "non-prep" veneers. [10]

Alternatives

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.

History

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. [11] 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 [12] 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 [13] in an article describing a technique for fabrication, and placement of etched bonded porcelain veneers using a refractory model technique and Horn [14] describing a platinum foil technique for veneer fabrication. Additional articles have proven the long-term reliability of this technique. [15] [16] [17] [18] [19] [20] [21] [22] [23]

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. [24]

Pros and cons of dental veneers

Pros:

Cons:

Case selection: In patients with unhealthy teeth with weak, or less enamel on the surface, extensive decay, or periodontal problems, veneers cannot be used as an option for the treatment of aesthetic corrections. [25]

See also

Related Research Articles

Dental products are specially fabricated materials, designed for use in dentistry. There are many different types of dental products, and their characteristics vary according to their intended purpose.

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance of teeth, gums and/or bite. It primarily focuses on improvement in dental aesthetics in color, position, shape, size, alignment and overall smile appearance. Many dentists refer to themselves as "cosmetic dentists" regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.

<span class="mw-page-title-main">Bridge (dentistry)</span> Dental restoration for missing teeth

A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.

Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure supported by dental implants. They are of two broad types—direct and indirect—and are further classified by location and size. A root canal filling, for example, is a restorative technique used to fill the space where the dental pulp normally resides.

<span class="mw-page-title-main">Dental porcelain</span>

Dental porcelain is a dental material used by dental technicians to create biocompatible lifelike dental restorations, such as crowns, bridges, and veneers. Evidence suggests they are an effective material as they are biocompatible, aesthetic, insoluble and have a hardness of 7 on the Mohs scale. For certain dental prostheses, such as three-unit molars porcelain fused to metal or in complete porcelain group, zirconia-based restorations are recommended.

Tooth whitening or tooth bleaching is the process of lightening the color of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching.

<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Dental composite</span> Substance used to fill cavities in teeth

Dental composite resins are dental cements made of synthetic resins. Synthetic resins evolved as restorative materials since they were insoluble, of good tooth-like appearance, insensitive to dehydration, easy to manipulate and inexpensive. Composite resins are most commonly composed of Bis-GMA and other dimethacrylate monomers, a filler material such as silica and in most applications, a photoinitiator. Dimethylglyoxime is also commonly added to achieve certain physical properties such as flow-ability. Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.

<span class="mw-page-title-main">Inlays and onlays</span> Restoration procedure in dentistry

In dentistry, inlays and onlays are used to fill cavities, and then cemented in place in the tooth. This is an alternative to a direct restoration, made out of composite, amalgam or glass ionomer, that is built up within the mouth.

<span class="mw-page-title-main">Temporary crown</span>

A temporary crown is a temporary (short-term) crown used in dentistry. Like other interim restorations, it serves until a final (definitive) restoration can be inserted. Usually the temporary crown is constructed from acrylic resins (monomethacrylate-based/polymethacrylate-based) or, chemical-cure/light cure composite (dimethacrylate-based), although alternative systems using aluminium crown forms are occasionally used. Temporary crowns function to protect the tooth, prevent teeth shifting, provide cosmetics, shape the gum tissue properly, and prevent sensitivity.

<span class="mw-page-title-main">CAD/CAM dentistry</span> Computer-aided design and manufacturing of dental prostheses

CAD/CAM dentistry is a field of dentistry and prosthodontics using CAD/CAM to improve the design and creation of dental restorations, especially dental prostheses, including crowns, crown lays, veneers, inlays and onlays, fixed dental prostheses (bridges), dental implant supported restorations, dentures, and orthodontic appliances. CAD/CAM technology allows the delivery of a well-fitting, aesthetic, and a durable prostheses for the patient. CAD/CAM complements earlier technologies used for these purposes by any combination of increasing the speed of design and creation; increasing the convenience or simplicity of the design, creation, and insertion processes; and making possible restorations and appliances that otherwise would have been infeasible. Other goals include reducing unit cost and making affordable restorations and appliances that otherwise would have been prohibitively expensive. However, to date, chairside CAD/CAM often involves extra time on the part of the dentist, and the fee is often at least two times higher than for conventional restorative treatments using lab services.

<span class="mw-page-title-main">Dental attrition</span>

Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.

Fixed prosthodontics is the branch of prosthodontics that focuses on dental prostheses that are permanently affixed (fixed). Crowns, bridges, inlays, onlays, and veneers are some examples of indirect dental restorations. Prosthodontists are dentists who have completed training in this specialty that has been recognized by academic institutes. Fixed prosthodontics can be used to reconstruct single or many teeth, spanning tooth loss areas. The main advantages of fixed prosthodontics over direct restorations are improved strength in big restorations and the possibility to build an aesthetic-looking tooth. The concepts utilised to select the suitable repair, as with any dental restoration, include consideration of the materials to be used, the level of tooth destruction, the orientation and placement of the tooth, and the condition of neighboring teeth.

Adhesive dentistry is a branch of dentistry which deals with adhesion or bonding to the natural substance of teeth, enamel and dentin. It studies the nature and strength of adhesion to dental hard tissues, properties of adhesive materials, causes and mechanisms of failure of the bonds, clinical techniques for bonding and newer applications for bonding such as bonding to the soft tissue. There is also direct composite bonding which uses tooth-colored direct dental composites to repair various tooth damages such as cracks or gaps.

A resin-retained bridge is a bridge replacing a missing tooth that relies for its retention on a composite resin cement. It is one of many available dental restoration methods which is considered minimally invasive and conservative of tooth tissue. The resin-retained-bridge has gone through a number of iterations. Perhaps the best known is the Maryland bridge and other designs used in the past include the Rochette bridge. The five-year survival rate is around 83.6% and the ten-year rate at 64.9%. The case selection is important and as with any dental prosthesis, good oral hygiene is paramount for success. In recent years, the indications for the use of resin-retained-bridges have diminished significantly and there have been changes in the principles underpinning their design. Resin-retained-bridges should be considered when a fixed prosthesis retained by natural teeth is required. The use has been driven by the advent of evidence-based dentistry showing the benefits to patients of reduced tooth preparation and the importance of an intact enamel structure for the long-term health of the teeth. The bridge is currently in favour in the United Kingdom for these reasons. Indeed, recent contemporary research shows resin retained bridges have better success rates than implants and are a cheaper alternative.

In dentistry, SMK, short for System kompozytowy most(in Polish), is an adhesive restorative prosthodontic technique, developed in Poland during the 1990s. Using the SMK method, a prosthetic tooth is constructed and fitted without damage to the neighbouring teeth.

<span class="mw-page-title-main">Tooth discoloration</span> Medical condition

Tooth discoloration is abnormal tooth color, hue or translucency. External discoloration is accumulation of stains on the tooth surface. Internal discoloration is due to absorption of pigment particles into tooth structure. Sometimes there are several different co-existent factors responsible for discoloration.

<span class="mw-page-title-main">Molar incisor hypomineralisation</span> Medical condition

Molar incisor hypomineralisation (MIH) is a type of enamel defect affecting, as the name suggests, the first molars and incisors in the permanent dentition. MIH is considered a worldwide problem with a global prevalence of 12.9% and is usually identified in children under 10 years old. This developmental condition is caused by the lack of mineralisation of enamel during its maturation phase, due to interruption to the function of ameloblasts. Peri- and post-natal factors including premature birth, certain medical conditions, fever and antibiotic use have been found to be associated with development of MIH. Recent studies have suggested the role of genetics and/or epigenetic changes to be contributors of MIH development. However, further studies on the aetiology of MIH are required because it is believed to be multifactorial.

Enamel microabrasion is a procedure in cosmetic dentistry used to improve the appearance of the teeth. Like tooth whitening it is used to remove discolorations of the tooth surface but microabrasion is both a mechanical and chemical procedure.

Anterior teeth are some of the most scrutinized teeth, as the size, shape and color of the anterior upper teeth plays an important role in dental aesthetics and smile aesthetics. A few aesthetic anterior problems, such as dental caries, tooth fracture, enamel defects and diastemas, can be solved with composite restorations. Composite restorations can also improve dental aesthetics by changing the shape, color, length and alignment of teeth.

References

  1. 1 2 3 4 5 Mitchell, David and Laura (2016). Oxford Handbook of Clinical Dentistry. OXFORD. ISBN   978-0-19-879581-0.
  2. ↑ ELHAMID A., AAZZAB B. Les facettes en céramique : de l'indication à l'utilisation Le courrier du dentiste
  3. ↑ "The Awesome History and Future of Dental Veneers". Oakville Place Dental Office. 2016-04-20. Retrieved 2019-10-31.
  4. ↑ Shakarchy, Yasmin; Jethwa, Sam (2023-12-05). "The art of the trial smile in cosmetic dentistry". Smilesbydrp.
  5. ↑ University of Manchester (4 March 2019). "Veneers" (PDF). Retrieved 4 March 2019.
  6. ↑ Lambrechts, P.; Van Meerbeek, B.; Perdigão, J.; Gladys, S.; Braem, M.; Vanherle, G. (1996). "Restorative therapy for erosive lesions". European Journal of Oral Sciences. 104 (2 ( Pt 2)): 229–240. doi:10.1111/j.1600-0722.1996.tb00072.x. PMID   8804891.
  7. ↑ Marshall, Richard. "Leading Cosmetic Dentist Glendale, AZ - Veneers". Stratland Dental. Retrieved 16 January 2024.
  8. ↑ Leading dentists [ who? ] question widespread use of porcelain crowns and veneers. Very few experienced cosmetic dentists question widespread use of porcelain crowns and veneers.
  9. ↑ Walls, A. W. G.; Steele, J. G.; Wassell, R. W. (2002-07-27). "Crowns and other extra-coronal restorations: porcelain laminate veneers". British Dental Journal. 193 (2): 73–76, 79–82. doi: 10.1038/sj.bdj.4801489 . ISSN   0007-0610. PMID   12199127.
  10. ↑ Porcelain dental veneers
  11. ↑ Pincus CL."Building mouth personality" A paper presented at: California State Dental Association;1937:San Jose, California
  12. ↑ Simonsen R.J. and Calamia John R. "Tensile Bond Strengths of Etched Porcelain", Journal of Dental Research, Vol. 62, March 1983, Abstract #1099.
  13. ↑ Calamia John R. "Etched Porcelain Facial Veneers: A New Treatment Modality Based on Scientific and Clinical Evidence", New York Journal of Dentistry, Vol. 53, #6, Sept./Oct. 1983, pp.255-259.
  14. ↑ Horn HR. "A new lamination, porcelain bonded to enamel". NY St Dent J 1983;49(6):401-403
  15. ↑ Calamia John R. and Simonsen R.J. "Effect of Coupling Agents on Bond Strength of Etched Porcelain", Journal of Dental Research, Vol. 63, March 1984, Abstract #79.
  16. ↑ Calamia John R. "Etched Porcelain Veneers: The Current State of the Art", Quintessence International, Vol. 16 #1, January 1985.
  17. ↑ Quinn F Mc Connell RJ "Porcelain Laminates: A review", Br Dental J. 1986:161(2):61-65
  18. ↑ Calamia John R. "Clinical evaluation of etched porcelain veneers" Am J Dent 1989:2:9-15
  19. ↑ Nathanson D, Strassler HE. Clinical evaluation of etched porcelain veneers over a period of 18 to 42 months J Esthet Dent 1989:1(1):21-28
  20. ↑ Strassler HE, Weiner S "Long-term clinical evaluation of etched porcelain veneers" J Dental Res 77 (Special Issue A):233 Abstract 1017,1998
  21. ↑ Friedman, MJ "A 15-year review of porcelain veneer failure- a clinicians' observations. Compend Contin Educ Dent. 1998:19 (6):625-636.
  22. ↑ Calamia John R. "Etched Porcelain Laminate Restorations: A 20-year Retrospective- Part 1" AACD Monograph Vol II 2005:137-145 Montage Media Publishing
  23. ↑ Barghi, N, Overton JD "Preserving Principles of Successful Porcelain Veneers" Contemporary Esthetics 2007:11(1)48-51
  24. ↑ Calamia John R., Calamia Christine S. Porcelain Laminate Veneers: Reasons for 25 Years of Success, Successful Esthetic and Cosmetic Dentistry for the Modern Dental Practice, Dental Clinics of North America. April 2007 Vol 51 No. 2 Calamia, Wolff, Simonsen Saunders/Elsevier, Inc., Veneers by Calamia, Enamelique.com Since 2018 dental tourism has become increasingly popular. Dental treatments in European countries such as turkey have become an affordable option for many customers from the USA and UK. The costs of dental treatment in turkey are up to 70% cheaper. The most popular treatments are cosmetic Hollywood smile makeovers. The cost of these treatments in European countries ranges from $5,049- $7,056, this style treatment would typically include 20 teeth.
  25. ↑ "5 Amazing Veneers Dental Solutions | Ventura Dentist" . Retrieved 2024-03-29.

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